Journal List > Dement Neurocogn Disord > v.13(2) > 1120726

Dement Neurocogn Disord. 2014 Jun;13(2):37-41. Korean.
Published online Jun 30, 2014.
© 2014 Korean Dementia Association
Clinical Usefulness of 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography for Early Phase Multiple System Atrophy
Jong-Yoon Lee, M.D.,* In-Uk Song, M.D.,* Sung-Woo Chung, M.D.,* Yong-An Chung, M.D., and YoungSoon Yang, M.D.
*Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Neurology, Veterans Hospital, Seoul Medical Center, Seoul, Korea.

Address for correspondence: In-Uk Song, M.D. Department of Neurology, Incheon St. Mary's Hospital, The Catholic University College of Medicine, 56 Dongsu-ro, Bupyeong-gu, Incheon 403-720, Korea. Tel: +32-280-5010, Email:
Received May 16, 2014; Revised May 28, 2014; Accepted May 28, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Clinical diagnosis of multiple system atrophy (MSA) relays on signs and symptoms that are often difficult to identify particularly at early stage. Indeed neuropathological studies have demonstrated that Parkinson variant of MSA (MSA-P) is the first cause of misdiagnosis in a cohort of patients presenting with parkinsonian features. But accurate diagnosis of these disorders is important for deciding on treatment, appropriate advice and prognosis since atypical parkinsonian disorders are characterized by poor response to dopaminergic treatment and more rapid disease progression. Therefore, we conducted this study to investigate difference of perfusion Single Photon Emission Computed Tomography (SPECT) in patients with the early phase of MSA-P using SPM program.


We recruited consecutively 21 patients with MSA-P and 48 age-matched healthy controls. All subjects underwent Tc-99m HMPAO perfusion SPECT and this perfusion images were analyzed.


For MSA-P, only hypoperfusion was seen in the middle frontal gyrus of left frontal lobe, superior frontal gyrus of right frontal lobe, precentral gyrus of left frontal lobe, middle frontal gyrus of right frontal lobe and precentral gyrus of right frontal lobe with respect to healthy subjects.


We cautiously assume that perfusion SPECT may offer significant advantages compared to other imaging techniques in the assessment of neuronal degeneration in MSA-P and may help the clinician in the diagnostic characterization of patients presenting with atypical parkinsonism.

Keywords: Multiple system atrophy; Tc-99m HMPAO perfusion SPECT; Frontal lobe


Fig. 1
Comparisons of patients with MSA-P compared with the healthy controls show cerebral regions (yellow color) with decreased regional cerebral blood flow in trans-axial MR fused images.
Click for larger image


Table 1
Demographic and clinical characteristics of all subjects
Click for larger image

Table 2
Areas with significantly decreased regional cerebral blood flow in the MSA-P patients compared with the healthy controls
Click for larger image

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