Logistic discriminant parametric mapping: a novel method for the pixel-based differential diagnosis of Parkinson's disease

Pd, Acton; Pd, Mozley; Hf, Kung

doi:10.1007/s002590050473

Cited by 26 publications

(16 citation statements)

References 33 publications

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“…While such analysis may give more detailed insight into pathophysiological characteristics, it does not lend itself to direct clinical applications with respect to differential diagnosis. Advanced novel procedures such as logistic discriminant parametric mapping may be more suited for further improved analysis [38]. In this study, no attempt was made to separate the putamen and globus pallidus in different VOIs, or to subdivide the putamen into posterior and anterior parts, owing to the relatively lower resolution for the earlier images (full-width at half-maximum, 10.5 mm).…”

Section: Discussionmentioning

confidence: 98%

Anatomically standardised 99m Tc-ECD brain perfusion SPET allows accurate differentiation between healthy volunteers, multiple system atrophy and idiopathic Parkinson's disease

Bosman

Laere

Santens

2003

European Journal of Nuclear Medicine and Molecular Imaging

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The clinical differentiation between typical idiopathic Parkinson's disease (IPD) and atypical parkinsonian disorders such as multiple system atrophy (MSA) is complicated by the presence of signs and symptoms common to both forms. The goal of this study was to re-evaluate the contribution of brain perfusion single-photon emission tomography (SPET) with anatomical standardisation and automated analysis in the differentiation of IPD and MSA. This was achieved by discriminant analysis in comparison with a large set of age- and gender-matched healthy volunteers. Technetium-99m ethyl cysteinate dimer SPET was performed on 140 subjects: 81 IPD patients (age 62.6+/-10.2 years; disease duration 11.0+/-6.4 years; 50 males/31 females), 15 MSA patients (61.5+/-9.2 years; disease duration 3.0+/-2.2 years; 9 males/6 females) and 44 age- and gender-matched healthy volunteers (age 59.2+/-11.9 years; 27 males/17 females). Patients were matched for severity (Hoehn and Yahr stage). Automated predefined volume of interest (VOI) analysis was carried out after anatomical standardisation. Stepwise discriminant analysis with cross-validation using the leave-one-out method was used to determine the subgroup of variables giving the highest accuracy for this differential diagnosis. Between MSA and IPD, the only regions with highly significant differences in uptake after Bonferroni correction were the putamen VOIs. Comparing MSA versus normals and IPD, with putamen VOI values as discriminating variables, cross-validated performance showed correct classification of MSA patients with a sensitivity of 73.3%, a specificity of 84% and an accuracy of 83.6%. Additional input from the right caudate head and the left prefrontal and left mesial temporal cortex allowed 100% discrimination even after cross-validation. Discrimination between the IPD group alone and healthy volunteers was accurate in 94% of the cases after cross-validation, with a sensitivity of 91.4% and a specificity of 100%. The three-group classification (MSA, IPD and healthy volunteers) resulted in an overall accuracy of 86% post hoc, with 98% of normals, 78% of IPD and 93% of MSA correctly classified. These values were slightly lower after cross-validation: 96% for healthy volunteers, 77% for IPD and 67% for MSA. In conclusion, using age- and gender-matched healthy volunteer data and anatomical standardisation, it is possible to differentiate between IPD and MSA with high discriminating power in clinically relevant circumstances.

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Section: Discussionmentioning

confidence: 98%

Anatomically standardised 99m Tc-ECD brain perfusion SPET allows accurate differentiation between healthy volunteers, multiple system atrophy and idiopathic Parkinson's disease

Bosman

Laere

Santens

2003

European Journal of Nuclear Medicine and Molecular Imaging

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“…Statistical Parametric Mapping [33], [34]). However, these methods are inappropriate for the diagnosis of individual subjects, and tend to have very poor specificity [35]. The results of this observer study certainly support the hypothesis that a new voxel-based technique is required for the differential diagnosis of individuals, possibly using a priori known information about the disease under study, and which can replicate the pattern recognition skills of a human observer.…”

Section: Discussionsupporting

confidence: 51%

Comparison of region-of-interest analysis and human observers in the diagnosis of Parkinson's disease using [/sup 99m/Tc]TRODAT-1 and SPECT

Acton

Newberg

Plossi

et al.

IEEE Symposium Conference Record Nuclear Science 2004.

