Putaminal and cerebellar imaging abnormalities in multiple system atrophy

Brain MRI in a patient with multiple system atrophy (MSA) with predominant parkinsonism (MSA-P). Transverse axial T2-weighted MRI (A1) and magnified inset (A2) show a "putaminal rim sign" consisting of linear hyperintensities along the lateral margins of both putamina (arrowheads). Mild atrophy of both putamina is also present (asterisks). Sagittal T1-weighted MRI (B) shows mild vermian cerebellar atrophy and normal mesopontine morphology.