Fractal dimension analysis for quantifying cerebellar morphological change of multiple system atrophy of the cerebellar type (MSA-C)

Multiple system atrophy of the cerebellar type (MSA-C) is a degenerative neurological disease of the central nervous system. This study aims to demonstrate that the morphological changes of cerebellar structure, specifically, the cerebellum white matter (CBWM) and cerebellum gray matter (CBGM) from T1-weighted magnetic resonance (MR) images, can be quantified by three-dimensional (3D) fractal dimension (FD) analysis, which is a measure of complexity. Twenty-three MSA-C patients and twenty-one normal subjects participated in this study. The results of this study show that MSA-C patients presented significantly lower FD values compared to the control group, and that morphological change in the CBWM dominates the cerebellar degeneration. In addition, the FD analysis method is superior to conventional volumetric methods in quantifying the structural changes of WM and GM because it exhibits smaller variances and less gender effect. Since a decrease of cerebellar FD value indicates degeneration of the cerebellar structure, this study further suggests that the morphological changes of cerebellar structures (CBGM and CBWM) can be characterized by FD analysis.