Abstract：
BACKGROUND: Diagnostic criteria for progressive supranuclear palsy (PSP) include midbrain atrophy in MRI and hypometabolism in [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET) as supportive features. Due to limited data regarding their relative and sequential value, there is no recommendation for an algorithm to combine both modalities to increase diagnostic accuracy. This study evaluated the added value of sequential imaging using state-of-the-art methods to analyse the images regarding PSP features.
METHODS: The retrospective study included 41 PSP patients, 21 with Richardson\'s syndrome (PSP-RS), 20 with variant PSP phenotypes (vPSP) and 46 sex- and age-matched healthy controls. A pretrained support vector machine (SVM) for the classification of atrophy profiles from automatic MRI volumetry was used to analyse T1w-MRI (output: MRI-SVM-PSP score). Covariance pattern analysis was applied to compute the expression of a predefined PSP-related pattern in FDG-PET (output: PET-PSPRP expression score).
RESULTS: The area under the receiver operating characteristic curve for the detection of PSP did not differ between MRI-SVM-PSP and PET-PSPRP expression score (p≥0.63): about 0.90, 0.95 and 0.85 for detection of all PSP, PSP-RS and vPSP. The MRI-SVM-PSP score achieved about 13% higher specificity and about 15% lower sensitivity than the PET-PSPRP expression score. Decision tree models selected the MRI-SVM-PSP score for the first branching and the PET-PSPRP expression score for a second split of the subgroup with normal MRI-SVM-PSP score, both in the whole sample and when restricted to PSP-RS or vPSP.
CONCLUSIONS: FDG-PET provides added value for PSP-suspected patients with normal/inconclusive T1w-MRI, regardless of PSP phenotype and the methods to analyse the images for PSP-typical features.
METHODS: The retrospective study included 41 PSP patients, 21 with Richardson\'s syndrome (PSP-RS), 20 with variant PSP phenotypes (vPSP) and 46 sex- and age-matched healthy controls. A pretrained support vector machine (SVM) for the classification of atrophy profiles from automatic MRI volumetry was used to analyse T1w-MRI (output: MRI-SVM-PSP score). Covariance pattern analysis was applied to compute the expression of a predefined PSP-related pattern in FDG-PET (output: PET-PSPRP expression score).
RESULTS: The area under the receiver operating characteristic curve for the detection of PSP did not differ between MRI-SVM-PSP and PET-PSPRP expression score (p≥0.63): about 0.90, 0.95 and 0.85 for detection of all PSP, PSP-RS and vPSP. The MRI-SVM-PSP score achieved about 13% higher specificity and about 15% lower sensitivity than the PET-PSPRP expression score. Decision tree models selected the MRI-SVM-PSP score for the first branching and the PET-PSPRP expression score for a second split of the subgroup with normal MRI-SVM-PSP score, both in the whole sample and when restricted to PSP-RS or vPSP.
CONCLUSIONS: FDG-PET provides added value for PSP-suspected patients with normal/inconclusive T1w-MRI, regardless of PSP phenotype and the methods to analyse the images for PSP-typical features.
摘要：
背景：进行性核上性麻痹（PSP）的诊断标准包括MRI中脑萎缩和[18F]氟代脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）的低代谢作为支持特征。由于有关其相对值和顺序值的数据有限，没有推荐将两种模式结合起来以提高诊断准确性的算法.这项研究使用最先进的方法评估了顺序成像的附加值，以分析有关PSP特征的图像。
方法：回顾性研究包括41例PSP患者，21患有理查森综合征（PSP-RS），具有变体PSP表型(vPSP)的20个和46个性别和年龄匹配的健康对照。使用预训练的支持向量机（SVM）对来自自动MRI容积法的萎缩谱进行分类，以分析T1w-MRI（输出：MRI-SVM-PSP评分）。应用协方差模式分析来计算FDG-PET中预定义的PSP相关模式的表达(输出:PET-PSPRP表达评分)。
结果：MRI-SVM-PSP和PET-PSPRP表达评分之间检测PSP的受试者工作特征曲线下面积没有差异（p≥0.63）：检测所有PSP约为0.90、0.95和0.85，PSP-RS和vPSP。与PET-PSPRP表达评分相比，MRI-SVM-PSP评分的特异性高约13％，敏感性低约15％。决策树模型选择第一个分支的MRI-SVM-PSP评分和第二个分裂的具有正常MRI-SVM-PSP评分的亚组的PET-PSPRP表达评分,在整个样本中以及仅限于PSP-RS或vPSP时。
结论：FDG-PET为疑似PSP的T1w-MRI正常/不确定的患者提供了附加价值，无论PSP表型和分析PSP典型特征的图像的方法。
方法：回顾性研究包括41例PSP患者，21患有理查森综合征（PSP-RS），具有变体PSP表型(vPSP)的20个和46个性别和年龄匹配的健康对照。使用预训练的支持向量机（SVM）对来自自动MRI容积法的萎缩谱进行分类，以分析T1w-MRI（输出：MRI-SVM-PSP评分）。应用协方差模式分析来计算FDG-PET中预定义的PSP相关模式的表达(输出:PET-PSPRP表达评分)。
结果：MRI-SVM-PSP和PET-PSPRP表达评分之间检测PSP的受试者工作特征曲线下面积没有差异（p≥0.63）：检测所有PSP约为0.90、0.95和0.85，PSP-RS和vPSP。与PET-PSPRP表达评分相比，MRI-SVM-PSP评分的特异性高约13％，敏感性低约15％。决策树模型选择第一个分支的MRI-SVM-PSP评分和第二个分裂的具有正常MRI-SVM-PSP评分的亚组的PET-PSPRP表达评分,在整个样本中以及仅限于PSP-RS或vPSP时。
结论：FDG-PET为疑似PSP的T1w-MRI正常/不确定的患者提供了附加价值，无论PSP表型和分析PSP典型特征的图像的方法。
