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- Title
Neuropathological correlation supports automated image-based differential diagnosis in parkinsonism.
- Authors
Schindlbeck, Katharina A.; Gupta, Deepak K.; Tang, Chris C.; O'Shea, Sarah A.; Poston, Kathleen L.; Choi, Yoon Young; Dhawan, Vijay; Vonsattel, Jean-Paul; Fahn, Stanley; Eidelberg, David
- Abstract
Purpose: Up to 25% of patients diagnosed as idiopathic Parkinson's disease (IPD) have an atypical parkinsonian syndrome (APS). We had previously validated an automated image-based algorithm to discriminate between IPD, multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). While the algorithm was accurate with respect to the final clinical diagnosis after long-term expert follow-up, its relationship to the initial referral diagnosis and to the neuropathological gold standard is not known. Methods: Patients with an uncertain diagnosis of parkinsonism were referred for 18F-fluorodeoxyglucose (FDG) PET to classify patients as IPD or as APS based on the automated algorithm. Patients were followed by a movement disorder specialist and subsequently underwent neuropathological examination. The image-based classification was compared to the neuropathological diagnosis in 15 patients with parkinsonism. Results: At the time of referral to PET, the clinical impression was only 66.7% accurate. The algorithm correctly identified 80% of the cases as IPD or APS (p = 0.02) and 87.5% of the APS cases as MSA or PSP (p = 0.03). The final clinical diagnosis was 93.3% accurate (p < 0.001), but needed several years of expert follow-up. Conclusion: The image-based classifications agreed well with autopsy and can help to improve diagnostic accuracy during the period of clinical uncertainty.
- Subjects
PARKINSONIAN disorders; DIFFERENTIAL diagnosis; PROGRESSIVE supranuclear palsy; MULTIPLE system atrophy; PARKINSON'S disease; AUTOPSY
- Publication
European Journal of Nuclear Medicine & Molecular Imaging, 2021, Vol 48, Issue 11, p3522
- ISSN
1619-7070
- Publication type
Article
- DOI
10.1007/s00259-021-05302-6