Neural correlates of metaphor processing in schizophrenia

OBJECTIVE: A main feature of schizophrenic thought and language disturbance is concretism, the inability to understand the figurative meaning of proverbs and metaphors. Although this is routinely tested during clinical interview, its neural basis is unknown. METHOD: We investigated processing of metaphoric sentences with functional magnetic resonance imaging (fMRI) in 12 patients with schizophrenia and 12 control subjects. Stimuli consisted of 60 novel short sentences with either metaphoric or literal meaning presented visually, intersparsed by a low level baseline (grey background). Subjects read these sentences silently and judged by button press whether they had a positive or negative connotation. RESULTS: Reading metaphors in contrast to literal sentences revealed signal changes in the left inferior frontal gyrus in the control subjects (BA 45/47) and an area 3 cm dorsal to that in the patients (BA 45). Only activation in this area was negatively correlated with the severity of concretism rated with the PANSS. Comparison between groups for the contrast metaphors vs. low level baseline revealed stronger signal changes in the control group in the right superior/middle temporal gyrus (BA 39) and the left inferior frontal gyrus (BA 45) in the patients. CONCLUSIONS: The results in the control subjects are in line with studies showing an involvement of the left inferior frontal and right lateral temporal cortex during context processing. Failure to recruit these areas in the patients may underlie schizophrenic concretism.     

Focal white matter density changes in schizophrenia: reduced inter-hemispheric connectivity

Gray matter changes have been demonstrated in several regions in schizophrenia. Particularly, the frontal and temporal cortices and amygdala-hippocampal region have been found decreased in volume and density in magnetic resonance imaging (MRI) studies. These abnormalities may reflect an aberrant neuronal network in schizophrenia, suggesting that white matter fibers connecting these regions may also be affected. However, it is unclear if particular white matter areas are (progressively) affected in schizophrenia and if these are related to the gray matter changes.Focal white matter changes in schizophrenia were studied in whole brain magnetic resonance images acquired from 159 patients with schizophrenia or schizophreniform disorder and 158 healthy comparison subjects using voxel-based morphometry. White matter density changes in the patients with schizophrenia were correlated to gray matter density changes and to illness severity.In the patients with schizophrenia, significant decreases in white matter density were found in the genu and truncus of the corpus callosum in the left and right hemisphere, in the right anterior internal capsule and in the right anterior commissure. No interactions between diagnosis and age were found. Increased illness severity was correlated with low density of the corpus callosum and anterior commissure. Decreased corpus callosum density correlated with decreased density of thalamus, lateral inferior frontal and insular gray matter in patients and controls and with decreased density of medial orbitofrontal and superior temporal gyri in patients. Decreased internal capsule and anterior commissure density correlated with increased caudate, and globus pallidus density in patients and controls.These findings suggest aberrant inter-hemispheric connectivity of anterior cortical and sub-cortical brain regions in schizophrenia, reflecting decreased hemispheric specialisation in schizophrenia.     

基于体素的形态学分析偏头痛患者灰质异常:Meta分析

目的 采用激活似然估计（ALE）的Meta分析方法,探讨偏头痛患者基于体素的形态学（VBM）分析所得的脑灰质改变。方法 在中国知网、PubMed和Embase数据库中检索从2000年1月—2015年6月间基于VBM的偏头痛患者灰质变化的文献,然后通过GingerALE软件包对所检索结果进行Meta分析。结果 检索后共纳入包括246例偏头痛患者和245名健康对照者的10项研究。偏头痛患者双侧额下回（BA44区）、右侧中央前回（BA43、44区）、双侧额中回（BA6、9区）、双侧扣带回前部（BA32区）、左侧扣带回（BA24区）、右侧颞上回（BA22区）、左侧岛叶（BA13区）、右侧顶下小叶（BA40区）灰质与健康对照者比较均显著减少（P均<0.05）。结论 偏头痛患者脑灰质结构的改变为进一步研究与疼痛有关的脑神经网络的病理、生理机制提供了形态学依据。     

