Diagnostic usefulness of putaminal abnormality on diffusion- and susceptibility-weighted imaging: two illustrative cases of multiple system atrophy-parkinsonian type

Excerpt

Brain magnetic resonance imaging (MRI) has been widely performed to evaluate patients with parkinsonism. Recently, putaminal changes, including putaminal atrophy, putaminal hypointensity, and hyperintense putaminal rim, have been investigated as characteristic radiological findings of the parkinsonian variant of multiple system atrophy (MSA-P) using various MRI modalities, including T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR) imaging, diffusion-weighted imaging (DWI), and susceptibility-weighted imaging (SWI) [1]. However, in clinical settings, the clinical usefulness of an individual assessment for putaminal abnormalities in those MRI modalities remains to be further elucidated. From our experiences with two patients with probable MSA-P, we found that not only SWI but also DWI might be more sensitive ways to identify putaminal abnormalities, than conventional MRIs. Moreover, we observed that DWI at B1000 might be more feasible than apparent diffusion coefficient (ADC) mapping when reading DWI for the visual assessment of putaminal abnormalities. …