Cerebellar blood perfusion is a diagnostic, but not a prognostic, marker for parkinsonian-dominant type multiple system atrophy

Kenta Shiina; Taiji Tsunemi; Nobutaka Hattori

doi:10.1016/j.parkreldis.2024.106975

Cerebellar blood perfusion is a diagnostic, but not a prognostic, marker for parkinsonian-dominant type multiple system atrophy

Parkinsonism Relat Disord. 2024 Apr 17:123:106975. doi: 10.1016/j.parkreldis.2024.106975. Online ahead of print.

Authors

Kenta Shiina¹, Taiji Tsunemi², Nobutaka Hattori¹

Affiliations

¹ Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
² Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. Electronic address: t-tsunemi@juntendo.ac.jp.

PMID: 38677216
DOI: 10.1016/j.parkreldis.2024.106975

Abstract

Introduction: Multiple system atrophy (MSA) is clinically characterized by various neurological symptoms. According to the diagnostic criteria, MSA is classified into parkinsonian-dominant type (MSA-P) or cerebellar ataxia-dominant type (MSA-C) based on the predominant signs displayed. Recently, N-isopropyl-p-[¹²³I] iodoamphetamine (¹²³I-IMP) single-photon emission computed tomography (SPECT), a radiological examination evaluating brain perfusion, has been successful in detecting cerebellar hypoperfusion in MSA-P patients, demonstrating its utility in the early detection of cerebellar dysfunction. In this study, we further explored whether this cerebellar hypoperfusion impacts the clinical features of MSA-P, whether it is observable in patients without cerebellar symptoms, and, most importantly, whether it influences the prognosis of MSA-P.

Methods: We conducted a retrospective analysis of 88 MSA patients who were admitted to our department for the last fifteen years. Clinical data were collected, and cerebellar perfusion was examined using ¹²³I-IMP SPECT. This analysis includes the application of the three-dimensional stereotactic surface projection (3D-SSP) technique and Z-score.

Results: Cerebellar perfusion decreased in MSA-P patients without cerebellar ataxia, compared to healthy individuals (p = 0.0017). The Receiver Operating Characteristic (ROC) curve demonstrated a moderate ability to distinguish MSA-P patients without cerebellar ataxia (MSA-Pp) from healthy controls (AUC = 0.6832). Among MSA-Pp, those exhibiting cerebellar hypoperfusion showed relatively improved neurological prognosis, although the difference was not statistically significant when compared to those with normal cerebellar perfusion.

Conclusion: Assessing cerebellar perfusion through IMP-SPECT proves valuable in detecting subclinical cerebellar dysfunction in MSA-Pp. Importantly, cerebellar hypoperfusion does not correlate with a poorer neurological prognosis.

Keywords: Multiple system atrophy; Single-photon emission computed tomography (SPECT).