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A large set of patients with Parkinson's Disease (PD), and normal healthy control subjects, were studied using the dopamine transporter tracer [ 99m Tc]TRODAT-1 and single photon emission tomography (SPECT). The sample used in this study was comprised of 81 PD patients (mean age ± SD, 63.4 ± 10.4 y; age range, 39.0 -84.2 y), and 94 healthy controls (mean age ± SD, 61.8 ± 11.0 y; age range, 40.9 -83.3 y). A standardized template containing six regions-of-interest (ROIs) was transposed onto subregions of the right and left basal ganglia. In addition, all images were coregistered to a standard [ 99m Tc]TRODAT-1 template. The three slices corresponding to the striatum were extracted and summed into a single transverse slice. These singleslice images were used in a human observer study, using four experienced investigators. Each observer was asked to rate their confidence that each randomly selected image had the appearance of a healthy control subject, or a patient with PD. The data from the observer study was analyzed using a Receiver Operating Characteristic (ROC) analysis. The area under the ROC curve (AUC) indicated the accuracy with which each observer identified each subject. In a similar manner, the ROI data was also analyzed using a ROC curve. The observer analysis gave a more accurate diagnosis (AUC = 0.93 ± 0.02) than the ROI technique (AUC = 0.90 ± 0.02). This suggests that the human observers are visually acquiring more information from the images than is contained in the quantitative striatal uptake alone. Indeed, it is likely that the pattern of uptake of the tracer is of more significance than the absolute uptake, which has implications for the analysis of radionuclide images using quantitative techniques.

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“…Also, the volumes of all putaminal VOIs were significantly reduced to approximately 50% of those of controls and IPD patients in a 18 F-FDG PET. This diminished striatal metabolism is believed to be a distinctive sign compared to the normal or IPD (6,19,21). In the studies of brain metabolism aimed at differentiating MSA from IPD, 18 F-FDG PET, dopamine D2 PET and SPECT ligands imaging have been employed.…”

Section: Proc Of Spie Vol 5746 689mentioning

confidence: 99%

Voxel based comparison of glucose metabolism in the differential diagnosis of the multiple system atrophy

et al. 2005

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Multiple system atrophy (MSA) including striatonigral degeneration (SND) and olivopontocerebellar atrophy (OPCA) is a group of heterogeneous degenerative neurological disorders, which differ from the idiopathic Parkinson's disease (IPD) in certain clinical features. The differential diagnosis between IPD and MSA is difficult because of the common of signs and symptoms common. The purpose of this study was comparison of cerebral glucose metabolic differences of SND, OPCA and IPD. The 18 F-FDG PET images of SND, OPCA and IPD patients were assessed by statistical pattern analysis using statistical parametric mapping (SPM) and image registration in order to determine the useful metabolic patterns. A total of 11 patients with MSA (5 SND: mean age 61.6±8.3 y, M/F 1/4; 6 OPCA: mean age 55.3±8.4 y, M/F 3/3), 8 patients (mean age 67.9 ± 10.7y; M/F: 3/5) with IPD were enrolled in this study. All subjects and 22 age matched normal controls underwent 18 F-FDG PET. Each of the SND, OPCA and IPD patients were individually compared with the normal control group using a two-sided t-test for SPM (P<0.05). The OPCA group showed significant hypometabolism in the cerebellum and pons compared to the control group, whereas in the patients with SND showed significant hypometabolism in the putamen. SPM also revealed pons, putamen hypometabolism in OPCA and SND patients compared with IPD patients. An assessment of the 18 F-FDG PET images using the image registration and statistical analysis might be a useful adjunct to a clinical examination when making a differential diagnosis of Parkinsonism.

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Logistic discriminant parametric mapping: a novel method for the pixel-based differential diagnosis of Parkinson's disease

Cited by 26 publications

References 33 publications

Anatomically standardised 99m Tc-ECD brain perfusion SPET allows accurate differentiation between healthy volunteers, multiple system atrophy and idiopathic Parkinson's disease

Anatomically standardised 99m Tc-ECD brain perfusion SPET allows accurate differentiation between healthy volunteers, multiple system atrophy and idiopathic Parkinson's disease

Comparison of region-of-interest analysis and human observers in the diagnosis of Parkinson's disease using [/sup 99m/Tc]TRODAT-1 and SPECT

Voxel based comparison of glucose metabolism in the differential diagnosis of the multiple system atrophy

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