Putaminal lesion in multiple system atrophy: postmortem MR-pathological correlations.

Abstract

INTRODUCTION:

Posterior putaminal atrophy, putaminal T2-hyper and/or hyposignal changes have been observed in patients with multiple system atrophy (MSA) with parkinsonism.

METHODS:

Postmortem T2-weighted images were compared with histological findings in seven autopsy-proven cases of putaminal lesions of MSA. All cases were evaluated on 1.5T magnetic resonance imaging (MRI) scanners and three cases were evaluated on 3T scanners.

RESULTS:

There were three types of putaminal changes: Type 1, mild putaminal atrophy and isointensity; Type 2, putaminal atrophy and diffuse hyperintensity with a hyperintense putaminal rim (HPR); Type 3, putaminal atrophy and iso-or-hypointensity with HPR. The signal intensities of the putamen in Types 1 and 3 were more hypointense on 3T images than on 1.5T images. In Type 1, mild putaminal atrophy showed mild neuronal loss and gliosis and diffuse ferritin deposition. In Types 2 and 3, the areas of putaminal atrophy, severe in the posterior region, showed severe neuronal loss and gliosis, many pigments that were positive for ferritin and Fe (3+) and diffuse ferritin deposition. Although, tissue rarefaction was more severe in Type 2 than in Type 3, pigment deposition was more severe in Type 3. The HPR showed a severe loss of myelin and axons with tissue rarefaction of the external capsule or putaminal rim in Types 2 and 3.

CONCLUSION:

Posterior putaminal atrophy reflects neuronal loss and gliosis. While putaminal iso-or -hypointensity reflects diffuse ferritin and Fe(3+) deposition, hyperintensity reflects tissue rarefaction. The HPR reflects degeneration of the putaminal lateral margin and/or external capsule. These findings reflect characteristic histological findings of MSA with parkinsonism.

• Authors: Eiji Matsusue, Shinya Fujii, Yoshiko Kanasaki, Shuji Sugihara, Hajime Miyata, Eisaku Ohama, Toshihide Ogawa
• Journal: Neuroradiology (Neuroradiology) Vol. 50 Issue 7 Pg. 559-67 (Jul 2008) ISSN: 1432-1920 [Electronic] Germany
• PMID: 18463858 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Cadaver
• Echo-Planar Imaging
• Female
• Gliosis (etiology, pathology)
• Humans
• Male
• Multiple System Atrophy (complications, pathology)
• Parkinsonian Disorders (etiology, pathology)
• Predictive Value of Tests
• Putamen (pathology)
• Retrospective Studies