Affiliation:
1. Department of Neurology Medical University Innsbruck Innsbruck Austria
2. Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
3. Neuroimaging Research Core Facility Medical University Innsbruck Innsbruck Austria
4. Department of Neuroradiology Medical University Innsbruck Innsbruck Austria
Abstract
AbstractBackgroundAdvanced imaging techniques have been studied for differential diagnosis between PD, MSA, and PSP.ObjectivesThis study aims to validate the utility of individual voxel‐based morphometry techniques for atypical parkinsonism in a blinded fashion.MethodsForty‐eight healthy controls (HC) T1‐WI were used to develop a referential dataset and fit a general linear model after segmentation into gray matter (GM) and white matter (WM) compartments. Segmented GM and WM with PD (n = 96), MSA (n = 18), and PSP (n = 20) were transformed into z‐scores using the statistics of referential HC and individual voxel‐based z‐score maps were generated. An imaging diagnosis was assigned by two independent raters (trained and untrained) blinded to clinical information and final diagnosis. Furthermore, we developed an observer‐independent index for ROI‐based automated differentiation.ResultsThe diagnostic performance using voxel‐based z‐score maps by rater 1 and rater 2 for MSA yielded sensitivities: 0.89, 0.94 (95% CI: 0.74–1.00, 0.84–1.00), specificities: 0.94, 0.80 (0.90–0.98, 0.73–0.87); for PSP, sensitivities: 0.85, 0.90 (0.69–1.00, 0.77–1.00), specificities: 0.98, 0.94 (0.96–1.00, 0.90–0.98). Interrater agreement was good for MSA (Cohen's kappa: 0.61), and excellent for PSP (0.84). Receiver operating characteristic analysis using the ROI‐based new index showed an area under the curve (AUC): 0.89 (0.77–1.00) for MSA, and 0.99 (0.98–1.00) for PSP.ConclusionsThese evaluations provide support for the utility of this imaging technique in the differential diagnosis of atypical parkinsonism demonstrating a remarkably high differentiation accuracy for PSP, suggesting potential use in clinical settings in the future.
Funder
Austrian Science Fund
Japan Society for the Promotion of Science
Oesterreichische Nationalbank