Brain Network Patterns in Patients With Multiple System Atrophy

BACKGROUND AND OBJECTIVES: F-fluorodeoxyglucose (FDG) PET to deconstruct disease heterogeneity and elucidate the large-scale brain network mechanisms of MSA. METHODS: This cross-sectional study included patients with MSA and healthy controls (HCs) from the Second Affiliated Hospital, Zhejiang University School of Medicine. MSA diagnosis was based on the 2022 Movement Disorder Society MSA criteria. All participants underwent FDG-PET imaging. Clinical assessments and dopamine transporter (DAT) PET were performed in patients with MSA. Spatial ICA was applied to identify metabolic covariance networks. Moderation analysis and structural equation modeling (SEM) were used to explore underlying pathway mechanisms. RESULTS: = 0.0038). DMN moderated the relationship between the cerebellar network and cognitive function. SEM demonstrated that posterior putamen DAT and basal ganglia network contributed to motor symptoms while the compensatory network acted as a compensatory mechanism. DISCUSSION: This study demonstrated that the metabolic abnormalities in MSA can be decomposed into 5 large-scale brain networks, providing a comprehensive understanding of the disease's heterogeneous mechanisms.