Assessing the value of MRI for the diagnosis of tauopathies

MRI and tauopathies

Progressive supranuclear palsy (PSP) and Corticobasal Degeneration (CBD) are two subtypes of Frontotemporal Lobular Degeneration characterized by cerebral accumulation of tau protein (tauopathies). These diseases present classically with motor symptoms that include postural instability, difficulty in ocular movements, and limb control. However, in recent years it has been shown that they can also occur before the onset of motor symptoms. These cases, also known as clinical variants, are characterized by subtle changes in cognitive function in speech and language. Despite the frequency of these diseases, we do not currently have good biomarkers for their diagnosis. It has been suggested in the past that brain magnetic resonance imaging (MRI) may help increase diagnostic certainty, but this diagnostic tool has not been adequately validated to date in this context.

What have we done in this study?

This prospective diagnostic study included participants with 4-repeat tauopathies (4RT), PSP, CBD, other neurodegenerative diseases and available MRI who appeared in the University of California, San Francisco, Memory and Aging Center database. Data were collected from October 27, 1994, to September 29, 2019. Data were analyzed from March 1 to September 14, 2021

Main Outcomes and Measures 

The main outcome of this study was the neuropathological diagnosis of PSP or CBD. The clinical diagnosis at the time of the MRI acquisition was noted. The imaging measures included the MRPI, cortical thickness, subcortical volumes, including the midbrain, pons, and superior cerebellar peduncle volumes. Multinomial logistic regression models (MLRM) combining different cortical and subcortical regions were defined to discriminate between PSP, CBD, and other pathologies. The areas under the receiver operating characteristic curves (AUROC) and cutoffs were calculated to differentiate between PSP, CBD, and other diseases.

Main results

Of the 326 included participants, 176 (54%) were male, and the mean (SD) age at MRI was 64.1 (8.0) years. The MRPI showed good diagnostic accuracy for the differentiation between PSP and all other pathologies (accuracy, 87%; AUROC, 0.90; 95% CI, 0.86-0.95) and between 4RT and other pathologies (accuracy, 80%; AUROC, 0.82; 95% CI, 0.76-0.87), but did not allow the discrimination of participants with CBD. Its diagnostic accuracy was lower in the subgroup of patients without the canonical PSP–Richardson syndrome (PSP-RS) or probable corticobasal syndrome (CBS) at MRI. MLRM combining cortical and subcortical measurements showed the highest accuracy for the differentiation between PSP and other pathologies (accuracy, 95%; AUROC, 0.98; 95% CI, 0.97-0.99), CBD and other pathologies (accuracy, 83%; AUROC, 0.86; 95% CI, 0.81-0.91), 4RT and other pathologies (accuracy, 89%; AUROC, 0.94; 95% CI, 0.92-0.97), and PSP and CBD (accuracy, 91%; AUROC, 0.95; 95% CI, 0.91-0.99), even in participants without PSP-RS or CBS at MRI.

Illan - Sant Pau Memory Unit - MRI - Barcelona
Cortical and subcortical effect sizes for the differentiation of progressive supranuclear palsy and other pathologies

Relevance of the study  

In this study, the combination of widely available cortical and subcortical measures of atrophy on MRI discriminated between PSP, CBD, and other pathologies and could be used to support the diagnosis of 4RT in clinical practice

More information

Diagnostic Accuracy of Magnetic Resonance Imaging Measures of Brain Atrophy Across the Spectrum of Progressive Supranuclear Palsy and Corticobasal Degeneration. Illán-Gala I, Falgàs N Friedberg A, et al., JAMA Netw Open. 2022

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