Discriminating between proposed Brain-First and Body-First Parkinson's disease using conventional and radiomics-enhanced dopamine transporter SPECT image analysis.
Discriminating between proposed Brain-First and Body-First Parkinson's disease using conventional and radiomics-enhanced dopamine transporter SPECT image analysis.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
Pisa, IT · Author affiliation
Center for Neurodegenerative Diseases-Parkinson's Disease and Movement Disorders, Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.Location evidence
Empoli, IT · Author affiliation
Neurology Department, San Giuseppe Hospital, Empoli, Italy.Location evidence
Newcastle upon Tyne, GB · Author affiliation
Clinical Ageing Research Unit, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.Location evidence
DK · Author affiliation · country only
Department of Clinical Medicine, Nuclear Medicine and PET, Aarhus University, Aarhus, Denmark.Location evidence
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Original abstract
Two Parkinson's disease subtypes-"Brain-First" and "Body-First"-have been proposed based on putative sites of onset. We examined whether "Body-First" markers relate to more symmetric striatal [123I]-FP-CIT uptake and whether imaging could discriminate the subtypes. In a retrospective cohort of 158 de novo PD patients imaged at diagnosis and followed for six years, patients were classified as "Body-First" if baseline REM sleep behavior disorder, constipation, or neurogenic orthostatic hypotension was present. DaTQUANT provided semiquantitative metrics; a radiomics-based classifier was also trained on DAT-SPECT images. Neither asymmetry indices nor other DaTQUANT measures differed between groups (all p > 0.05). Radiomics showed poor discrimination (AUC ≈ 0.46). Clinically, "Body-First" patients displayed a more adverse course, with higher MCI prevalence and greater MMSE decline and neuropsychiatric burden, whereas motor severity and complications were comparable between groups. These data suggest DAT-SPECT-conventional or radiomics-enhanced-does not separate proposed subtypes at diagnosis, although "Body-First" features forecast worse non-motor progression.