Magnetic resonance imaging markers predict disease progression in early-stage multiple system atrophy: a 2-year prospective cohort study

BACKGROUND: Magnetic resonance imaging (MRI) markers are identified as important indicators for the diagnosis of multiple system atrophy (MSA). However, whether these MRI markers can predict the disease progression of MSA remain undefined. We aimed to investigate the relationship between MRI markers and disease progression in patients with early MSA. METHODS: The patients were divided into MRI-positive and MRI-negative groups based on MSA-specific MRI markers. Disease progression was evaluated using the Unified MSA Rating Scale (UMSARS), Montreal Cognitive Assessment and Frontal Assessment Battery. A repeated measures ANCOVA was used to compare the rate of disease progression between the two groups. A multiple linear regression model was used to assess the association between MRI subtype and disease progression. RESULTS: A total of 144 patients with early MSA were enrolled and 73 patients completed the 2-year follow-up. Patients with MSA and MSA of the parkinsonian subtype (MSA-P) in the MRI-positive group exhibited significantly faster disease progression on the total UMSARS score over a 2-year follow-up compared to those in the MRI-negative group (p = 0.002 and p = 0.020, respectively). Multiple linear regression analysis revealed that MRI-positive status was a significant predictor of more severe disease progression on the UMSARS total score in patients with MSA and MSA-P at the 1- and 2-year follow-up after adjusting for age, sex, and baseline disease duration (all p < 0.05). CONCLUSIONS: This study highlights that MRI markers are valuable imaging predictors of disease progression in early MSA, in addition to their diagnostic role.