Neuropathological correlation supports automated image-based differential diagnosis in parkinsonism. European journal of nuclear medicine and molecular imaging Schindlbeck, K. A., Gupta, D. K., Tang, C. C., O'Shea, S. A., Poston, K. L., Choi, Y. Y., Dhawan, V., Vonsattel, J., Fahn, S., Eidelberg, D. 2021


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.

View details for DOI 10.1007/s00259-021-05302-6

View details for PubMedID 33839891