18F-FDG PET/MRI in Multiple System Atrophy–Parkinsonian Type (MSA-P)

A 64-year-old woman presented with a progressive movement disorder for 4 years, characterized by freezing of gait and left lower extremity discoordination. DaTScan performed 1 year after the presentation was abnormal and consistent with Parkinsonian syndrome. The patient went on to suffer from orthostatic symptomatology resulting in loss of consciousness. She also suffered from urinary incontinence and nocturia. The patient then underwent 18 F-FDG brain PET/MRI, which demonstrated markedly decreased tracer uptake in the bilateral putamina, with accompanying putaminal atrophy, marginal T2-hyperintensity (putaminal rim sign), and central T2* hypointensity. Collectively the imaging findings and clinical presentation are compatible with multiple system atrophy, parkinsonian type (MSA-P).