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No early imaging biomarkers currently differentiate these disorders.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Simple visual imaging analysis of the <jats:italic>substantia nigra<\/jats:italic> and <jats:italic>locus coeruleus<\/jats:italic> in neuromelanin-sensitive magnetic resonance imaging and nigrosome 1 in susceptibility-weighted sequences was performed in thirty patients with parkinsonian variant of multiple system atrophy fulfilling possible\/probable second consensus diagnostic criteria. The neuromelanin visual pattern was compared to patients with Parkinson\u2019s disease with the same disease duration (<jats:italic>n<\/jats:italic>\u2009=\u200910) and healthy controls (<jats:italic>n<\/jats:italic>\u2009=\u200910). <jats:italic>Substantia nigra<\/jats:italic> semi-automated neuromelanin area\/signal intensity was compared to the visual data.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Groups were similar in age, sex, disease duration, and levodopa equivalent dose. Hoehn &amp; Yahr stage was higher in parkinsonian multiple system atrophy patients, 69% of whom had normal neuromelanin size\/signal, significantly different from Parkinson\u2019s disease patients, and similar to controls. Nigrosome 1 signal was lost in 74% of parkinsonian multiple system atrophy patients. Semi-automated neuromelanin <jats:italic>substantia nigra<\/jats:italic> signal, but not area, measurements were able to differentiate groups.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In patients with parkinsonism, simple visual magnetic resonance imaging analysis showing normal neuromelanin <jats:italic>substantia nigra<\/jats:italic> and <jats:italic>locus coeruleus,<\/jats:italic> combined with nigrosome 1 loss, allowed the distinction of the parkinsonian variant of multiple system atrophy from Parkinson\u2019s disease and healthy controls. This easy and widely available method was superior to semi-automated measurements in identifying specific imaging changes in <jats:italic>substantia nigra<\/jats:italic> and <jats:italic>locus coeruleus<\/jats:italic>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12883-020-02007-5","type":"journal-article","created":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T05:14:37Z","timestamp":1606454077000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["A distinct neuromelanin magnetic resonance imaging pattern in parkinsonian multiple system atrophy"],"prefix":"10.1186","volume":"20","author":[{"given":"Rita Moiron","family":"Sim\u00f5es","sequence":"first","affiliation":[]},{"given":"Ana","family":"Castro Caldas","sequence":"additional","affiliation":[]},{"given":"Joana","family":"Grilo","sequence":"additional","affiliation":[]},{"given":"Daisy","family":"Correia","sequence":"additional","affiliation":[]},{"given":"Carla","family":"Guerreiro","sequence":"additional","affiliation":[]},{"given":"Patr\u00edcia","family":"Pita Lobo","sequence":"additional","affiliation":[]},{"given":"Anabela","family":"Valadas","sequence":"additional","affiliation":[]},{"given":"Marguerita","family":"Fabbri","sequence":"additional","affiliation":[]},{"given":"Leonor","family":"Correia Guedes","sequence":"additional","affiliation":[]},{"given":"Miguel","family":"Coelho","sequence":"additional","affiliation":[]},{"given":"Mario Miguel","family":"Rosa","sequence":"additional","affiliation":[]},{"given":"Joaquim J.","family":"Ferreira","sequence":"additional","affiliation":[]},{"given":"Sofia","family":"Reim\u00e3o","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,11,27]]},"reference":[{"key":"2007_CR1","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1212\/01.wnl.0000324625.00404.15","volume":"71","author":"S Gilman","year":"2008","unstructured":"Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, et al. 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Imaging and clinical data were retrospectively collected, so the need for individual consent was waived.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"RMS has no conflict of interest relevant to this work but is currently a consultant for BIAL \u2013 PORTELA & C.a, S.A. and has been a consultant for Zambon and AbbVie.JJF has no conflict of interest relevant to this work but reports having received grants from GlaxoSmithKline, Grunenthal, Funda\u00e7\u00e3o MSD (Portugal), TEVA, MSD, Allergan, Novartis, Medtronic. He received consultancy fees from GlaxoSmithKline, Novartis, TEVA, Lundbeck, Solvay, BIAL, Merck-Serono, Merz, Ipsen, Biogen, Acadia, Allergan, Abbvie, Sunovion Pharmaceuticals. He is employed by Faculdade de Medicina de Lisboa and CNS - Campus Neurol\u00f3gico S\u00e9nior. He also participated in advisory boards for Bial and expert testimony to Novartis.MF has no conflict of interest relevant to this work but received honoraria to speak from AbbVie.Remaining authors have no conflict of interest nor relevant disclosures for the past 12\u2009months.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"432"}}