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Vemuri P, Castillo AM, Thostenson KB, Ward CP, Raghavan S, Reid RI, Lesnick TG, Reddy AL, Gehrking TL, Gehrking JA, Sletten DM, Jack CR, Low PA, Singer W. Imaging biomarkers for early multiple system atrophy. Parkinsonism Relat Disord 2022; 103:60-68. [PMID: 36063706 PMCID: PMC10597684 DOI: 10.1016/j.parkreldis.2022.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To systematically evaluate structural MRI and diffusion MRI features for cross-sectional discrimination and tracking of longitudinal disease progression in early multiple system atrophy (MSA). METHODS In a prospective, longitudinal study of synucleinopathies with imaging on 14 controls and 29 MSA patients recruited at an early disease stage (15 predominant cerebellar ataxia subtype or MSA-C and 14 predominant parkinsonism subtype or MSA-P), we computed regional morphometric and diffusion MRI features. We identified morphometric features by ranking them based on their ability to distinguish MSA-C from controls and MSA-P from controls and evaluated diffusion changes in these regions. For the top performing regions, we evaluated their utility for tracking longitudinal disease progression using imaging from 12-month follow-up and computed sample size estimates for a hypothetical clinical trial in MSA. We also computed these selected morphometric features in an independent validation dataset. RESULTS We found that morphometric changes in the cerebellar white matter, brainstem, and pons can separate early MSA-C patients from controls both cross-sectionally and longitudinally (p < 0.01). The putamen and striatum, though useful for separating early MSA-P patients from control subjects at baseline, were not useful for tracking MSA disease progression. Cerebellum white matter diffusion changes aided in capturing early disease related degeneration in MSA. INTERPRETATION Regardless of clinically predominant features at the time of MSA assessment, brainstem and cerebellar pathways progressively deteriorate with disease progression. Quantitative measurements of these regions are promising biomarkers for MSA diagnosis in early disease stage and potential surrogate markers for future MSA clinical trials.
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Affiliation(s)
- Prashanthi Vemuri
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Anna M Castillo
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kaely B Thostenson
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chadwick P Ward
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Robert I Reid
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Timothy G Lesnick
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ashritha L Reddy
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tonette L Gehrking
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jade A Gehrking
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - David M Sletten
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Clifford R Jack
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Phillip A Low
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Wolfgang Singer
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA.
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2
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A Review of Diagnostic Imaging Approaches to Assessing Parkinson's Disease. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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3
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Arribarat G, De Barros A, Péran P. Modern Brainstem MRI Techniques for the Diagnosis of Parkinson's Disease and Parkinsonisms. Front Neurol 2020; 11:791. [PMID: 32849237 PMCID: PMC7417676 DOI: 10.3389/fneur.2020.00791] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/25/2020] [Indexed: 01/22/2023] Open
Abstract
The brainstem is the earliest vulnerable structure in many neurodegenerative diseases like in Multiple System Atrophy (MSA) or Parkinson's disease (PD). Up-to-now, MRI studies have mainly focused on whole-brain data acquisition. Due to its spatial localization, size, and tissue characteristics, brainstem poses particular challenges for MRI. We provide a brief overview on recent advances in brainstem-related MRI markers in Parkinson's disease and Parkinsonism's. Several MRI techniques investigating brainstem, mainly the midbrain, showed to be able to discriminate PD patients from controls or to discriminate PD patients from atypical parkinsonism patients: iron-sensitive MRI, nigrosome imaging, neuromelanin-sensitive MRI, diffusion tensor imaging and advanced diffusion imaging. A standardized multimodal brainstem-dedicated MRI approach at high resolution able to quantify microstructural modification in brainstem nuclei would be a promising tool to detect early changes in parkinsonian syndromes.