无灶性癫痫静息态功能MRI的功能连接研究

目的应用静息态功能MRI(rs-f MRI)功能连接方法(FC)研究无灶性癫痫(NLE)的脑功能改变,探论FC对NLE的应用价值。加深对NLE病理生理机制的理解,为其诊断及治疗提供可靠的理论依据。材料与方法对43例NLE患者和46例性别、年龄、教育程度及利手相匹配的健康志愿者(对照组),采用3.0 T超导MR扫描仪进行静息态功能序列扫描,然后将病例组与对照组分别进行FC分析,再对ALFF分析结果进行两样本t检验分析,并分析FC统计脑图与病程的相关性。结果与正常对照组相比,病例组右侧海马FC增加的脑区位于右颞上回、左颞下回、双颞中回、双前额内侧回,右额中回;左侧海马FC增加的脑区位于双颞上回、左海马旁回、左额叶、右前额内侧回、左顶下小叶、右中央后回。右侧海马FC降低的脑区位于左内囊膝、左顶下小叶、右扣带回、左额上回、左额叶;左侧海马降低的脑区位于右小脑后叶、左小脑前叶、右颞上回、右丘脑。病例组右侧海马FC病程正相关的脑区位于:左额下回、左颞下回、左颞上回、右额叶、右楔前叶、右顶叶、右顶下小叶、右额中回;左侧海马FC与病程正相关的脑区位于左舌回、双额中回、左顶下小叶、右中央后回。病例组右侧海马FC与病程呈负相关的脑区位于左小脑前叶、左内囊膝;病例组左侧海马FC与病程负相关的脑区位于左小脑扁桃体、左额上回、右颞上回、左楔前叶。结论 ALFF和FC方法可作为一种无创的脑功能研究方法,能检测出NLE静息态脑功能变化,了解与临床变量(病程)的相关性,为癫痫的病理生理机制研究提供可靠的理论依据。     

β-Amyloid affects frontal and posterior brain networks in normal aging

Although deposition of β-amyloid (Aβ), a pathological hallmark of Alzheimer's disease (AD), has also been reported in cognitively intact older people, its influence on brain structure and cognition during normal aging remains controversial. Using PET imaging with the radiotracer Pittsburgh compound B (PIB), structural MRI, and cognitive measures, we examined the relationships between Aβ deposition, gray matter volume, and cognition in older people without AD. Fifty-two healthy older participants underwent PIB-PET and structural MRI scanning and detailed neuropsychological tests. Results from the whole-brain voxel-based morphometry (VBM) analysis revealed that gray matter volume in the left inferior frontal cortex was negatively associated with amyloid deposition across all participants whereas reduced gray matter volume was shown in the posterior cingulate among older people with high amyloid deposition. When gray matter density measures extracted from these two regions were related to other brain regions by applying a structural covariance analysis, distinctive frontal and posterior brain networks were seen. Gray matter volume in these networks in relation to cognition, however, differed such that reduced frontal network gray matter volume was associated with poorer working memory performance while no relationship was found for the posterior network. The present findings highlight structural and cognitive changes in association with the level of Aβ deposition in cognitively intact normal elderly and suggest a differential role of Aβ-dependent gray matter loss in the frontal and posterior networks in cognition during normal aging.     

