title: Differentiation of neurodegenerative parkinsonian syndromes by volumetric magnetic resonance imaging analysis and support vector machine classification.
abstract: Clinical differentiation of parkinsonian syndromes is still challenging.
  
  
  
  A fully automated method for quantitative MRI analysis using atlas-based volumetry combined with support vector machine classification was evaluated for differentiation of parkinsonian syndromes in a multicenter study.
  
  
  
  Atlas-based volumetry was performed on MRI data of healthy controls (n = 73) and patients with PD (204), PSP with Richardson's syndrome phenotype (106), MSA of the cerebellar type (21), and MSA of the Parkinsonian type (60), acquired on different scanners. Volumetric results were used as input for support vector machine classification of single subjects with leave-one-out cross-validation.
  
  
  
  The largest atrophy compared to controls was found for PSP with Richardson's syndrome phenotype patients in midbrain (-15%), midsagittal midbrain tegmentum plane (-20%), and superior cerebellar peduncles (-13%), for MSA of the cerebellar type in pons (-33%), cerebellum (-23%), and middle cerebellar peduncles (-36%), and for MSA of the parkinsonian type in the putamen (-23%). The majority of binary support vector machine classifications between the groups resulted in balanced accuracies of >80%. With MSA of the cerebellar and parkinsonian type combined in one group, support vector machine classification of PD, PSP and MSA achieved sensitivities of 79% to 87% and specificities of 87% to 96%. Extraction of weighting factors confirmed that midbrain, basal ganglia, and cerebellar peduncles had the largest relevance for classification.
  
  
  
  Brain volumetry combined with support vector machine classification allowed for reliable automated differentiation of parkinsonian syndromes on single-patient level even for MRI acquired on different scanners. © 2016 International Parkinson and Movement Disorder Society.
authors.affiliation: Swiss Epilepsy Centre, Klinik Lengg, Zurich, Switzerland.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Huppertz
authors.affiliation: Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.
authors.forename: Leona
authors.initials: L
authors.lastname: Möller
authors.affiliation: Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Südmeyer
authors.affiliation: Department of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hilker
authors.affiliation: Department of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Hattingen
authors.affiliation: Department of Neuroradiology, Medical University Center Freiburg, Freiburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Egger
authors.affiliation: Department of Neurology, Medical University Center Freiburg, Freiburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Amtage
authors.affiliation: Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.|Department of Neurology, Technische Universität München, Munich, Germany.|German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
authors.forename: Gesine
authors.initials: G
authors.lastname: Respondek
authors.affiliation: Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.
authors.forename: Maria
authors.identifier: 0000-0003-1668-9925
authors.initials: M
authors.lastname: Stamelou
authors.affiliation: Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Alfons
authors.identifier: 0000-0002-6414-7939
authors.initials: A
authors.lastname: Schnitzler
authors.affiliation: Department of Neurology, University of Ulm, Ulm, Germany.
authors.forename: Elmar H
authors.initials: EH
authors.lastname: Pinkhardt
authors.affiliation: Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.affiliation: Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Knake
authors.affiliation: Department of Neurology, University of Ulm, Ulm, Germany. jan.kassubek@uni-ulm.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Kassubek
authors.affiliation: Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.|Department of Neurology, Technische Universität München, Munich, Germany.|German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
authors.forename: Günter U
authors.initials: GU
authors.lastname: Höglinger
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019578:Multiple System Atrophy / Q000000981:diagnostic imaging*; D020734:Parkinsonian Disorders / Q000145:classification* / Q000000981:diagnostic imaging*; D060388:Support Vector Machine; D013494:Supranuclear Palsy, Progressive / Q000000981:diagnostic imaging*
keywords: Parkinson's disease; magnetic resonance imaging; multiple system atrophy; progressive supranuclear palsy; support vector machine; volumetry