title: Significance of combined use of MRI and perfusion SPECT for evaluation of multiple system atrophy, cerebellar type.
abstract: BACKGROUND
  Multiple system atrophy, cerebellar type (MSA-C) sometimes shows asymmetrical findings on magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT).
  
  
  OBJECTIVE
  To assess the frequency and clinical significance of asymmetrical MRI and (99m)Tc-ethyl cysteinate dimer perfusion (ECD) SPECT findings of the cerebellum, middle cerebellar peduncle (MCP), and pons in MSA-C patients.
  
  
  METHODS
  We retrospectively reviewed 28 patients with MSA-C who underwent MRI and (99m)Tc-ECD SPECT and evaluated laterality of atrophy and signal changes on MRI, and laterality of perfusion on (99m)Tc-ECD SPECT transversely and longitudinally.
  
  
  RESULTS
  Laterality was identified for 64%, 61%, and 21% of atrophy in the cerebellum, MCP, and pons, respectively, on MRI and for 71% of atrophy in the cerebellum on perfusion SPECT. Concerning comparisons between the latest MRI and SPECT findings, laterality of cerebellar/MCP atrophy on MRI and decreased cerebellar perfusion on SPECT was matched in 57%, mismatched in 11%, and absent in 25% of patients. On past images, MRI and SPECT showed matched laterality in 33%, mismatched laterality in 27%, no laterality in 13%, and SPECT precedent laterality in 27% of patients. Including the latest and past images, asymmetrical changes were observed in 75% of patients. We could not identify any correlation between laterality of image findings and cerebellar symptoms in most patients.
  
  
  CONCLUSIONS
  Asymmetrical changes on MRI and perfusion SPECT are common in MSA-C patients. Perfusion SPECT is useful for diagnosing MSA-C in the early stages from a functional perspective.
authors.affiliation: Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Faculty of Medicine fuminori_113344@hotmail.com.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Miyoshi
authors.affiliation: Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Faculty of Medicine.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kanasaki
authors.affiliation: Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Faculty of Medicine.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Shinohara
authors.affiliation: Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Faculty of Medicine.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Faculty of Medicine.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kaminou
authors.affiliation: Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Faculty of Medicine.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tanabe
authors.affiliation: Division of Radiology, Department of Pathophysiological and Therapeutic Science, Tottori University, Faculty of Medicine.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D003545:Cysteine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000000981:diagnostic imaging*; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine
keywords: MSA cerebellum; magnetic resonance imaging (MRI); single photon emission computed tomography (SPECT)