Voxel-based morphometry reveals increased gray matter density in Broca's area in male symphony orchestra musicians

Broca's area is a major neuroanatomical substrate for spoken language and various musically relevant abilities, including visuospatial and audiospatial localization. Sight reading is a musician-specific visuospatial analysis task, and spatial ability is known to be amenable to training effects. Musicians have been reported to perform significantly better than nonmusicians on spatial ability tests, which is supported by our findings with the Benton judgement of line orientation (JOL) test (P < 0.001). We hypothesised that use-dependent adaptation would lead to increased gray matter density in Broca's area in musicians. Voxel-based morphometry (VBM) and stereological analyses were applied to high-resolution 3D MR images in male orchestral musicians (n = 26) and sex, handedness, and IQ-matched nonmusicians (n = 26). The wide age range (26 to 66 years) of volunteers permitted a secondary analysis of age-related effects. VBM with small volume correction (SVC) revealed a significant (P = 0.002) region of increased gray matter in Broca's area in the left inferior frontal gyrus in musicians. We observed significant age-related volume reductions in cerebral hemispheres, dorsolateral prefrontal cortex subfields bilaterally and gray matter density in the left inferior frontal gyrus in controls but not musicians; a positive correlation between JOL test score and age in musicians but not controls; a positive correlation between years of playing and the volume of gray matter in a significant region identified by VBM in under-50-year-old musicians. We suggest that orchestral musical performance promotes use-dependent retention, and possibly expansion, of gray matter involving Broca's area and that this provides further support for shared neural substrates underpinning expressive output in music and language.     

Cortical metabolic changes in the cerebellar variant of multiple system atrophy: a voxel-based FDG-PET study in 41 patients

In addition to neuronal loss in the cerebellum and basal ganglia, recent imaging studies have suggested that cortical involvement may be more extensive in patients with MSA. In this study, we focused on cortical metabolic patterns in 41 patients with MSA-C and 30 controls, using statistical parametric mapping analysis to evaluate whether metabolic derangement in MSA-C patients involved the cortical area and correlated cerebral metabolism with clinical parameters. In patients with MSA-C, SPM analysis revealed that, apart from the expected reduction of FDG-uptake in brainstem-cerebellar area, there was a significant hypometabolism in widespread frontal cortex, including inferior orbitofrontal, rectus, middle and superior frontal, and superior mesiofrontal extending to cingulum, and left inferior parietal cortex. In a subgroup analysis of MSA-C patients, metabolic derangement in the cerebral cortex was visible even in the early stages of MSA-C. In advanced stages, the metabolic derangement tended to evolve into the rostral brainstem and into other cortical areas, including left inferior frontal cortex and right inferior orbitofrontal, right anterior and middle cingulate, and anterior portion of superior mesiofrontal gyri. In correlation analysis, reduced FDG-uptake in orbitofrontal area was most significantly correlated with disease severity and duration, followed by the medial frontal, the dorsal portion of the midbrain, and the cerebellum. Our study demonstrated that there were widespread areas of decreased metabolism in the cerebral cortex and, as the disease progressed, the pattern of metabolic derangement tended to evolve into other frontal areas without significant changes in cerebellar metabolism, suggesting that reduced FDG-uptake in cortical area may be associated with the primary disease process.     

慢性主观性耳鸣患者大脑局部一致性和灰质结构的MRI分析

目的 采用MRI观察慢性主观性耳鸣患者大脑局部神经活动和灰质结构的改变特点。方法 对21例慢性主观性耳鸣患者（病例组）和21名健康志愿者（对照组）行结构与功能MR扫描,采用基于体素的形态学及局部一致性（ReHo）方法,分析大脑灰质结构和体积改变。结果 与对照组比较,病例组右颞上回、颞中回和颞下回ReHo值增高（P<0.05）,右眶部额中回和三角部额下回、左侧额中回和角回及小脑蚓部ReHo值降低（P<0.05）,右颞中回和双侧额上回灰质体积缩小（P<0.01）。病例组右侧颞中回ReHo值与耳鸣残疾量表评分呈正相关（r=0.604,P=0.005）。结论 主观性耳鸣患者在听觉和非听觉不同脑区存在脑功能活动和灰质体积的改变,为寻找神经影像学标记提供了参考基础。     

