• Ralph Buchert, Hans-Jürgen Huppertz, Florian Wegner, Georg Berding, Matthias Brendel, Ivayla Apostolova, Carsten Buhmann, Monika Poetter-Nerger, Alexander Dierks, Sabrina Katzdobler, Martin Klietz, Johannes Levin, Nima Mahmoudi, Andreas Rinscheid, Andrea Quattrone, Sophia Rogozinski, Jost-Julian Rumpf, Christine Schneider, Sophia Stoecklein, Phoebe G Spetsieris, David Eidelberg, Osama Sabri, Henryk Barthel, Mike P Wattjes, Günter Höglinger, and Alzheimer’s Disease Neuroimaging Initiative.
• Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany r.buchert@uke.de.
• J. Neurol. Neurosurg. Psychiatr. 2024 Aug 8.

BackgroundDiagnostic 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.MethodsThe 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).ResultsThe 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.ConclusionsFDG-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.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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