title: Putaminal hypointensity on T2*-weighted MR imaging is the most practically useful sign in diagnosing multiple system atrophy: A preliminary study.
abstract: OBJECTIVE
  To identify useful MRI abnormalities in the putamen for diagnosing multiple system atrophy.
  
  
  METHODS
  Patients with multiple system atrophy (n=15), Parkinson's disease (n=16), or progressive supranuclear palsy (n=9) and healthy controls (n=10) were enrolled. Using a visual analog scale, 4 examiners independently rated high-intensity signals along the lateral putamen on T2-weighted and T2*-weighted images, low-intensity signals within the putamen on T2-weighted and T2*-weighted images, and putaminal atrophy. Receiver operating characteristic analyses were performed, and the area under the receiver operating characteristic curve was calculated.
  
  
  RESULTS
  For differentiating multiple system atrophy from progressive supranuclear palsy, Parkinson's disease, and healthy controls, the mean area under the curve values was the highest for low-intensity signals within the putamen on T2*-weighted images (0.797, 0.867, 0.896, respectively). Variations in the area under the curve values among the 4 examiners were the smallest in low-intensity signals within the putamen on T2*-weighted images. Good inter-rater reliability was achieved for low-intensity signals within the putamen on T2*-weighted images and high-intensity signals along the lateral putamen on T2*-weighted images.
  
  
  CONCLUSIONS
  Low-intensity signals within the putamen on T2*-weighted images is the most useful MRI abnormality for diagnosing multiple system atrophy.
authors.affiliation: Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: chinneosyo0624@yahoo.co.jp.
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Sugiyama
authors.affiliation: Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan; Office of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Neurology, Japanese Red Cross Narita Hospital, Narita, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Suichi
authors.affiliation: Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Mukai
authors.affiliation: Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Yokota
authors.affiliation: Department of Neurology, Japanese Red Cross Narita Hospital, Narita, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Yonezu
authors.affiliation: Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuwabara
mesh_terms: D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000473:pathology*; D010300:Parkinson Disease / Q000175:diagnosis / Q000473:pathology; D011699:Putamen / Q000473:pathology*; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis / Q000473:pathology
keywords: Iron deposition; Multiple system atrophy; Parkinson's disease; Progressive supranuclear palsy; Receiver operating characteristic analysis; T2*-weighted image