MRI评价抗癫痫药物对原发全面性癫痫患者脑灰质结构的影响

目的 运用基于体素的形态学(VBM)分析方法,探讨抗癫痫药物(AEDs)对全面强直阵挛癫痫(GTCS)患者脑灰质结构的影响。方法 将19例服用AEDs治疗的GTCS患者(服药组)及19例未服药患者(未服药组)纳入本研究。采集3D T1数据,并采用VBM方法将患者脑灰质结构进行分割,并对分割后的灰质结构进行两样本t检验。针对服药患者,分2次分别纳入及不纳入病程作为协变量,将服药时间与全脑灰质体积进行相关分析。结果 与未服药组比较,服药组GTCS患者脑灰质体积增加的区域以双侧额叶、顶叶、颞叶、尾状核及小脑半球为主。无论是否将病程纳为协变量,双侧壳核、丘脑灰质体积与服药时间呈正相关。结论 VBM可显示AEDs对脑灰质结构造成的微细改变;AEDs对GTCS患者脑灰质结构可能具有一定的保护作用。     

前庭性偏头痛患者基于体素的脑灰质体积研究

目的采用基于体素的形态分析法(voxel-based morphological analysis,VBM)分析前庭性偏头痛(vestibular migraine,VM)患者大脑灰质体积改变区域,以期提供临床病理生理方面的新思路。材料与方法严格按照纳入标准及排除标准,招募了17例VM患者及20例健康对照组。所有受试者均接受头部三维T1加权像磁共振成像(magnetic resonance imaging,MRI)扫描,采用VBM技术对两组大脑灰质体积进行比较,探索与该疾病病理生理相关的局部灰质变化。结果与健康对照组相比,VM患者小脑、小脑蚓部、前扣带回、眶部额中回、右颞横回,枕颞内侧回、右侧角回体积减少(P<0.001,FEW校正)。结论VM患者存在多个疼痛伤害性和多感觉整合性脑区域的灰质体积异常,出现体积改变的中枢性脑区域可能参与了该疾病的病理生理机制。     

Brain pathology in first-episode psychosis: Magnetization transfer imaging provides additional information to MRI measurements of volume loss

BackgroundLoss of brain volume in first-episode psychosis can be detected using conventional magnetic resonance imaging (MRI), but subtle changes – not leading to reduction in volume – that may contribute to clinical and cognitive abnormalities, may go undetected. Magnetization transfer imaging (MTI), a technique more sensitive to subtle neuropathological changes than conventional MRI, could yield important information on the extent and nature of structural abnormalities.MethodsForty-eight patients (33 males) from a population-based sample with first-episode psychosis (41 with schizophrenia and 7 with schizoaffective psychosis) and 47 healthy volunteers (27 males) were studied. Differences in magnetization transfer ratio (MTR) and white and grey matter volumes between groups were investigated.ResultsIn patients, MTR was reduced in right entorhinal cortex, fusiform, dentate and superior frontal gyri and in left superior frontal and inferior/rostral cingulate gyri. Grey matter volume was reduced in right insula, frontal operculum and middle and superior temporal gyri and in left middle temporal gyrus. Grey matter volume increases were seen in patients in the superior frontal gyrus. White matter volume loss was found adjacent to grey matter loss. In patients MTR was lower in all areas of volumetric differences between groups suggesting that both changes may be related. Similar findings were observed when patients with schizoaffective psychosis were removed from the analysis. The correlations between clinical and MRI parameters did not survive correction for multiple comparisons.ConclusionsMTI frontal and temporal abnormalities suggesting neuroaxonal and myelin changes were more extensive in our patients than those detected with conventional MRI. Our findings also suggest that there is regional variation in the severity of structural brain abnormalities.     

