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<p>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 [<sup>123</sup>I]-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 <i>p</i> &gt; 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.</p>

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Discriminating between proposed Brain-First and Body-First Parkinson’s disease using conventional and radiomics-enhanced dopamine transporter SPECT image analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月20日

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  • Giovanni Palermo,
  • Gayanè Aghakhanyan,
  • Gabriele Bellini,
  • Sara Giannoni,
  • Gabriele Vadi,
  • Roberto Francischello,
  • Giovanna Nonne,
  • Maria Giulia Tedeschi,
  • Riccardo Morganti,
  • Daniela Frosini,
  • Nicola Pavese,
  • Duccio Volterrani,
  • Roberto Ceravolo

摘要

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.