Neuropathological studies have shown that approximately 20% of patients diagnosed in life with PD may prove at post-mortem to have MSA. PET studies have shown that a distinctive pattern of striatal receptor and glucose metabolism is associated with MSA. However, studies with SPECT may afford greater diffusion and practicability than PET. Analogously, MRI could provide complementary information in the differential diagnosis. Methods: We have performed ECD/SPECT and 1.5 T MRI scans in 30 patients with probable PD (H&Y II-IV; age 60±9) and 24 patients presenting with possible or probable MSA (H&Y II-IV; age 59±8). ECD/SPECT regions of interest were determined in the caudate nucleus, lentiform and the thalamus. For MRI we evaluated the presence of putaminal T2 hypointensity relative to globus pallidus and of a hyperintense band in the lateral putamen on proton density images. Sensitivity and specificity in detecting MSA vs. PD were then calculated for each technique. Results: For ECD/SPECT we found that perfusion values in the putamen significantly discriminated between MSA and PD (F = 15.5; p <0.0001). Specificity was 100% and sensitivity 88% to correctly identify MSA. For MRI the hyperintense band in the lateral had a specificity of 100% and a sensitivity of 83%. By contrast, the putaminal T2 hypointensity had a specificity of 84% and a sensitivity of 83%. Overall both investigations gave a positive predictive value of 100%. Conclusion: Both ECD/SPECT and MRI scanning afford high sensitivity and specificity and their combination represents a useful adjunct to clinical evaluation in supporting the diagnosis of possible or probable MSA. MRI and SPECT perfusion changes in the basal ganglia are suggestive of degeneration of striatal projection neurons in those individuals.
|Number of pages||1|
|Journal||Italian Journal of Neurological Sciences|
|Publication status||Published - 1999|
ASJC Scopus subject areas
- Clinical Neurology