Imaging Markers of Multiple System Atrophy and Their Association With Disease Severity: A Cross-Sectional Study.

Background Multiple system atrophy (MSA) is a rare, adult-onset neurodegenerative disorder marked by autonomic failure, parkinsonism, and cerebellar ataxia, with subtypes classified as parkinsonian (MSA-P), cerebellar (MSA-C), and autonomic (MSA-A). This study aims to identify MRI biomarkers for MSA and their correlation with disease severity. Methodology A total of 30 patients with probable MSA (20 MSA-C, 10 MSA-P) aged 45-65 years were studied. Motor and non-motor symptoms were assessed using the Unified Multiple System Atrophy Rating Scale (UMSARS), and all patients underwent 3T MRI brain imaging. Data analysis was performed using SPSS version 22 (IBM Corp., Armonk, NY, USA) with Spearman's correlation for clinical-imaging correlations. Results The mean age of the study population was 54.43 years, with a male predominance (56.7%). The most common symptoms included gait ataxia (43.3%) and urinary dysfunction (96.7%), with orthostatic symptoms in 33.3%. Moderate disease severity was observed, with mean UMSARS scores of 15.9 (Part 1) and 16 (Part 2), showing no significant subtype differences. MRI revealed abnormalities in all patients, predominantly cerebellar atrophy (90%). The "hot cross bun" (HCB) sign was seen in 75% of MSA-C patients, but none of MSA-P patients showed the same. The HCB sign was significantly correlated with severity in MSA-C (USMSARS-4). Putaminal signs were less frequent and slightly more prevalent in MSA-P, without significant clinical-imaging correlation. Conclusions This study reinforces the critical role of MRI biomarkers in the diagnosis of MSA patients. Notably, the HCB sign exhibited a significant association with clinical severity in MSA-C patients, while such correlation was absent in MSA-P cases.
Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee, National Institute of Mental Health and Neurosciences, Bengaluru issued approval IEC/No. 3.02/3-11-2015. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
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