It has been assumed that cognitive disorder and visual-spatial disturbance in multiple system atrophy of the predominantly cerebellar type (MSA-C) are attributable to degradation of cerebellar function. The purpose of this study was to use diffusion tensor imaging (DTI) tractography to determine if patients with MSA-C characterized in part by visual-spatial disorders and cognitive disorders have changes of the structural connectivity network of nerve fibers, and to further describe the structural connectivity network. The study included 20 patients with MSA-C and 30 age- and sex-matched healthy controls. A 1.5T magnetic resonance imaging (MRI) scanner was used to obtain images for DTI tractography. Image preprocessing was done by large deformation diffeomorphic metric mapping. Whole-brain connectivity analysis was carried out. The patients had decreased numbers of long association fibers connecting the right parietal lobe to the frontal lobe. The commissural fibers and short association fibers connecting the bilateral frontal and occipital lobes and the number of short association fibers at the bilateral frontal and occipital region were also decreased significantly. The patients had a significant decrease in fiber density in the cerebellum compared to the healthy subjects. Our results provide DTI evidence suggesting that frontal and occipital white matter is involved in patients with MSA-C. This finding may correlate with their clinical symptoms such as cognitive disturbance as well as visual-spatial impairment. Therefore, cognitive disturbance and visual-spatial deficits in MSA-C might not be due to cerebellar lesions only as is widely believed but also involve cerebral lesions.
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