PMC5757992_01
Multiplan reconstructions of 3D time-of-flight MRA images in transverse plane at the superior collicular level. (A) The first MR examination, (B) follow-up 2 years later.. Note: Development of midbrain atrophy is seen on the follow-up image, with reduction of AP midbrain diameter.. Abbreviations: AP, anteroposterior; MR, magnetic resonance; MRA, magnetic resonance angiography.
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It revealed reduction of the anteroposterior diameter of midbrain at the superior collicular level from 15.5 mm on the first examination to 13.5 mm on follow-up images (Figure 1).
Sagittal spin-echo T1-weighted magnetic resonance images on follow-up examination show mild midbrain atrophy with "hummingbird" sign (arrow).. Note: Development of generalized brain atrophy is also seen.
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Mild midbrain atrophy with concave upper surface was seen on sagittal images (the "hummingbird" or "penguin" sign), as shown in Figure 2. T2-weighted images was noted (Figure 3A), which was not considered typical for MSA-P. There was also progression of generalized brain atrophy (Figures 2 and 3A, B), more prominent in the posterior frontal lobes.
Transverse turbo spin-echo T2-weighted images on follow-up examination (A) at the basal ganglia and (B) at the pontine level.. Note: Minor bilateral putaminal hypointensity and generalized brain atrophy are seen.
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T2-weighted images was noted (Figure 3A), which was not considered typical for MSA-P. There was also progression of generalized brain atrophy (Figures 2 and 3A, B), more prominent in the posterior frontal lobes.
Brain three-dimensional stereotactic surface projection maps of positron emission tomography scans with activity maps in the top two rows and z maps showing deviation from a normal control cohort in the third and fourth rows.
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Occipital lobes were less hypometabolic in comparison to the other brain areas (Figures 4 and 5).
Coregistered PET and MR images in axial views in different levels demonstrating generalized brain atrophy, more prominent in the posterior frontal lobe, and hypometabolism of both cerebral hemispheres that was especially pronounced in the middle and posterior part of the left frontal lobe. Diffusely decreased metabolism was noted in the basal ganglia.. Abbreviations: PET, positron emission tomography; MR, magnetic resonance.
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Occipital lobes were less hypometabolic in comparison to the other brain areas (Figures 4 and 5).