Gray matter density increase in the primary sensorimotor cortex in long-term essential blepharospasm

In this study, we investigated gray matter density in essential blepharospasm (EB) patients, focusing on the duration of disease and severity of symptoms. We studied 32 patients (10 males and 22 females; age, 55.0 ± 6.5years) with EB and 48 controls (15 males and 33 females; age, 54.4 ± 10.3years) by using 3D T1-weighted magnetic resonance imaging and voxel-based morphometry. We defined an activity index (AI) that reflects the severity and duration of EB symptoms in each patient. The difference between the 2 groups was examined by statistical parametric mapping software (SPM8). After controlling for age, gray matter density increased in the bilateral primary sensorimotor cortex (S1M1) and cingulate gyrus. The gray matter density in the bilateral S1M1 was found to have a significant positive correlation with the duration of disease and a more robust correlation with AI. The correlation coefficients, after correcting for age, in the S1M1 and left cingulate gyrus were as follows: with duration, right S1M1, 0.72 (P<0.00001); left S1M1, 0.72 (P<0.00001); and left cingulate gyrus, 0.33 (not significant); and with AI, right S1M1, 0.81 (P<10(-7)); left S1M1, 0.74 (P<0.00001); and left cingulate gyrus, 0.43 (P<0.05). The increase in gray matter density in the S1M1 and cingulate gyrus might be a secondary effect caused by long-term hyperactivity in these areas instead of a predisposing factor.     

慢性梗阻性肺部病变患者脑皮质MRI形态学初步研究

目的研究应用基于体素的形态学分析(VBM)方法,观察慢性梗阻性肺部病变(COPD)患者的大脑皮质变化。材料与方法搜集在住院中的COPD患者(患者组)25例和年龄、性别、文化背景等相似的志愿者(对照组)25例进行肺功能、精神状态检查及血气分析。二组均行3D T1WI检查,采用VBM、FSL分析软件(簇体积减少70体素)。应用一般线性模型进行统计学分析,计算两组的全脑灰质总体积,基于体素比较两组全脑灰质各个体素体积的差异。结果COPD患者日常生活活动性、简易精神状态测试、视觉重建及数字记忆测试预测值明显低于正常人。患者额叶的双侧眶回、双侧额下回三角区(Broca区),以及双额内側回、右侧前岛回及深部核团等局部灰质体积较正常对照组减少(P值均0.01)。以统计学t值最大的体素在MNI中的坐标值分析,萎缩最明显的Brodmann脑区主要有47脑区(额上叶皮层)、双侧的13脑区(岛叶皮层)、22脑区(颞上回),及双侧的32脑区(前上扣带回皮层)、24脑区(前下扣带回皮质)。结论COPD患者的多个脑区可出现皮层体积的减少。损伤区域主要涉及前额叶皮质,以及双额内側回、右侧前岛回。与阻塞性睡眠呼吸暂停、先天性中枢呼气不足综合征以及高海拔居民的脑损伤部位相一致。     

原发性痛经患者灰质体积改变与临床指标的相关性: 基于体素形态学测量技术

  目的  基于体素形态学测量技术探究原发性痛经患者脑灰质体积改变及其与临床量表评分间的相关性。  方法  收集符合纳入标准的41例原发性痛经患者和41例健康对照者在月经来潮的第1~3天内进行高分辨率T1结构像扫描,并且填写痛经程度量表、COX痛经症状量表、焦虑自评量表、抑郁自评量表。采用SPM8软件在全脑水平比较灰质体积,观察两组灰质体积显著变化的脑区。  结果  原发性痛经患者较健康对照脑灰质体积缩小,差异脑区主要包括:左侧眶部额中回、左侧前扣带回、右侧前扣带回（P < 0.001）,未发现灰质体积明显增加的脑区。痛经组和健康组在痛经程度量表、COX痛经症状量表、焦虑自评量表、抑郁自评量表评分的差异有统计学意义（P < 0.001）。左侧前扣带回与痛经程度量表、COX痛经症状量表、焦虑自评量表、抑郁自评量表评分存在负相关关系。  结论  基于体素形态学测量技术可以准确评估原发性痛经患者脑灰质微结构改变,这些灰质体积缩小的脑区主要涉及疼痛传递、处理及情绪调节相关的脑区,其灰质体积的变化在原发性痛经疼痛的发生及持续中可能有着重要作用。      

