Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders
Separating progressive supranuclear palsy (PSP) from Parkinson's disease (PD) and multiple system atrophy (MSA) is often challenging in early disease but is important for appropriate management. Magnetic resonance imaging (MRI) can aid the diagnostics and manual 2D measurements are often used....
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| Veröffentlicht in: | Parkinsonism & related disorders 2020-10, Vol.79, p.18-25 |
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| description | Separating progressive supranuclear palsy (PSP) from Parkinson's disease (PD) and multiple system atrophy (MSA) is often challenging in early disease but is important for appropriate management. Magnetic resonance imaging (MRI) can aid the diagnostics and manual 2D measurements are often used. However, new fully automatic brainstem volumetry could potentially be more accurate and increase availability of brainstem metrics.
Clinical 3D T1-weighted MRI were obtained from 196 consecutive patients; 29 PSP, 27 MSA, 140 PD. Midbrain-pons ratio and magnetic resonance parkinsonism index (MRPI) 1.0 and 2.0 were manually calculated, and intra-rater and inter-rater reliability was assessed. FreeSurfer was used to automatically segment brainstem substructures, normalized to the intracranial volume. The robustness of the automated analysis was evaluated in 3 healthy controls. The diagnostic accuracy of the brainstem biomarkers was assessed using receiver operating characteristic curves.
Automatic brainstem volumetry had good repeatability/reproducibility with intra-scanner coefficient of variation 0.3–5.5% and inter-scanner coefficient of variation 0.9–8.4% in the different brainstem regions. Midbrain volume performs better than planimetric measurements in separating PSP from PD (Area under the curve (AUC) 0.90 compared with 0.81 for midbrain-pons ratio (p = 0.019), 0.77 for MRPI 1.0 (p = 0.007) and 0.81 for MRPI 2.0 (p = 0.021)). Midbrain volume performed on par with planimetry for separation between PSP and MSA.
Automatic brainstem segmentation is robust and shows promising diagnostic performance in separating PSP from PD and MSA. If further developed, it could play a role in diagnosing PSP and could potentially be used as an outcome in clinical trials.
•Automatic brainstem volumetry helps separate progressive supranuclear palsy from other causes of parkinsonism.•Midbrain volume is a promising marker for the diagnosis of progressive supranuclear palsy.•A robust automatic measurement could increase availability of brainstem metrics in the diagnostics of parkinsonism. |
| doi_str_mv | 10.1016/j.parkreldis.2020.08.004 |
| format | Article |
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Clinical 3D T1-weighted MRI were obtained from 196 consecutive patients; 29 PSP, 27 MSA, 140 PD. Midbrain-pons ratio and magnetic resonance parkinsonism index (MRPI) 1.0 and 2.0 were manually calculated, and intra-rater and inter-rater reliability was assessed. FreeSurfer was used to automatically segment brainstem substructures, normalized to the intracranial volume. The robustness of the automated analysis was evaluated in 3 healthy controls. The diagnostic accuracy of the brainstem biomarkers was assessed using receiver operating characteristic curves.
Automatic brainstem volumetry had good repeatability/reproducibility with intra-scanner coefficient of variation 0.3–5.5% and inter-scanner coefficient of variation 0.9–8.4% in the different brainstem regions. Midbrain volume performs better than planimetric measurements in separating PSP from PD (Area under the curve (AUC) 0.90 compared with 0.81 for midbrain-pons ratio (p = 0.019), 0.77 for MRPI 1.0 (p = 0.007) and 0.81 for MRPI 2.0 (p = 0.021)). Midbrain volume performed on par with planimetry for separation between PSP and MSA.
Automatic brainstem segmentation is robust and shows promising diagnostic performance in separating PSP from PD and MSA. If further developed, it could play a role in diagnosing PSP and could potentially be used as an outcome in clinical trials.
