Article Figures & Data
Figures
- Fig 1.
Measurement of putaminal width and mean phase-shift values from corrected phase images by using ImageJ software. A, Three lines crossing the mid-, posterior half, and far posterior putamen are drawn to allow measurements. B, The corresponding plot profile of the line crossing the far posterior portion of the putamen demonstrates increased phase-shift values in both putamina (arrows).
- Fig 2.
Distribution of putaminal atrophy (A) and posterolateral putaminal signal intensity (B) in each group. Putaminal atrophy: 0 = negative, 1 = suspicious, 2 = definite; posterolateral putaminal signal intensity: 0 = hyperintense, 1 = isointense, 2 = hypointense, 3 = markedly hypointense.
- Fig 3.
A 71-year-old woman who initially presented with right-leg dragging 3 years ago was clinically diagnosed as having probable MSA-p. A, On the T2-weighed axial image, the bilateral posterolateral putamen shows subtle hypointensity. The phase image (B) and final SWI (C) show a marked phase shift in the left posterolateral putamen with loss of lateral convexity of the posterolateral aspect of the putamen, suggesting atrophic change. D, Phase values along the far posterior of both putamina show asymmetric phase-shift values, and mean phase-shift values of the left putamina are measured as 2686.5 Siemens Phase Units.
- Fig 4.
A 69-year-old woman who initially presented with gait disturbance and bradykinesia 8 years ago was clinically diagnosed with IPD. The T2-weighed axial image (A), phase image (B), and final SWI (C) show no substantial signal alteration or atrophy in the bilateral putamina, while excessive iron deposition in the bilateral globus pallidus is observed. D, Phase values along the far posterior portion of both putamina show symmetric phase-shift values, and mean phase-shift values of the right and left putamina are measured as 2114.5 and 2111.7 Siemens Phase Units, respectively.
- Fig 5.
Receiver operating characteristic curves of values measured at the far posterior putamen to distinguish MSA-p from IPD.
Tables
Imaging Finding MSA-p IPD Healthy Control No. 27 50 27 Putaminal atrophy Suspicious 3 (11.1%) 0 0 Definite 11 (40.7%) 0 0 Putaminal signal intensity Hyperintense 10 (37.0%) 24 (48.0%) 15 (55.6%) Isointense 3 (11.1%) 22 (44.0%) 10 (37.0%) Hypointense 2 (7.4%) 4 (8.0%) 2 (7.4%) Markedly hypointense 12 (44.4%) 0 0 Hot-cross bun sign 2 (7.4%) 0 0 High signal intensity of middle cerebellar peduncle Suspicious 3 (11.1%) 0 0 Definite 1 (3.7%) 0 0 Cerebellar atrophy Suspicious 11 (40.7%) 10 (20.0%) 0 Definite 3 (11.1%) 0 0 - Table 3:
Correlation between the clinically symptomatic side and asymmetry of imaging findings
Clinical Symptom Putaminal Atrophy (n = 14) Marked Signal Hypointensity (n = 12) Symmetric Right Left Symmetric Right Left Symmetric 0 1 2 1 1 0 Right-dominant 1 0 4 2 0 3 Left-dominant 0 5 1 1 3 1 - Table 4:
Quantitatively measured putaminal width and phase-shift values: the ratios of dominant-to-nondominant-side values in the far posterior portion of putamena
MSA-p IPD Healthy Control P Value Measured values: dominant side Putamen widthb 3.17 ± 0.65 3.81 ± 0.53 3.87 ± 0.47 <.001 Phase-shift valueb 2322.2 ± 236.9 2121.5 ± 44.4 2136.7 ± 45.8 <.001 Measured values: mean of both sides Putamen widthb 3.42 ± 0.57 3.98 ± 0.52 4.05 ± 0.45 <.001 Phase-shift valueb 2258.4 ± 180.1 2108.1 ± 39.8 2122.5 ± 37.6 <.001 Ratio of dominant/nondominant side Putamen width (shorter/longer side) 0.866 ± 0.123 0.921 ± 0.070 0.912 ± 0.048 .095 Phase-shift valueb (higher/lower side) 1.057 ± 0.065 1.013 ± 0.011 1.013 ± 0.011 <.001
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