Diagnostic Accuracy of Magnetic Resonance Imaging Measures of Brain Atrophy Across the Spectrum of Progressive Supranuclear Palsy and Corticobasal Degeneration.
Diagnostic Accuracy of Magnetic Resonance Imaging Measures of Brain Atrophy Across the Spectrum of Progressive Supranuclear Palsy and Corticobasal Degeneration.
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DOI：
10.1001/jamanetworkopen.2022.9588
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发表时间：
2022-04-01
影响因子：
13.8
通讯作者：
Boxer, Adam L.
中科院分区：
文献类型：
--
作者：
Illan-Gala, Ignacio;Nigro, Salvatore;VandeVrede, Lawren;Falgas, Neus;Heuer, Hilary W.;Painous, Celia;Compta, Yaroslau;Marti, Maria J.;Montal, Victor;Pagonabarraga, Javier;Kulisevsky, Jaime;Lleo, Alberto;Fortea, Juan;Logroscino, Giancarlo;Quattrone, Andrea;Quattrone, Aldo;Perry, David C.;Gorno-Tempini, Maria Luisa;Rosen, Howard J.;Grinberg, Lea T.;Spina, Salvatore;La Joie, Renaud;Rabinovici, Gil D.;Miller, Bruce L.;Rojas, Julio C.;Seeley, William W.;Boxer, Adam L.
磁共振成像（MRI）上广泛使用的萎缩测量能提高进行性核上性麻痹（PSP）和皮质基底变性（CBD）的诊断准确性吗？在这项326名参与者的诊断研究中，采用了不同的方法来量化MRI首次诊断时的脑萎缩。皮质和皮质下萎缩测量的结合对于区分PSP、CBD和其他病理具有极好的诊断准确性，即使在诊断时没有运动障碍的参与者亚组中也是如此。这些发现表明，在不同的临床相关情况下，结构MRI可用于提高潜在的PSP和CBD的诊断确定性。本诊断研究评估并比较磁共振帕金森病指数和其他基于磁共振成像的脑萎缩指标的价值，以区分进行性核上性麻痹、皮质基底变性和其他神经退行性疾病。进行性核上性麻痹（PSP）和皮质基底变性（CBD）的准确诊断受到不完善的临床病理相关性的阻碍。评估和比较磁共振帕金森病指数（MRPI）和其他基于磁共振成像的脑萎缩指标在区分PSP、CBD和其他神经退行性疾病中的诊断价值。这项前瞻性诊断研究包括患有4重复tau病变（4RT）、PSP、CBD、其他神经退行性疾病和出现在加州大学旧金山分校记忆与衰老中心数据库中的可用MRI的参与者。数据收集时间为1994年10月27日至2019年9月29日。数据分析时间为2021年3月1日至9月14日。本研究的主要结果是PSP或CBD的神经病理学诊断。记录了MRI采集时的临床诊断。成像测量包括mri、皮质厚度、皮质下体积，包括中脑、脑桥和小脑上蒂体积。定义了结合不同皮层和皮层下区域的多项逻辑回归模型（MLRM）来区分PSP、CBD和其他病理。计算受者工作特征曲线（AUROC）和截止点下的面积，以区分PSP、CBD和其他疾病。在纳入的326名参与者中，176名（54%）为男性，MRI的平均（SD）年龄为64.1（8.0）岁。MRPI在区分PSP和所有其他病理（准确率87%；AUROC, 0.90; 95% CI, 0.86-0.95）以及4RT和其他病理（准确率80%；AUROC, 0.82; 95% CI, 0.76-0.87）方面显示出良好的诊断准确性，但不允许区分CBD参与者。在MRI上没有典型PSP-Richardson综合征（PSP-RS）或可能的皮质基底综合征（CBS）的患者亚组中，其诊断准确性较低。结合皮质和皮质下测量的MLRM在区分PSP和其他病理（准确度，95%；AUROC, 0.98; 95% CI, 0.97-0.99）、CBD和其他病理（准确度，83%；AUROC, 0.86; 95% CI, 0.81-0.91）、4RT和其他病理（准确度，89%；AUROC, 0.94; 95% CI, 0.92-0.97）、PSP和CBD（准确度，91%；AUROC, 0.95; 95% CI, 0.91-0.99）方面显示出最高的准确度，即使在MRI上没有PSP- rs或CBS的参与者中也是如此。在本研究中，MRI上广泛可用的皮层和皮层下萎缩测量相结合，可以区分PSP、CBD和其他病理，并可用于临床实践中支持4RT的诊断。
Can widely available atrophy measures on magnetic resonance imaging (MRI) increase diagnostic accuracy of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD)? In this diagnostic study of 326 participants, different methods for quantifying cerebral atrophy on MRI at first diagnosis were applied. The combination of cortical and subcortical measures of atrophy had excellent diagnostic accuracy for the differentiation between PSP, CBD, and other pathologies, even in the subgroup of participants who did not have a movement disorder at diagnosis. These findings suggest that structural MRI could be used to increase diagnostic certainty of underlying PSP and CBD in diverse clinically relevant scenarios. This diagnostic study assesses and compares the value of the magnetic resonance parkinsonism index and other magnetic resonance imaging–based measures of cerebral atrophy to differentiate between progressive supranuclear palsy, corticobasal degeneration, and other neurodegenerative diseases. The