Web-based Automated Imaging Differentiation of Parkinsonism - SUMMARY
Across the globe, there has been a considerable growth in the number of people diagnosed with Parkinsonism.
Estimates indicate that from 1990 to 2015 the number of Parkinsonism diagnoses doubled, with more than 6
million people currently carrying the diagnosis, and by year 2040, 12 and 14.2 million people will be diagnosed
with Parkinsonism. Parkinson’s disease (PD), multiple system atrophy Parkinsonian variant (MSAp), and
progressive supranuclear palsy (PSP) are neurodegenerative forms of Parkinsonism, which can be difficult to
diagnose as they share similar motor and non-motor features, and they each have an increased chance of
developing dementia. In the first five years of a PD diagnosis, about 58% of PD are misdiagnosed, and of these
misdiagnoses about half have either MSA or PSP. Since PD, MSAp, and PSP require unique treatment plans
and different medications, and clinical trials testing new medications require the correct diagnosis, there is an
urgent need for both clinic ready and clinical-trial ready markers for differential diagnosis of PD, MSAp, and PSP.
Over the past decade, we have developed diffusion imaging as an innovative biomarker for differentiating PD,
MSAp, and PSP. In this proposal, we will leverage our extensive experience to create a web-based software tool
that can process diffusion imaging data from anywhere in the world. We will disseminate and test the tool in the
largest prospective cohort of participants with Parkinsonism (PD, MSAp, PSP), working closely with the
Parkinson Study Group. The reason to test this in the Parkinson Study Group network, is because they are the
community that evaluates Phase II and Phase III clinical trials in Parkinsonism. This web-based software tool
will be capable of reading raw diffusion imaging data, performing quality assurance procedures, analyzing the
data using a validated pipeline, and providing imaging metrics and diagnostic probability. We will test the
performance of the wAID-P by enrolling 315 total subjects (105 PD, 105 MSAp, 105 PSP) across 21 sites in the
Parkinson Study Group. Each site will perform imaging, clinical scales, diagnosis, and will upload the data to
the web-based software tool. The clinical diagnosis will be blinded to the diagnostic algorithm and the imaging
diagnosis will be compared to the movement disorders trained neurologist diagnosis. We will also enroll a portion
of the cohort into a brain bank to ascertain pathological confirmation and to test the algorithm against cases with
post-mortem diagnoses. The final outcome will be to disseminate a validated diagnostic algorithm to the
Parkinson neurological and radiological community and to make it available to all on a website.