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Affiliation(s)
- Germain Arribarat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Centre de Recherche Cerveau et Cognition (CNRS, Cerco, UMR5549), UPS, Toulouse, France
| | - Amaury De Barros
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Anatomy, Toulouse Faculty of Medicine, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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Shah A, Prasad S, Rastogi B, Dash S, Saini J, Pal PK, Ingalhalikar M. Altered structural connectivity of the motor subnetwork in multiple system atrophy with cerebellar features. Eur Radiol 2018; 29:2783-2791. [PMID: 30552481 DOI: 10.1007/s00330-018-5874-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the structural connectivity of the motor subnetwork in multiple system atrophy with cerebellar features (MSA-C), a distinct subtype of MSA, characterized by predominant cerebellar symptoms. METHODS Twenty-three patients with MSA-C and 25 age- and gender-matched healthy controls were recruited for the study. Disease severity was quantified using the Unified Multiple System Atrophy Rating Scale (UMSARS). Diffusion MRI images were acquired and used to compute the structural connectomes (SCs) using probabilistic fiber tracking. The motor network with 12 brain regions and 26 cerebellar regions was extracted and was compared between the groups using analysis of variance at a global (network-wide), nodal (at each node), and edge (at each connection) levels, and was corrected for multiple comparisons. In addition, the acquired connectivity measures were correlated with duration of illness, total Unified MSA Rating Scale (UMSARS), and the motor component score. RESULTS Significantly lower global network metrics-global density, transitivity, clustering coefficient, and characteristic path length-were observed in MSA-C (corrected p < 0.05). Reduced nodal strength was observed in the bilateral ventral diencephalon, the left thalamus, and several cerebellar regions. Network-based statistics revealed significant abnormal edge-wise connectivity in 40 connections (corrected p < 0.01), with majority of deficits observed in the cerebellum. Finally, significant negative correlations were observed between UMSARS scores and thalamic and cerebellar connectivity (p < 0.05) as well as between duration of illness and cerebellar connectivity. CONCLUSIONS Abnormal connectivity of the basal ganglia and cerebellar network may be causally implicated for the motor features observed in MSA-C. KEY POINTS • Structural connectivity of the motor subnetwork was explored in patients with multiple system atrophy with cerebellar features (MSA-C) using probabilistic tractography. • The motor subnetwork in MSA-C has significant alterations in both basal ganglia and cerebellar connectivity, with a higher extent of abnormality in the cerebellum. • These findings may be causally implicated for the motor features of cerebellar dysfunction and parkinsonism observed in MSA-C.
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Affiliation(s)
- Apurva Shah
- Symbiosis Center for Medical Image Analysis and Symbiosis Institute of Technology, Symbiosis International University, Lavale, Mulshi, Pune, Maharashtra, 412115, India
| | - Shweta Prasad
- Department of Clinical Neurosciences and Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India
| | - Bharti Rastogi
- Symbiosis Center for Medical Image Analysis and Symbiosis Institute of Technology, Symbiosis International University, Lavale, Mulshi, Pune, Maharashtra, 412115, India
| | - Santosh Dash
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India
| | - Jitender Saini
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India.
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis and Symbiosis Institute of Technology, Symbiosis International University, Lavale, Mulshi, Pune, Maharashtra, 412115, India.
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Abnormalities of white and grey matter in early multiple system atrophy: comparison of parkinsonian and cerebellar variants. Eur Radiol 2018; 29:716-724. [DOI: 10.1007/s00330-018-5594-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/21/2018] [Accepted: 06/05/2018] [Indexed: 11/26/2022]
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6
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de Oliveira RV, Pereira JS. The role of diffusion magnetic resonance imaging in Parkinson's disease and in the differential diagnosis with atypical parkinsonism. Radiol Bras 2017; 50:250-257. [PMID: 28894333 PMCID: PMC5586516 DOI: 10.1590/0100-3984.2016-0073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Parkinson's disease is one of the most common neurodegenerative diseases.
Clinically, it is characterized by motor symptoms. Parkinson's disease should be
differentiated from atypical parkinsonism conditions. Conventional magnetic
resonance imaging is the primary imaging method employed in order to facilitate
the differential diagnosis, and its role has grown after the development of
advanced techniques such as diffusion-weighted imaging. The purpose of this
article was to review the role of magnetic resonance imaging in Parkinson's
disease and in the differential diagnosis with atypical parkinsonism,
emphasizing the diffusion technique.