•Automatic brainstem volumetry helps separate progressive supranuclear palsy from other causes of parkinsonism.•Midbrain volume is a promising marker for the diagnosis of progressive supranuclear palsy.•A robust automatic measurement could increase availability of brainstem metrics in the diagnostics of parkinsonism.</description><identifier>ISSN: 1353-8020</identifier><identifier>EISSN: 1873-5126</identifier><identifier>DOI: 10.1016/j.parkreldis.2020.08.004</identifier><identifier>PMID: 32858488</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Brain Stem - diagnostic imaging ; Brain Stem - pathology ; Diagnosis, Differential ; Female ; Humans ; Image Interpretation, Computer-Assisted - methods ; Image Interpretation, Computer-Assisted - standards ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multiple ; Multiple System Atrophy - diagnostic imaging ; Neuroimaging - methods ; Neuroimaging - standards ; Parkinson Disease - diagnostic imaging ; Parkinson's disease ; Parkinsonism ; Progressive supranuclear palsy ; Reproducibility of Results ; Retrospective Studies ; Supranuclear Palsy, Progressive - diagnostic imaging ; System atrophy</subject><ispartof>Parkinsonism & related disorders, 2020-10, Vol.79, p.18-25</ispartof><rights>2020 The Authors</rights><rights>Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-a028deeacecb6fdf0c0ff672da351c357e998832d99f70b0cd8e6c9429ab878d3</citedby><cites>FETCH-LOGICAL-c462t-a028deeacecb6fdf0c0ff672da351c357e998832d99f70b0cd8e6c9429ab878d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1353802020306702$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32858488$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:145005531$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Sjöström, Henrik</creatorcontrib><creatorcontrib>Granberg, Tobias</creatorcontrib><creatorcontrib>Hashim, Farouk</creatorcontrib><creatorcontrib>Westman, Eric</creatorcontrib><creatorcontrib>Svenningsson, Per</creatorcontrib><title>Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders</title><title>Parkinsonism & related disorders</title><addtitle>Parkinsonism Relat Disord</addtitle><description>Separating progressive supranuclear palsy (PSP) from Parkinson's disease (PD) and multiple system atrophy (MSA) is often challenging in early disease but is important for appropriate management. Magnetic resonance imaging (MRI) can aid the diagnostics and manual 2D measurements are often used. However, new fully automatic brainstem volumetry could potentially be more accurate and increase availability of brainstem metrics.
Clinical 3D T1-weighted MRI were obtained from 196 consecutive patients; 29 PSP, 27 MSA, 140 PD. Midbrain-pons ratio and magnetic resonance parkinsonism index (MRPI) 1.0 and 2.0 were manually calculated, and intra-rater and inter-rater reliability was assessed. FreeSurfer was used to automatically segment brainstem substructures, normalized to the intracranial volume. The robustness of the automated analysis was evaluated in 3 healthy controls. The diagnostic accuracy of the brainstem biomarkers was assessed using receiver operating characteristic curves.
Automatic brainstem volumetry had good repeatability/reproducibility with intra-scanner coefficient of variation 0.3–5.5% and inter-scanner coefficient of variation 0.9–8.4% in the different brainstem regions. Midbrain volume performs better than planimetric measurements in separating PSP from PD (Area under the curve (AUC) 0.90 compared with 0.81 for midbrain-pons ratio (p = 0.019), 0.77 for MRPI 1.0 (p = 0.007) and 0.81 for MRPI 2.0 (p = 0.021)). Midbrain volume performed on par with planimetry for separation between PSP and MSA.
Automatic brainstem segmentation is robust and shows promising diagnostic performance in separating PSP from PD and MSA. If further developed, it could play a role in diagnosing PSP and could potentially be used as an outcome in clinical trials.
•Automatic brainstem volumetry helps separate progressive supranuclear palsy from other causes of parkinsonism.•Midbrain volume is a promising marker for the diagnosis of progressive supranuclear palsy.•A robust automatic measurement could increase availability of brainstem metrics in the diagnostics of parkinsonism.</description><subject>Aged</subject><subject>Brain Stem - diagnostic imaging</subject><subject>Brain Stem - pathology</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Humans</subject><subject>Image Interpretation, Computer-Assisted - methods</subject><subject>Image Interpretation, Computer-Assisted - standards</subject><subject>Image Processing, Computer-Assisted</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multiple</subject><subject>Multiple System Atrophy - diagnostic imaging</subject><subject>Neuroimaging - methods</subject><subject>Neuroimaging - standards</subject><subject>Parkinson Disease - diagnostic imaging</subject><subject>Parkinson's disease</subject><subject>Parkinsonism</subject><subject>Progressive supranuclear palsy</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Supranuclear Palsy, Progressive - diagnostic imaging</subject><subject>System