基于语言双流模型的卒中后失语右脑功能网络研究

目的探究右脑功能网络在左侧脑损伤卒中后失语(PSA)的效应特点。方法2018年12月至2019年6月,招募左脑半球损伤PSA患者12例(患者组)和匹配的健康成年人12例(对照组),以双流语言模型为参照,应用静息态功能磁共振观察右脑功能网络特征。结果2例患者脱落。与对照组相比,在语言背侧通路中,患者组缘上回至额中回、三角部额下回功能连接增强,中央后回至岛盖部额下回功能连接降低;在语言腹侧通路中,角回至眶部额下回功能连接增强;在腹、背侧双通路模型中,语言功能皮质至皮质下核团功能连接增强,额、颞叶和边缘系统功能连接减弱。三角部额下回至豆状壳核功能连接增强与复述能力呈负相关(r=-0.720,P<0.05),岛盖部额下回至尾状核功能连接增强与说和复述能力呈负相关关系(r<-0.696,P<0.05)。患者组右脑语言关键脑区局部网络指标和全局指标均与对照组有显著性差异(|t|>2.143,P<0.05)。结论PSA患者右脑功能网络在脑卒中后发生功能重组,语言关键皮质与皮质下核团功能连接增强可能是右脑代偿的关键环节。     

A comprehensive assessment of gray and white matter volumes and their relationship to outcome and severity in schizophrenia

Preliminary data suggest an association of posterior cortical gray matter reduction with poor outcome in schizophrenia. We made a systematic MRI assessment of regional gray and white matter volumes, parcellated into 40 Brodmann's areas, in 104 patients with schizophrenia (51 with good outcomes, 53 with poor outcomes) and 41 normal comparison subjects, and investigated correlations of regional morphometry with outcome and severity of the illness. Schizophrenia patients displayed differential reductions in frontal and to a lesser degree temporal gray matter volumes in both hemispheres, most pronounced in the frontal pole and lateral temporal cortex. White matter volumes in schizophrenia patients were bilaterally increased, primarily in the frontal, parietal, and isolated temporal regions, with volume reductions confined to anterior cingulate gyrus. In patients with schizophrenia as a group, higher illness severity was associated with reduced temporal gray matter volumes and expanded frontal white matter volumes in both hemispheres. In comparison to good-outcome group, patients with poor outcomes had lower temporal, occipital, and to a lesser degree parietal gray matter volumes in both hemispheres and temporal, parietal, occipital, and posterior cingulate white matter volumes in the right hemisphere. While gray matter deficits in the granular cortex were observed in all schizophrenia patients, agranular cortical deficits in the left hemisphere were peculiar to patients with poor outcomes. These results provide support for frontotemporal gray matter reduction and frontoparietal white matter expansion in schizophrenia. Poor outcome is associated with more posterior distribution (posteriorization) of both gray and white matter changes, and with preferential impairment in the unimodal visual and paralimbic cortical regions.     

Gender differences in the left inferior frontal gyrus in normal children

This study examined frontal lobe subregions in 46 normal children and adolescents (25 females, mean age: 11.08, SD: 3.07; and 21 males, mean age: 10.76, SD: 2.61) to assess the effects of age and gender on volumetric measures as well as hemispheric asymmetries. Superior, middle, inferior, and orbito-frontal gray, white, and cerebrospinal (CSF) volumes were manually delineated in high-resolution magnetic resonance imaging (MRI) data to assess possible morphological changes. We report a significant age-related increase in the white matter of the left inferior frontal gyrus (IFG) in boys (P = 0.007). Additionally, the left IFG was significantly larger in boys compared to girls (P = 0.004). Boys showed increased gray matter volume relative to girls even after correcting for total cerebral volume. Also, boys were found to have significant Right > Left asymmetry patterns with greater right hemispheric volumes for total cerebral volume, total cerebral white matter, MFG white matter, and SFG white matter (P < 0.001). Girls showed significant Right > Left asymmetry patterns in total cerebral and SFG white matter (P < 0.001). These findings suggest continued modification of the IFG during normal development in boys, and significant gender differences in IFG gray matter between boys and girls that may be possibly linked to gender differences in speech development and lateralization of language.     

