AIMS: In Wilson disease (WD), T2/T2*-weighted (T2*w) MRI frequently shows hypointensity in the basal ganglia that is suggestive of paramagnetic deposits. It is currently unknown whether this hypointensity is related to copper or iron deposition. We examined the neuropathological correlates of this MRI pattern, particularly in relation to iron and copper concentrations. METHODS: Brain slices from nine WD and six control cases were investigated using a 7T-MRI system. High-resolution T2*w images were acquired and R2* parametric maps were reconstructed using a multigradient recalled echo sequence. R2* was measured in the globus pallidus (GP) and the putamen. Corresponding histopathological sections containing the lentiform nucleus were examined using Turnbull iron staining, and double staining combining Turnbull with immunohistochemistry for macrophages or astrocytes. Quantitative densitometry of the iron staining as well as copper and iron concentrations were measured in the GP and putamen and correlated with R2* values. RESULTS: T2*w hypointensity in the GP and/or putamen was apparent in WD cases and R2* values correlated with quantitative densitometry of iron staining. In WD, iron and copper concentrations were increased in the putamen compared to controls. R2* was correlated with the iron concentration in the GP and putamen, whereas no correlation was observed for the copper concentration. Patients with more pronounced pathological severity in the putamen displayed increased iron concentration, which correlated with an elevated number of iron-containing macrophages. CONCLUSIONS: T2/T2*w hypointensity observed in vivo in the basal ganglia of WD patients is related to iron rather than copper deposits.

2nd Department of Neurology Institute Psychiatry and Neurology Warsaw Poland

Berlin Ultrahigh Field Facility Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany

Department of Experimental and Clinical Pharmacology Medical University Warsaw Poland

Department of Neurology and Center for Stroke Research Berlin Charité Universitätsmedizin Berlin Germany

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine and General University Hospital Prague Charles University Prague Praha Czech Republic

Department of Neurology Ludwig Maximilians University Munich Germany

Experimental and Clinical Research Center Berlin Germany

Faculty of Chemistry Biological and Chemical Research Centre University of Warsaw Warsaw Poland

Institute of Neuropathology University Medical Center Göttingen Göttingen Germany

Institute of Neuroradiology University Medical Center Göttingen Göttingen Germany

Medical Imaging Analysis Center AG Basel Switzerland

NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center Department of Neurology Charité Universitätsmedizin Berlin Germany

Neurology Department University of Kiel Kiel Germany

Distinctive Pattern of Metal Deposition in Neurologic Wilson Disease: Insights From 7T Susceptibility-Weighted Imaging

Cerebral Iron Deposition in Neurodegeneration

Neurologic impairment in Wilson disease

Wilson disease