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Affiliation(s)
- Romulo Varella de Oliveira
- Full Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Masters Student in the Graduate Program in Medical Sciences at the Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), MD, Radiologist at the Hospital Universitário Pedro Ernesto (HUPE) and at the Clínica Alta Excelência Diagnóstica (DASA), Rio de Janeiro, RJ, Brazil
| | - João Santos Pereira
- PhD, Full Member of the Academia Brasileira de Neurologia (ABN), Associate Professor, Coordinator of the Movement Disorders Sector of the Neurology Department of the Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (HUPE-UERJ), Rio de Janeiro, RJ, Brazil
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7
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Xie F, Xing W, Wang X, Liao W, Shi W. Altered states of consciousness in epilepsy: a DTI study of the brain. Int J Neurosci 2016; 127:667-672. [PMID: 27575403 DOI: 10.1080/00207454.2016.1229668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Fangfang Xie
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Xiaoyi Wang
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Wei Shi
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
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Brettschneider J, Irwin DJ, Boluda S, Byrne MD, Fang L, Lee EB, Robinson JL, Suh E, Van Deerlin VM, Toledo JB, Grossman M, Hurtig H, Dengler R, Petri S, Lee VMY, Trojanowski JQ. Progression of alpha-synuclein pathology in multiple system atrophy of the cerebellar type. Neuropathol Appl Neurobiol 2016; 43:315-329. [PMID: 27716988 DOI: 10.1111/nan.12362] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/19/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this study was to identify early foci of α-synuclein (α-syn pathology) accumulation, subsequent progression and neurodegeneration in multiple system atrophy of the cerebellar type (MSA-C). METHODS We analysed 70-μm-thick sections of 10 cases with MSA-C and 24 normal controls. RESULTS MSA-C cases with the lowest burden of pathology showed α-syn glial cytoplasmic inclusions (GCIs) in the cerebellum as well as in medullary and pontine cerebellar projections. Cerebellar pathology was highly selective and severely involved subcortical white matter, whereas deep white matter and granular layer were only mildly affected and the molecular layer was spared. Loss of Purkinje cells increased with disease duration and was associated with neuronal and axonal abnormalities. Neocortex, basal ganglia and spinal cord became consecutively involved with the increasing burden of α-syn pathology, followed by hippocampus, amygdala, and, finally, the visual cortex. GCIs were associated with myelinated axons, and the severity of GCIs correlated with demyelination. CONCLUSIONS Our findings indicate that cerebellar subcortical white matter and cerebellar brainstem projections are likely the earliest foci of α-syn pathology in MSA-C, followed by involvement of more widespread regions of the central nervous system and neurodegeneration with disease progression.
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Affiliation(s)
- J Brettschneider
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - D J Irwin
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - S Boluda
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - M D Byrne
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - L Fang
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm, Ulm, Germany
| | - E B Lee
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - J L Robinson
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - E Suh
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - V M Van Deerlin
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - J B Toledo
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - M Grossman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - H Hurtig
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R Dengler
- Department of Neurology, Hanover Medical School, Hanover, Germany
| | - S Petri
- Department of Neurology, Hanover Medical School, Hanover, Germany
| | - V M-Y Lee
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - J Q Trojanowski
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Kim HJ, Jeon B, Fung VSC. Role of Magnetic Resonance Imaging in the Diagnosis of Multiple System Atrophy. Mov Disord Clin Pract 2016; 4:12-20. [PMID: 30363358 DOI: 10.1002/mdc3.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 12/14/2022] Open
Abstract
Background Multiple system atrophy (MSA) is a rapidly progressing neurodegenerative disorder without effective disease-modifying therapies. Because of a lack of reliable diagnostic biomarkers, there has been increasing interest in using magnetic resonance imaging (MRI) to improve the diagnostic accuracy of MSA. Methods This review summarizes recent literatures on the role of MRI in the diagnosis of MSA. Results Several MRI abnormalities on conventional MRI already are included in the current diagnostic criteria for MSA. Other features on conventional MRI are also used to make a diagnosis of MSA or to rule out alternative diagnoses. On the other hand, some of the MRI findings that were previously considered suggestive of a diagnosis of MSA are now being challenged, because it turned out that they were not as specific to MSA as previously thought. More advanced MRI modalities, including susceptibility-weighted imaging, diffusion-weighted imaging, diffusion tensor imaging, voxel-based morphometry, and cortical thickness analysis, are now used to study the changes in the brains of patients with MSA. Furthermore, studies have produced promising results demonstrating the use of MRI as a tool for monitoring and assessing disease progression in MSA. Conclusions MRI is useful and indispensable in the diagnosis of MSA and also possibly for monitoring disease progression. In this regard, well-designed, long-term, prospective studies on large numbers of patients are needed.
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Victor S C Fung
- Movement Disorders Unit Department of Neurology Westmead Hospital and Sydney Medical School Sydney Australia
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Baldarçara L, Currie S, Hadjivassiliou M, Hoggard N, Jack A, Jackowski AP, Mascalchi M, Parazzini C, Reetz K, Righini A, Schulz JB, Vella A, Webb SJ, Habas C. Consensus paper: radiological biomarkers of cerebellar diseases. THE CEREBELLUM 2015; 14:175-96. [PMID: 25382714 DOI: 10.1007/s12311-014-0610-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine.
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