Which MRI findings are characteristic of multiple system atrophy (MSA)?

Updated: Oct 17, 2018
  • Author: André Diedrich, MD, PhD; Chief Editor: Selim R Benbadis, MD  more...
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Expected MRI findings in MSA are as follows:

  • Atrophy of cerebellum and brainstem in OPCA and striatonigral degeneration (SND)

  • No vascular damage

  • No multi-infarct pattern in brain

  • No other lesions

  • Hyperintensity in the pons, peduncles, and cerebellum on T2-weighted and proton density–weighted MRI scans

  • Slitlike hyperintensity on T2-weighted and proton density–weighted MRI scans; a cruciform hyperintensity in the pons on T2-weighted MRI, known as the hot cross bun sign, is diagnostically helpful, but it is not specific to MSA. [34]

In addition, MRI and proton MR studies can be used to exclude other conditions, such as multi-infarct syndromes.

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