accurate diagnosis of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) is hampered by imperfect clinical-pathological correlations. To assess and compare the diagnostic value of the magnetic resonance parkinsonism index (MRPI) and other magnetic resonance imaging–based measures of cerebral atrophy to differentiate between PSP, CBD, and other neurodegenerative diseases. This prospective diagnostic study included participants with 4-repeat tauopathies (4RT), PSP, CBD, other neurodegenerative diseases and available MRI who appeared in the University of California, San Francisco, Memory and Aging Center database. Data were collected from October 27, 1994, to September 29, 2019. Data were analyzed from March 1 to September 14, 2021. The main outcome of this study was the neuropathological diagnosis of PSP or CBD. The clinical diagnosis at the time of the MRI acquisition was noted. The imaging measures included the MRPI, cortical thickness, subcortical volumes, including the midbrain, pons, and superior cerebellar peduncle volumes. Multinomial logistic regression models (MLRM) combining different cortical and subcortical regions were defined to discriminate between PSP, CBD, and other pathologies. The areas under the receiver operating characteristic curves (AUROC) and cutoffs were calculated to differentiate between PSP, CBD, and other diseases. Of the 326 included participants, 176 (54%) were male, and the mean (SD) age at MRI was 64.1 (8.0) years. The MRPI showed good diagnostic accuracy for the differentiation between PSP and all other pathologies (accuracy, 87%; AUROC, 0.90; 95% CI, 0.86-0.95) and between 4RT and other pathologies (accuracy, 80%; AUROC, 0.82; 95% CI, 0.76-0.87), but did not allow the discrimination of participants with CBD. Its diagnostic accuracy was lower in the subgroup of patients without the canonical PSP–Richardson syndrome (PSP-RS) or probable corticobasal syndrome (CBS) at MRI. MLRM combining cortical and subcortical measurements showed the highest accuracy for the differentiation between PSP and other pathologies (accuracy, 95%; AUROC, 0.98; 95% CI, 0.97-0.99), CBD and other pathologies (accuracy, 83%; AUROC, 0.86; 95% CI, 0.81-0.91), 4RT and other pathologies (accuracy, 89%; AUROC, 0.94; 95% CI, 0.92-0.97), and PSP and CBD (accuracy, 91%; AUROC, 0.95; 95% CI, 0.91-0.99), even in participants without PSP-RS or CBS at MRI. In this study, the combination of widely available cortical and subcortical measures of atrophy on MRI discriminated between PSP, CBD, and other pathologies and could be used to support the diagnosis of 4RT in clinical practice.
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DOI：
10.1016/s1474-4422(17)30157-6
发表时间：
2017-07
期刊：
The Lancet. Neurology
影响因子：
--
作者：
Boxer AL;Yu JT;Golbe LI;Litvan I;Lang AE;Höglinger GU
通讯作者：
Höglinger GU
影响因子：
16.2
作者：
GOEDERT, M;SPILLANTINI, MG;CROWTHER, RA
通讯作者：
CROWTHER, RA
影响因子：
--
作者：
REBEIZ, JJ;KOLODNY, EH;RICHARDSON, EP
通讯作者：
RICHARDSON, EP
影响因子：
9.9
作者：
Dutt, Shubir;Binney, Richard J.;Boxer, Adam L.
通讯作者：
Boxer, Adam L.
影响因子：
5.7
作者：
Iglesias JE;Van Leemput K;Bhatt P;Casillas C;Dutt S;Schuff N;Truran-Sacrey D;Boxer A;Fischl B;Alzheimer's Disease Neuroimaging Initiative
通讯作者：
Alzheimer's Disease Neuroimaging Initiative