Session Information
Date: Monday, June 5, 2017
Session Title: Parkinsonism, MSA, PSP (Secondary and Parkinsonism-Plus)
Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: To critically evaluate the degree to which structural and molecular radiologic metrics fulfill criteria for diagnostic biomarkers of progressive supranuclear palsy (PSP).
Background: PSP is a pathologically defined neurodegenerative tauopathy with a variety of clinical presentations including Richardson’s syndrome (PSP-RS) and other variant PSP syndromes (vPSP). A large body of neuroimaging research has been conducted over the past two decades, with different structural MRI and molecular PET/SPECT biomarkers proposed for PSP. However, it is unclear whether there is enough evidence to support the inclusion of any of these biomarkers in clinical diagnostic criteria for PSP.
Methods: We queried the PubMed, Cochrane, Medline, and PSYCInfo databases for original research articles using postmortem or NINDS-SPSP criteria as the diagnostic standard from 1996-2016. Articles were subjected to methodological analysis using the Scottish Intercollegiate Guidelines Network checklist and independent experts collated standardized information on study design, patient characteristics, imaging metric, findings, and diagnostic value for included articles. We defined a 5-level theoretical construct for the utility of neuroimaging biomarkers: 1=group-level findings, 2=biomarkers with demonstrable individual-level diagnostic utility, 3=biomarkers for early disease, 4=surrogate biomarkers of PSP pathology, and 5=definitive biomarkers of PSP pathology.
Results: The literature search identified 1737 abstracts, of which 193 articles met inclusion criteria and underwent review. Neuroimaging metrics that fulfilled criteria for level 2 biomarkers of PSP-RS included MRI midbrain measurements, frontal hypometabolism on FDG-PET, superior cerebellar peduncle measurements on diffusion MRI, striatal dopamine imaging and [18F]AV-1451 tau PET measurements. Midbrain measurements and frontal hypometabolism may provide level 3 biomarkers. No neuroimaging metric fulfilled criteria for level 4 or 5 biomarkers.
Conclusions: Data so far only supports neuroimaging biomarkers as level 2, or possibly level 3, biomarkers for PSP-RS. More work is needed to assess the value of these metrics in vPSP and in autopsy-confirmed cases to determine whether they could be useful level 4 biomarkers. Tau-PET imaging is promising but more work is needed to understand the biological underpinnings of the tau-PET signal in PSP.
To cite this abstract in AMA style:
J. Whitwell, G. Hoglinger, A. Antonini, Y. Bordelon, A. Boxer, C. Colosimo, R. Dodel, T. van Eimeren, L. Golbe, J. Kassubek, C. Kurz, I. Litvan, A. Pantelyat, G. Respondek, G. Rabinovici, J. Rowe, M. Stamelou, K. Josephs. An evaluation of the diagnostic utility of radiological biomarkers in PSP [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/an-evaluation-of-the-diagnostic-utility-of-radiological-biomarkers-in-psp/. Accessed June 14, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/an-evaluation-of-the-diagnostic-utility-of-radiological-biomarkers-in-psp/