Annals of Indian Academy of Neurology
  Users Online: 1973 Home | About the Journal | InstructionsCurrent Issue | Back IssuesLogin      Print this page Email this page  Small font size Default font size Increase font size

Table of Contents
Year : 2021  |  Volume : 24  |  Issue : 4  |  Page : 468

Evaluation of multiple system atrophy subtypes with FDG-PET

Institute of Clinical Neurobiology, Vienna, Austria

Date of Submission20-Jan-2021
Date of Acceptance20-Jan-2021
Date of Web Publication09-Jul-2021

Correspondence Address:
Dr. Kurt Jellinger
Institute of Clinical Neurobiology Alberichgasse 5/13, A-1150 Vienna
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_54_21

Rights and Permissions


How to cite this article:
Jellinger K. Evaluation of multiple system atrophy subtypes with FDG-PET. Ann Indian Acad Neurol 2021;24:468

How to cite this URL:
Jellinger K. Evaluation of multiple system atrophy subtypes with FDG-PET. Ann Indian Acad Neurol [serial online] 2021 [cited 2022 Jan 21];24:468. Available from:


Seniaray N, et al. Recently analysed the functional spectrum of multiple system atrophy (MSA) using 18F-FDG PET/CT and 99mTc TRODAT-1 SPECT in 67 patients with clinically diagnosed MSA (29 MSA-P, 25 MSA-C and 13 mixed subtypes).[1] While dopamine transporter (DAT) imaging with TRODAT-1 SPECT cannot distinguish between MSA, PD, DLB and PSP and cannot differentiate MSA-P from PD and MSA-C, subtypes show characteristic patterns of FDG uptake on PET scan: MSA-P subjects showed diffuse hypometabolism in putamen-pallidum with relative sparing of the caudate nuclei, while in MSA-C patients hypometabolism was seen in cerebellum and brainstem. In mixed subtypes, variable hypometabolism in basal ganglia, cerebellum and brainstem was associated with that in fronto-parietal regions. Thus, FDG-PET may help in differentiating the subtypes of MSA in the presence of overlapping syndromes.

Targeting postsynaptic dopaminergic function using [123I] FP-CIT SPECT does not differentiate PD from MSA (both showing normal or increased signal),[2] DAT imaging showed more prominent and earlier DAT loss in anterior caudate and ventral putamen in MSA,[3] although normal DAT imaging does not exclude MSA.[4] In autopsy-confirmed cases, a greater asymmetry of striatal binding was seen in MSA than in PD,[5] but it is highly correlated with substantia nigra cell loss.[6] 18F-DOPA-PET showed more widespread basal ganglia dysfunction in MSA than in PD without evidence of early compensatory increase in DOPA uptake.[7] The above FDG-PET data confirm previous studies showing different patterns of decreased glucose metabolism between MSA-P and PD with a positive predictive value of 95%,[8],[9] while MSA-related patterns of metabolic topographies discriminated between normal, MSA, PSP and PD, and correlate with standard ratings of clinical stages and motor symptoms in MSA.[10] Moreover, they show further possibilities in differentiating the various subtypes of MSA. In conclusion, 18F-FDG PET provides a new basis for the differentiation of MSA-P and MSA-C,[11] reflecting distinct clinical features of MSA.[12] Future neuroimaging studies, such as Tau-PET will enlarge the diagnostic spectrum of MSA, its functional subtypes and its differentiation from other parkinsonian syndromes.


The author thanks Erich Mitter-Ferstl, PhD, for secretarial work.

   References Top

Seniaray N, Verma R, Ranjan R, Belho E, Mahajan H. Comprehensive Functional Evaluation of the Spectrum of Multi-System Atrophy with 18F-FDG PET/CT and 99mTc TRODAT-1 SPECT: 5 Year’s Experience from a Tertiary Care Center. Ann Indian Acad Neurol 2021;24:490-4.  Back to cited text no. 1
  [Full text]  
Brooks DJ, Seppi K. Proposed neuroimaging criteria for the diagnosis of multiple system atrophy. Mov Disord 2009;24:949-64.  Back to cited text no. 2
Nocker M, Seppi K, Donnemiller E, Virgolini I, Wenning GK, Poewe W, et al. Progression of dopamine transporter decline in patients with the Parkinson variant of multiple system atrophy: A voxel-based analysis of [123I] beta-CIT SPECT. Eur J Nucl Med Mol Imaging 2012;39:1012-20.  Back to cited text no. 3
McKinley J, O'Connell M, Farrell M, Lynch T. Normal dopamine transporter imaging does not exclude multiple system atrophy. Parkinsonism Relat Disord 2014;20:933-4.  Back to cited text no. 4
Perju-Dumbrava LD, Kovacs GG, Pirker S, Jellinger K, Hoffmann M, Asenbaum S, et al. Dopamine transporter imaging in autopsy-confirmed Parkinson's disease and multiple system atrophy. Mov Disord 2012;27:65-71.  Back to cited text no. 5
Kraemmer J, Kovacs GG, Perju-Dumbrava L, Pirker S, Traub-Weidinger T, Pirker W. Correlation of striatal dopamine transporter imaging with post mortem substantia nigra cell counts. Mov Disord 2014;29:1767-73.  Back to cited text no. 6
Levin J, Maass S, Schuberth M, Höglinger G. Multiple system atrophy. In: Falup-Pecurariu C, Ferreira J, Martinez-Martin P, Chaudhuri KR, editors. Movement Disorders Curricula. Wien: Springer; 2017. 183-92.  Back to cited text no. 7
Tang CC, Eidelberg D. Abnormal metabolic brain networks in Parkinson's disease from blackboard to bedside. Prog Brain Res 2010;184:161-76.  Back to cited text no. 8
Grimaldi S, Boucekine M, Witjas T, Fluchere F, Renaud M, Azulay JP, et al. Multiple system atrophy: Phenotypic spectrum approach coupled with brain 18-FDG PET. Parkinsonism Relat Disord 2019;67:3-9.  Back to cited text no. 9
Shen B, Wei S, Ge J, Peng S, Liu F, Li L, et al. Reproducible metabolic topographies associated with multiple system atrophy: Network and regional analyses in Chinese and American patient cohorts. Neuroimage Clin 2020;28:102416.  Back to cited text no. 10
Zhao P, Zhang B, Gao S, Li X. Clinical features, MRI, and 18F-FDG-PET in differential diagnosis of Parkinson disease from multiple system atrophy. Brain Behav 2020;10:e01827.  Back to cited text no. 11
Lee R, Shin JH, Choi H, Kim HJ, Cheon GJ, Jeon B. Variability of FP-CIT PET patterns associated with clinical features of multiple system atrophy. Neurology 2021;online Feb 3: doi 10.1212/WNL.0000000000011634.  Back to cited text no. 12


Print this article  Email this article


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (314 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


 Article Access Statistics
    PDF Downloaded164    
    Comments [Add]    

Recommend this journal