STUDY OBJECTIVES Patients with isolated rapid eye movement (REM) sleep behavior disorder (IRBD) develop Parkinson disease (PD), dementia with Lewy bodies (DLB), or multiple system atrophy (MSA). Magnetic resonance imaging (MRI) is abnormal in MSA showing abnormalities in the putamen, cerebellum, and brainstem. Our objective was to evaluate the usefulness of MRI to detect MRI abnormalities in IRBD and predict development of MSA and not PD and DLB. METHODS In IRBD patients that eventually developed PD, DLB, and MSA, we looked for the specific structural MRI abnormalities described in manifest MSA (e.g. hot cross-bun sign, putaminal rim, and cerebellar atrophy). We compared the frequency of these MRI changes among groups of converters (PD, DLB, and MSA) and analyzed their ability to predict development of MSA. The clinical and radiological features of the IRBD patients that eventually converted to MSA are described in detail. RESULTS A total of 61 IRBD patients who underwent MRI phenoconverted to PD (n = 30), DLB (n = 26), and MSA (n = 5) after a median follow-up of 2.4 years from neuroimaging. MRI changes typical of MSA were found in four of the five (80%) patients who converted to MSA and in three of the 56 (5.4%) patients who developed PD or DLB. MRI changes of MSA had sensitivity of 80.0%, specificity of 94.6%, positive likelihood ratio of 14.9 (95% CI 4.6-48.8), and negative likelihood ratio of 0.2 (95% CI 0.04-1.2) to predict MSA. CONCLUSIONS In IRBD, conventional brain MRI is helpful to predict conversion to MSA. The specific MRI abnormalities of manifest MSA may be detected in its premotor stage.

中文翻译：

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磁共振成像异常作为孤立快速眼动睡眠行为障碍多系统萎缩的标志

研究目标 患有孤立性快速眼动 (REM) 睡眠行为障碍 (IRBD) 的患者会发展为帕金森病 (PD)、路易体痴呆 (DLB) 或多系统萎缩 (MSA)。MSA 的磁共振成像 (MRI) 异常，显示壳核、小脑和脑干异常。我们的目标是评估 MRI 在检测 IRBD 中的 MRI 异常和预测 MSA 而不是 PD 和 DLB 的发展方面的有用性。方法 在最终发展为 PD、DLB 和 MSA 的 IRBD 患者中，我们寻找在明显 MSA 中描述的特定结构 MRI 异常（例如热十字面包征、壳核和小脑萎缩）。我们比较了转换器组（PD、DLB 和 MSA）之间这些 MRI 变化的频率，并分析了它们预测 MSA 发展的能力。详细描述了最终转变为 MSA 的 IRBD 患者的临床和放射学特征。结果 共有 61 名接受 MRI 的 IRBD 患者在神经影像学的中位随访 2.4 年后转为 PD（n = 30）、DLB（n = 26）和 MSA（n = 5）。在转换为 MSA 的五名 (80%) 患者中的四名和发生 PD 或 DLB 的 56 名 (5.4%) 患者中的三名中发现了 MSA 的典型 MRI 变化。MSA 的 MRI 变化预测 MSA 的敏感性为 80.0%，特异性为 94.6%，阳性似然比为 14.9（95% CI 4.6-48.8），阴性似然比为 0.2（95% CI 0.04-1.2）。结论 在 IRBD 中，常规脑部 MRI 有助于预测转换为 MSA。明显 MSA 的特定 MRI 异常可能在其运动前阶段被检测到。