Abstract
BackgroundParkinson's disease (PD) and progressive supranuclear palsy – Richardson's syndrome (PSP-RS) are often represented by similar clinical symptoms, which may challenge diagnostic accuracy. The objective of this study was to investigate and compare regional cerebral diffusion properties in PD and PSP-RS subjects and evaluate the use of these metrics for an automatic classification framework.Material and methodsDiffusion-tensor MRI datasets from 52 PD and 21 PSP-RS subjects were employed for this study. Using an atlas-based approach, regional median values of mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) were measured and employed for feature selection using RELIEFF and subsequent classification using a support vector machine.ResultsAccording to RELIEFF, the top 17 diffusion values consisting of deep gray matter structures, the brainstem, and frontal cortex were found to be especially informative for an automatic classification. A MANCOVA analysis performed on these diffusion values as dependent variables revealed that PSP-RS and PD subjects differ significantly (p < .001). Generally, PSP-RS subjects exhibit reduced FA, and increased MD, RD, and AD values in nearly all brain structures analyzed compared to PD subjects. The leave-one-out cross-validation of the support vector machine classifier revealed that the classifier can differentiate PD and PSP-RS subjects with an accuracy of 87.7%. More precisely, six PD subjects were wrongly classified as PSP-RS and three PSP-RS subjects were wrongly classified as PD.ConclusionThe results of this study demonstrate that PSP-RS subjects exhibit widespread and more severe diffusion alterations compared to PD patients, which appears valuable for an automatic computer-aided diagnosis approach.
Highlights
The primary cause of Parkinson's disease (PD) is typically accredited to the accumulation of alpha-synuclein and progressive loss of dopaminergic cells within the substantia nigra (Sharma et al, 2013)
progressive supranuclear palsy – Richardson's syndrome (PSP-RS) subjects exhibited reduced fractional anisotropy (FA), and increased mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) values in most brain structures analyzed compared to PD subjects
The finding that progressive supranuclear palsy (PSP)-RS subjects exhibit reduced FA, and increased MD, RD, and AD values in most brain structures analyzed compared to PD subjects is generally in line with previous studies (Chung et al, 2009; Erbetta et al, 2009; Gattellaro et al, 2009; Karagulle Kendi et al, 2008; Nicoletti et al, 2008, 2006; Rizzo et al, 2008; Rolheiser et al, 2011; Schocke et al, 2002)
Summary
The primary cause of Parkinson's disease (PD) is typically accredited to the accumulation of alpha-synuclein and progressive loss of dopaminergic cells within the substantia nigra (Sharma et al, 2013). Due to significant overlap of clinical symptoms and inadequate accuracy of bedside tests, differential diagnosis is often challenging, in the early disease course. Within this context, failure rates of up to 24% are reported, even by movement disorders specialists (Hughes et al, 1992). The correct diagnosis, Abbreviations: HC, healthy control; PD, Parkinson's disease; PSP-RS, progressive supranuclear palsy – Richardson's syndrome; MNI, Montreal Neurological Institute; MD, mean diffusivity; AD, axial diffusivity; FA, fractional anisotropy; RD, radial diffusivity; ROC, receiver operating characteristic; UPDRS, unified Parkinson's disease rating scale. Conclusion: The results of this study demonstrate that PSP-RS subjects exhibit widespread and more severe diffusion alterations compared to PD patients, which appears valuable for an automatic computer-aided diagnosis approach
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