Comparing gray matter loss profiles between dementia with Lewy bodies and Alzheimer's disease using cortical pattern matching: diagnosis and gender effects

We used magnetic resonance imaging (MRI) and cortical pattern matching to map differences in cortical gray matter deficits between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), and explored the possible influence of gender on these patterns. Twenty-nine patients with AD (age 77.9 +/- 5.5), 16 patients with DLB (76.4 +/- 6.7), and 38 controls (75.3 +/- 6.8) were included. Dementia groups were matched for illness severity. Detailed spatial analyses of gray matter were conducted across the entire cerebral cortex by measuring local proportions of gray matter at thousands of homologous cortical surface locations in each subject and between diagnostic groups. To visualize regional changes, statistical differences were mapped at each cortical surface location in 3D. Main effects of diagnosis demonstrated prominent gray matter differences in orbitofrontal and temporal cortices, where AD exhibited the greatest deficits relative to DLB. Main effects of sex showed less gray matter in men within all group comparisons. Exploratory findings for sex by diagnosis interactions suggest greater gray matter loss in the anterior cingulate for men with AD, relative to controls, AD females, and individuals with DLB. Relative preservation of orbitofrontal cortices in addition to temporal structures may contribute to distinguishing DLB from AD. Further investigation of the influence of gender might provide a more comprehensive understanding of the pathophysiological differences underlying the two forms of dementia.     

阿尔茨海默病及轻度认知障碍所致脑灰质体积及脑功能改变

目的 基于体素形态学分析(VBM)及静息态功能MRI(rs-fMRI)技术观察阿尔茨海默病(AD)及轻度认知障碍(MCI)患者全脑灰质体积及功能改变.方法 对AD(AD组)、MCI患者(MCI组)各30例及正常老年人30名(HC组)采集rs-fMRI和三维磁化强度预备梯度回波序列T1加权像,比较3组全脑灰质体积、脑区分...     

Voxel-based morphometry and voxel-based relaxometry in multiple system atrophy-a comparison between clinical subtypes and correlations with clinical parameters

Multiple system atrophy (MSA) is a neurodegenerative disease affecting basal ganglia, brainstem, cerebellum, and intermediolateral cell columns of the spinal cord. Clinically, a cerebellar (MSA-C) and a parkinsonian variant of MSA (MSA-P) are distinguished. We used voxel-based morphometry (VBM) and voxel-based relaxometry (VBR) in 48 MSA patients (32 MSA-C, 16 MSA-P) and 46 controls. In MSA-C, VBM revealed gray matter loss in cerebellum, right thalamus, both putamina and several cortical regions including insular cortex. Gray matter loss in the cerebellum and insular cortex was correlated with disease duration and severity. There was white matter loss in the brainstem, which was correlated with disease duration and severity. VBR analysis in MSA-C showed decreased relaxation rate R2 in cerebellum, pontine brainstem and cortical regions including insular cortex. In MSA-P, gray matter was reduced in cerebellum, dorsal midbrain, both putamina, and several cortical regions including insular cortex. A correlation with disease duration and severity was detected only for some small cortical areas. Direct comparison of MSA-C and MSA-P showed differences only in infratentorial brain regions where structural abnormalities were more pronounced in MSA-C than in MSA-P. In MSA-C, there was a stronger reduction of gray matter in the basal parts of the cerebellum, of white matter in the brainstem and of the relaxation rate R2 in the cerebellum and brainstem.