Imaging-based differential diagnosis between multiple system atrophy and Parkinson's disease

• We aimed to determine the optimal tool for differentiating between MSA-P and PD.
• We measured middle cerebellar peduncle (MCP) width.
• We measured apparent diffusion coefficient (ADC) value of the putamen and cerebellum.
• We measured 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy images.
• MCP width and ADC value of the putamen may be helpful relative to other methods.

There are many tools for differentiating between multiple system atrophy with predominant parkinsonian features (MSA-P) and Parkinson's disease (PD). These include middle cerebellar peduncle (MCP) width, apparent diffusion coefficient (ADC) value of the putamen and cerebellum, and 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy images. We aimed to directly compare the above-mentioned methods, and to determine the optimal tool for differential diagnosis. Eleven patients with MSA-P and 36 patients with PD were enrolled. Of these, 7 patients with MSA-P and 14 patients with PD were chosen as background-matched subjects. We measured MCP width, ADC value of the putamen and cerebellum, and MIBG myocardial scintigraphy images. Area under curve (AUC) of receiver operating characteristic (ROC) was assessed to compare the above-mentioned methods. MCP width and ADC value of the putamen may be helpful for differentiating between MSA-P and PD relative to other methods in background-matched patients (MCP, AUC = 0.95; putamen ADC, AUC = 0.88; cerebellar ADC, AUC = 0.70; MIBG, AUC = 0.78). Similar AUCs were seen in all patients with different backgrounds. Our findings suggested that MCP width and ADC value of the putamen could be superior to ADC value of the cerebellum and MIBG uptake for differentiating between MSA-P and PD.