Abstract
IntroductionTo determine an exploratory multimodal approach including serum NFL and MR planimetric measures to discriminate Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). MethodsMR planimetric measurements and NFL serum levels, with a mean time interval of 60 months relative to symptom onset, were assessed in a retrospective cohort of 11 progressive supranuclear palsy (PSP), 22 Parkinson's disease (PD), 16 multiple system atrophy (MSA) patients and 42 healthy controls (HC). A decision tree model to discriminate PD, PSP, and MSA was constructed using receiver operating characteristic curve analysis and Classification and Regression Trees algorithm. ResultsOur multimodal decision tree provided accurate differentiation of PD versus MSA and PSP patients using a serum NFL cut-off of 14.66 ng/L. The pontine-to-midbrain-diameter-ratio (Pd/Md) discriminated MSA from PSP at a cut-off value of 2.06. The combined overall diagnostic yield was an accuracy of 83.7% (95% CI 69.8–90.8%). ConclusionWe provide a clinically feasible decision algorithm which combines serum NFL levels and a planimetric MRI marker to differentiate PD, MSA and PSP with high diagnostic accuracy. Classification of evidenceThis study provides Class III evidence that the combination of serum NFL levels und MR planimetric measurements discriminates between PD, PSP and MSA.
Highlights
To determine an exploratory multimodal approach including serum neurofilament light chain (NFL) and MR planimetric measures to discriminate Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP)
Demographic and clinical data of the study participants are shown in Table 1, imaging measurements and serum NFL data for each group as well as between group comparisons in Table 1, comparison of demographic, imaging and serum NFL data between APS and PD in Supplementary Table 1
Gender was distributed in all parkinsonism subgroups and in healthy controls (HC)
Summary
To determine an exploratory multimodal approach including serum NFL and MR planimetric measures to discriminate Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Conclusion: We provide a clinically feasible decision algorithm which combines serum NFL levels and a planimetric MRI marker to differentiate PD, MSA and PSP with high diagnostic accuracy. Classification of evidence: This study provides Class III evidence that the combination of serum NFL levels und MR planimetric measurements discriminates between PD, PSP and MSA. Neurodegenerative parkinsonian disorders such as Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) differ in their natural disease courses, symptomatic treatment responses and targets for disease modification therapies. This marker would help differential diagnosis of clinical entities at an earlier time point [2]
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