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Spotorno N, Hall S, Irwin DJ, Rumetshofer T, Acosta-Cabronero J, Deik AF, Spindler MA, Lee EB, Trojanowski JQ, van Westen D, Nilsson M, Grossman M, Nestor PJ, McMillan CT, Hansson O. Diffusion Tensor MRI to Distinguish Progressive Supranuclear Palsy from α-Synucleinopathies. Radiology 2019; 293:646-653. [PMID: 31617796 PMCID: PMC6889922 DOI: 10.1148/radiol.2019190406] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/21/2019] [Accepted: 08/21/2019] [Indexed: 01/25/2023]
Abstract
Background The differential diagnosis of progressive supranuclear palsy (PSP) and Lewy body disorders, which include Parkinson disease and dementia with Lewy bodies, is often challenging due to the overlapping symptoms. Purpose To develop a diagnostic tool based on diffusion tensor imaging (DTI) to distinguish between PSP and Lewy body disorders at the individual-subject level. Materials and Methods In this retrospective study, skeletonized DTI metrics were extracted from two independent data sets: the discovery cohort from the Swedish BioFINDER study and the validation cohort from the Penn Frontotemporal Degeneration Center (data collected between 2010 and 2018). Based on previous neuroimaging studies and neuropathologic evidence, a combination of regions hypothesized to be sensitive to pathologic features of PSP were identified (ie, the superior cerebellar peduncle and frontal white matter) and fractional anisotropy (FA) was used to compute an FA score for each individual. Classification performances were assessed by using logistic regression and receiver operating characteristic analysis. Results In the discovery cohort, 16 patients with PSP (mean age ± standard deviation, 73 years ± 5; eight women, eight men), 34 patients with Lewy body disorders (mean age, 71 years ± 6; 14 women, 20 men), and 44 healthy control participants (mean age, 66 years ± 8; 26 women, 18 men) were evaluated. The FA score distinguished between clinical PSP and Lewy body disorders with an area under the curve of 0.97 ± 0.04, a specificity of 91% (31 of 34), and a sensitivity of 94% (15 of 16). In the validation cohort, 34 patients with PSP (69 years ± 7; 22 women, 12 men), 25 patients with Lewy body disorders (70 years ± 7; nine women, 16 men), and 32 healthy control participants (64 years ± 7; 22 women, 10 men) were evaluated. The accuracy of the FA score was confirmed (area under the curve, 0.96 ± 0.04; specificity, 96% [24 of 25]; and sensitivity, 85% [29 of 34]). Conclusion These cross-validated findings lay the foundation for a clinical test to distinguish progressive supranuclear palsy from Lewy body disorders. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Shah in this issue.
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Affiliation(s)
- Nicola Spotorno
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Sara Hall
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - David J. Irwin
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Theodor Rumetshofer
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Julio Acosta-Cabronero
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Andres F. Deik
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Meredith A. Spindler
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Edward B. Lee
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - John Q. Trojanowski
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Danielle van Westen
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Markus Nilsson
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Murray Grossman
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Peter J. Nestor
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Corey T. McMillan
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Oskar Hansson
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
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