atrophy</subject><issn>1353-8020</issn><issn>1873-5126</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNqFkU1PHDEMhiNUBBT4C1WOXGbqSebDcwTUQiWkShWco0zioVlmJtskQ8W_b1a7pceebNnPa1t-GeMVlBVU7edNudXhJdBkXSwFCCgBS4D6iJ1V2MmiqUT7IeeykQXm9in7GOMGALoG5Ak7lQIbrBHP2I_rNflZJ7J8CNotMdHMX_20zpTCGzd64dpZ7haefhK3Tj8vPiZnIvcj3x2RJX5xGcun-GApxAt2POop0uUhnrOnr18eb--Lh-93326vHwpTtyIVGgRaIm3IDO1oRzAwjm0nrJZNZWTTUd8jSmH7fuxgAGORWtPXotcDdmjlOSv2c-Nv2q6D2gY36_CmvHbqUHrJGam6xaZvMn-157fB_1opJjW7aGia9EJ-jUrUElsUHWBGcY-a4GMMNL4Pr0DtHFAb9c8BtXNAAarsQJZ-OmxZh5nsu_DvyzNwswco_-bVUVDROFoMWRfIJGW9-_-WP1wCn2U</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Sjöström, Henrik</creator><creator>Granberg, Tobias</creator><creator>Hashim, Farouk</creator><creator>Westman, Eric</creator><creator>Svenningsson, Per</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20201001</creationdate><title>Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders</title><author>Sjöström, Henrik ; Granberg, Tobias ; Hashim, Farouk ; Westman, Eric ; Svenningsson, Per</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-a028deeacecb6fdf0c0ff672da351c357e998832d99f70b0cd8e6c9429ab878d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Brain Stem - diagnostic imaging</topic><topic>Brain Stem - pathology</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Humans</topic><topic>Image Interpretation, Computer-Assisted - methods</topic><topic>Image Interpretation, Computer-Assisted - standards</topic><topic>Image Processing, Computer-Assisted</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multiple</topic><topic>Multiple System Atrophy - diagnostic imaging</topic><topic>Neuroimaging - methods</topic><topic>Neuroimaging - standards</topic><topic>Parkinson Disease - diagnostic imaging</topic><topic>Parkinson's disease</topic><topic>Parkinsonism</topic><topic>Progressive supranuclear palsy</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Supranuclear Palsy, Progressive - diagnostic imaging</topic><topic>System atrophy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sjöström, Henrik</creatorcontrib><creatorcontrib>Granberg, Tobias</creatorcontrib><creatorcontrib>Hashim, Farouk</creatorcontrib><creatorcontrib>Westman, Eric</creatorcontrib><creatorcontrib>Svenningsson, Per</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Parkinsonism & related disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sjöström, Henrik</au><au>Granberg, Tobias</au><au>Hashim, Farouk</au><au>Westman, Eric</au><au>Svenningsson, Per</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders</atitle><jtitle>Parkinsonism & related disorders</jtitle><addtitle>Parkinsonism Relat Disord</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>79</volume><spage>18</spage><epage>25</epage><pages>18-25</pages><issn>1353-8020</issn><eissn>1873-5126</eissn><abstract>Separating progressive supranuclear palsy (PSP) from Parkinson's disease (PD) and multiple system atrophy (MSA) is often challenging in early disease but is important for appropriate management. Magnetic resonance imaging (MRI) can aid the diagnostics and manual 2D measurements are often used. However, new fully automatic brainstem volumetry could potentially be more accurate and increase availability of brainstem metrics.
Clinical 3D T1-weighted MRI were obtained from 196 consecutive patients; 29 PSP, 27 MSA, 140 PD. Midbrain-pons ratio and magnetic resonance parkinsonism index (MRPI) 1.0 and 2.0 were manually calculated, and intra-rater and inter-rater reliability was assessed. FreeSurfer was used to automatically segment brainstem substructures, normalized to the intracranial volume. The robustness of the automated analysis was evaluated in 3 healthy controls. The diagnostic accuracy of the brainstem biomarkers was assessed using receiver operating characteristic curves.
Automatic brainstem volumetry had good repeatability/reproducibility with intra-scanner coefficient of variation 0.3–5.5% and inter-scanner coefficient of variation 0.9–8.4% in the different brainstem regions. Midbrain volume performs better than planimetric measurements in separating PSP from PD (Area under the curve (AUC) 0.90 compared with 0.81 for midbrain-pons ratio (p = 0.019), 0.77 for MRPI 1.0 (p = 0.007) and 0.81 for MRPI 2.0 (p = 0.021)). Midbrain volume performed on par with planimetry for separation between PSP and MSA.
Automatic brainstem segmentation is robust and shows promising diagnostic performance in separating PSP from PD and MSA. If further developed, it could play a role in diagnosing PSP and could potentially be used as an outcome in clinical trials.
•Automatic brainstem volumetry helps separate progressive supranuclear palsy from other causes of parkinsonism.•Midbrain volume is a promising marker for the diagnosis of progressive supranuclear palsy.•A robust automatic measurement could increase availability of brainstem metrics in the diagnostics of parkinsonism.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>32858488</pmid><doi>10.1016/j.parkreldis.2020.08.004</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Brain Stem - diagnostic imaging Brain Stem - pathology Diagnosis, Differential Female Humans Image Interpretation, Computer-Assisted - methods Image Interpretation, Computer-Assisted - standards Image Processing, Computer-Assisted Magnetic Resonance Imaging Male Middle Aged Multiple Multiple System Atrophy - diagnostic imaging Neuroimaging - methods Neuroimaging - standards Parkinson Disease - diagnostic imaging Parkinson's disease Parkinsonism Progressive supranuclear palsy Reproducibility of Results Retrospective Studies Supranuclear Palsy, Progressive - diagnostic imaging System atrophy |
| title | Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders |
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