J Clin Neurol.  2007 Jun;3(2):79-81. 10.3988/jcn.2007.3.2.79.

Use of the Putamen/Caudate Volume Ratio for Early Differentiation between Parkinsonian Variant of Multiple System Atrophy and Parkinson Disease

• Shin HY
• Kang SY
• Yang JH
• Kim HS
• Lee MS
• Sohn YH

• KMID: 1851016
• DOI: http://doi.org/10.3988/jcn.2007.3.2.79

Abstract

BACKGROUND AND PURPOSE
Neuropathological studies have demonstrated that multiple system atrophy (MSA) produces selective atrophy of the putamen with sparing of the caudate nucleus, while both structures are spared in idiopathic Parkinson's disease (PD). In this study we evaluated the clinical efficacy of using putaminal atrophy in brain MRI to differentiate MSA and PD.
METHODS
We measured the putamen/caudate volume ratio on brain MRI in 24 patients with MSA and 21 patients with PD. Two clinicians who were blinded to the patients' diagnoses and to each other's assessments measured the volume ratio using a computer program.
RESULTS
The measured volume ratios of the two investigators were highly correlated (r=0.72, p<0.0001). The volume ratio was significantly lower in MSA (1.29+/-0.28) than PD (1.91+/-0.29, p<0.0001). Setting an arbitrary cutoff ratio of 1.6 resulted in about 90% of patients with MSA falling into the group with a lower ratio, whereas more than 80% of patients with PD belonged to the other group.
CONCLUSIONS
The present results demonstrate that putaminal atrophy in MSA as measured on brain MRI represents an effective tool for differentiating MSA from PD.

Keyword

Parkinson's disease; Multiple system atrophy; Putamen; Brain MRI

MeSH Terms

Atrophy
Brain
Caudate Nucleus
Diagnosis
Humans
Magnetic Resonance Imaging
Multiple System Atrophy*
Parkinson Disease*
Putamen
Research Personnel

Figure

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  Figure 1 Axial T2-weighted magnetic resonance imaging showing the outlines of the putamen and caudate nucleus. The volume of each structure was calculated as the sum of the area measured on each section that contained it.

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  Figure 2 Scatter diagram showing the putamen/caudate volume ratio as measured by two investigators in patients with Parkinson's disease (PD; filled circles) and in those with the striatonigral variant of multiple system atrophy (MSA-P; open circles). This ratio was significantly higher in patients with PD than in those with MSA-P (according to the measurements of both investigators). An arbitrary cutoff of 1.6 differentiated more than 80% of the patients with these two diseases.

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