Patterns of iron accumulation in patients with Multiple System Atrophy evaluated using Quantitative Susceptibility Mapping

Motivation: Iron accumulation is central to multiple system atrophy (MSA) pathogenesis, and promising compounds targeting iron dysregulation are being developed. Biomarkers for quantifying iron deposition are needed to improve diagnosis and demonstrate target engagement. Goal(s): To assess the utility of iron quantification for early MSA diagnosis and progression monitoring. Approach: We enrolled patients with MSA and employed quantitative susceptibility mapping (QSM) and a novel histogram analysis to quantify the topography of subcortical iron accumulation. Results: Our study revealed distinctive iron accumulation patterns in early MSA stages, highlighting the significance of iron quantification for differential diagnosis and progression assessment in MSA patients. Impact: Quantitative susceptibility mapping (QSM) provides valuable insights into the pathological alterations associated with iron dysregulation in patients with multiple system atrophy (MSA) and could serve as a valuable tool for improving early diagnosis and evaluating novel treatments.