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Dynamic Digital Biomarkers of Motor and Cognitive Function in Parkinson's Disease
Published on: July 24, 2019
Accuracy of MR markers for differentiating Progressive Supranuclear Palsy from Parkinson's disease
Stefano Zanigni1, Giovanna Calandra-Buonaura2, David Neil Manners1
1Functional MR Unit, Policlinico S. Orsola - Malpighi, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Background:
Advanced brain MR techniques are useful tools for differentiating Progressive Supranuclear Palsy from Parkinson's disease, although time-consuming and unlikely to be used all together in routine clinical work. We aimed to compare the diagnostic accuracy of quantitative morphometric, volumetric and DTI metrics for differentiating Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease.
Methods:
23 Progressive Supranuclear Palsy-Richardson's Syndrome and 42 Parkinson's disease patients underwent a standardized 1.5T brain MR protocol comprising high-resolution T1W1 and DTI sequences. Brainstem and cerebellar peduncles morphometry, automated volumetric analysis of brain deep gray matter and DTI metric analyses of specific brain structures were carried out. We determined diagnostic accuracy, sensitivity and specificity of MR-markers with respect to the clinical diagnosis by using univariate receiver operating characteristics curve analyses. Age-adjusted multivariate receiver operating characteristics analyses were then conducted including only MR-markers with a sensitivity and specificity exceeding 80%.
Results:
Morphometric markers (midbrain area, pons to midbrain area ratio and MR Parkinsonism Index), DTI parameters (infratentorial structures) and volumetric analysis (thalamus, putamen and pallidus nuclei) presented moderate to high diagnostic accuracy in discriminating Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease, with midbrain area showing the highest diagnostic accuracy (99%) (mean ± standard deviation: 75.87 ± 16.95 mm(2) vs 132.45 ± 20.94 mm(2), respectively; p < 0.001).
Conclusion:
Although several quantitative brain MR markers provided high diagnostic accuracy in differentiating Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease, the morphometric assessment of midbrain area is the best single diagnostic marker and should be routinely included in the neuroradiological work-up of parkinsonian patients.
Insights
Quantitative MRI markers can differentiate Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease. Midbrain area measurement offers the highest diagnostic accuracy for routine clinical use in parkinsonian patients.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Differentiating Progressive Supranuclear Palsy (PSP)-Richardson's Syndrome from Parkinson's disease (PD) is clinically important.
- Advanced brain MRI techniques show promise but are time-consuming for routine use.
- Quantitative MRI metrics require comparative analysis for diagnostic accuracy.
Purpose of the Study:
- To compare the diagnostic accuracy of quantitative morphometric, volumetric, and Diffusion Tensor Imaging (DTI) metrics.
- To differentiate PSP-Richardson's Syndrome from PD using these MRI markers.
- To identify the most effective single MRI marker for routine clinical application.
Main Methods:
- 23 PSP-Richardson's Syndrome and 42 PD patients underwent 1.5T brain MRI with T1W1 and DTI sequences.
- Analysis included brainstem/cerebellar peduncle morphometry, deep gray matter volumetrics, and DTI metrics.
- Receiver operating characteristic (ROC) curve analyses determined diagnostic accuracy, sensitivity, and specificity.
Main Results:
- Morphometric markers (midbrain area, pons-to-midbrain ratio, MR Parkinsonism Index), DTI parameters, and volumetric analyses showed moderate to high accuracy.
- The midbrain area measurement demonstrated the highest diagnostic accuracy (99%) in differentiating the two conditions.
- p < 0.001 for the difference in midbrain area between PSP-Richardson's Syndrome and PD patients.
Conclusions:
- Several quantitative MRI markers accurately differentiate PSP-Richardson's Syndrome from PD.
- Morphometric assessment of the midbrain area is the most accurate single diagnostic marker.
- Routine inclusion of midbrain area measurement in the work-up of parkinsonian patients is recommended.
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