title: Putaminal lesion in multiple system atrophy: postmortem MR-pathological correlations.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Pathophysiological and Therapeutic Science, Division of Radiology, Faculty of Medicine, Tottori University, Yonago, Tottori Prefecture, Japan. matsusue@grape.med.tottori-u.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Matsusue
authors.forename: Shinya
authors.initials: S
authors.lastname: Fujii
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kanasaki
authors.forename: Shuji
authors.initials: S
authors.lastname: Sugihara
authors.forename: Hajime
authors.initials: H
authors.lastname: Miyata
authors.forename: Eisaku
authors.initials: E
authors.lastname: Ohama
authors.forename: Toshihide
authors.initials: T
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D017352:Echo-Planar Imaging; D005260:Female; D005911:Gliosis / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D019578:Multiple System Atrophy / Q000150:complications / Q000473:pathology*; D020734:Parkinsonian Disorders / Q000209:etiology / Q000473:pathology*; D011237:Predictive Value of Tests; D011699:Putamen / Q000473:pathology*; D012189:Retrospective Studies