Morphometric MRI profiles of multiple system atrophy variants and implications for differential diagnosis

Florian Krismer; Klaus Seppi; Georg Göbel; Ruth Steiger; Isabel Zucal; Sylvia Boesch; Elke R Gizewski; Gregor K Wenning; Werner Poewe; Christoph Scherfler

doi:10.1002/mds.27669

Morphometric MRI profiles of multiple system atrophy variants and implications for differential diagnosis

Mov Disord. 2019 Jul;34(7):1041-1048. doi: 10.1002/mds.27669. Epub 2019 Mar 28.

Authors

Florian Krismer^{1

2}, Klaus Seppi^{1

2}, Georg Göbel³, Ruth Steiger^{2

4}, Isabel Zucal¹, Sylvia Boesch¹, Elke R Gizewski^{2

4}, Gregor K Wenning¹, Werner Poewe^{1

2}, Christoph Scherfler^{1

2}

Affiliations

¹ Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
² Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.
³ Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria.
⁴ Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria.

Abstract

Background: Manual width measurements of the middle cerebellar peduncle on MRI were shown to improve the accuracy of an imaging-guided diagnosis of multiple system atrophy (MSA). Recently, automated volume segmentation algorithms were able to reliably differentiate patients with Parkinson's disease (PD) and the parkinsonian variant of MSA. The objective of the current study was to integrate probabilistic information of the middle cerebellar peduncle into an existing MRI atlas for automated subcortical segmentation and to evaluate the diagnostic properties of the novel atlas for the differential diagnosis of MSA (parkinsonian and cerebellar variant) versus PD.

Methods: Three Tesla MRI scans of 48 healthy individuals were used to establish an automated whole-brain segmentation procedure that includes the volumes of the putamen, cerebellar gray and white matter, and the middle cerebellar peduncles. Classification accuracy of segmented volumes were tested in early-stage MSA patients (18 MSA-parkinsonism, 13 MSA-cerebellar) and 19 PD patients using a C4.5 classifier.

Results: Putaminal and infratentorial atrophy were present in 77.8% and 61.1% of MSA-parkinsonian patients, respectively. Four of 18 MSA-parkinsonian patients (22.2%) had infratentorial atrophy without evidence of putaminal atrophy. Infratentorial atrophy was present in all MSA-cerebellar patients, with concomitant putaminal atrophy in 46.2% of these cases. The diagnostic algorithm using putaminal and infratentorial volumetric information correctly classified all PD patients and 96.8% of MSA patients.

Conclusions: The middle cerebellar peduncle was successfully integrated into a subcortical segmentation atlas, and its excellent diagnostic accuracy outperformed existing volumetric MRI processing strategies in differentiating MSA patients with variable atrophy patterns from PD patients. © 2019 International Parkinson and Movement Disorder Society.

Keywords: FreeSurfer; MRI; Parkinson's disease; atlas; multiple system atrophy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Algorithms
Atrophy / diagnosis
Atrophy / pathology
Brain / pathology
Diagnosis, Differential
Female
Humans
Magnetic Resonance Imaging / methods
Male
Middle Aged
Multiple System Atrophy / diagnosis
Multiple System Atrophy / pathology*
Multiple System Atrophy / physiopathology
Parkinson Disease / diagnosis
Parkinson Disease / pathology*
Parkinsonian Disorders / diagnosis
Parkinsonian Disorders / pathology*
Putamen / pathology
Putamen / physiology*