Evidence map›Paper›PMID 41083252›Full record

ArticleJournal of neurology, neurosurgery, and psychiatry2026

Revisiting 'hot cross bun' sign: a multicentre MRI study of 97 patients with autopsy-confirmed multiple system atrophy.

Atsuhiko Sugiyama, Yuichi Riku, Shunsuke Koga, Hajime Yokota, Hiroki Mukai, Masaki Takao, Kentaro Hayashi, Takahiro Takeda, Shigeki Hirano, Mari Yoshida and 15 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neurology, neurosurgery, and psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Atsuhiko SugiyamaNeurology, Graduate School of Medicine, Chiba University, Chiba, Japan asugiyama@chiba-u.jp.ORCID http://orcid.org/0000-0003-0705-9892
Yuichi RikuNeuropathology, Aichi Medical University, Nagakute, Japan.
Shunsuke KogaNeuroscience, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA.
Hajime YokotaDiagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Hiroki MukaiRadiology, Chiba University Hospital, Chiba, Japan.
Masaki TakaoLaboratory Medicine, National Center of Neurology and Psychiatry, Kodaira, Japan.
Kentaro HayashiNeurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
Takahiro TakedaNeurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan.
Shigeki HiranoNeurology, Graduate School of Medicine, Chiba University, Chiba, Japan.ORCID http://orcid.org/0000-0003-3473-2317
Mari YoshidaNeuropathology, Aichi Medical University, Nagakute, Japan.ORCID http://orcid.org/0000-0002-8520-6184
Yasushi IwasakiNeuropathology, Aichi Medical University, Nagakute, Japan.
Keizo YasuiNeurology, Japanese Red Cross Aichi Medical Center Nagoya Second Hospital, Nagoya, Japan.
Takashi AndoNeurology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan.ORCID http://orcid.org/0000-0001-7045-7098
Yasuhiro ItoNeurology, Toyota Memorial Hospital, Toyota, Japan.
Takuya TamuraNeurology, Ichinomiya Municipal Hospital, Aichi, Japan.
Hiroaki SekiyaNeuroscience, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA.ORCID http://orcid.org/0000-0001-9683-5966
Dennis W DicksonNeuroscience, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA.
Erik H MiddlebrooksRadiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA.
Yuji TakahashiNeurology, National Center of Neurology and Psychiatry, Kodaira, Japan.
Noriko SatoRadiology, National Center of Neurology and Psychiatry, Kodaira, Japan.
Masashi MizutaniLaboratory Medicine, National Center of Neurology and Psychiatry, Kodaira, Japan.
Terunori SanoLaboratory Medicine, National Center of Neurology and Psychiatry, Kodaira, Japan.ORCID http://orcid.org/0000-0001-8967-5984
Ban MiharaNeurology, Mihara Memorial Hospital, Isesaki, Japan.
Takashi KomoriLaboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
Satoshi KuwabaraNeurology, Graduate School of Medicine, Chiba University, Chiba, Japan.ORCID http://orcid.org/0000-0002-4716-8578

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe purpose of this study was to clarify the usefulness of the 'hot cross bun' sign (HCBS) as a diagnostic imaging marker in a large cohort of patients with multiple system atrophy (MSA) and spinocerebellar ataxia (SCA).

methodsThis multicentre study included 97 patients with neuropathologically confirmed MSA, and 105 patients with genetically confirmed SCA. Neuroimaging features, including HCBS and middle cerebellar peduncle (MCP) hyperintensities, were assessed. HCBS was graded from 0 to 2: 0, none; 1, only a vertical hyperintense line; and 2, a cruciform hyperintense line. The neuropathological correlates of HCBS were evaluated in 15 patients with MSA with ≤3 months between MRI and autopsy.

resultsIn patients with a disease duration <3 years, grade 1 or 2 HCBS was detected in 100% patients with MSA with predominant cerebellar ataxia (MSA-C) and 39.0% with SCA; whereas grade 2 HCBS was observed in 50% with MSA-C and 2.4% with SCA. Moreover, the coexistence of grade 2 HCBS and MCP hyperintensities exhibited a specificity of 100%. A neuropathological assessment revealed myelin loss, alpha-synuclein aggregates and astrocytic reaction in the MCP, transverse fibres, central zone between longitudinal fasciculi and raphe nucleus, with relative preservation in the longitudinal fasciculi and medial lemniscus in patients with MSA and grade 2 HCBS.

conclusionsGrade 1 or 2 HCBS is a highly sensitive finding in patients with MSA-C, and the observation of grade 2 HCBS within 3 years of motor symptom onset has excellent specificity for discriminating MSA-C from SCA, especially when accompanied by MCP hyperintensities.

Indexed as

BrainMagnetic Resonance ImagingMultiple System AtrophySpinocerebellar AtaxiasAdultAgedAutopsyFemaleHumansMaleMiddle AgedMiddle Cerebellar PeduncleCEREBELLAR ATAXIAIMAGE ANALYSISMRIMULTISYSTEM ATROPHY

Identifiers

PMID41083252
PMCPMC12911589

What Socratic holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.