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Atrophy of cerebellar peduncles in essential tremor: a machine learning–based volumetric analysis

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Abstract

Background

Subtle cerebellar signs are frequently observed in essential tremor (ET) and may be associated with cerebellar dysfunction. This study aims to evaluate the macrostructural integrity of the superior, middle, and inferior cerebellar peduncles (SCP, MCP, ICP) and cerebellar gray and white matter (GM, WM) volumes in patients with ET, and compare these volumes between patients with and without cerebellar signs (ETc and ETnc).

Methods

Forty patients with ET and 37 age- and gender-matched healthy controls were recruited. Atlas-based region-of-interest analysis of the SCP, MCP, and ICP and automated analysis of cerebellar GM and WM volumes were performed. Peduncular volumes were employed in a multi-variate classification framework to attempt discrimination of ET from controls.

Results

Significant atrophy of bilateral MCP and ICP and bilateral cerebellar GM was observed in ET. Cerebellar signs were present in 20% of subjects with ET. Comparison of peduncular and cerebellar volumes between ETnc and ETc revealed atrophy of right SCP, bilateral MCP and ICP, and left cerebellar WM in ETc. The multi-variate classifier could discriminate between ET and controls with a test accuracy of 86.66%.

Conclusions

Patients with ET have significant atrophy of cerebellar peduncles, particularly the MCP and ICP. Additional atrophy of the SCP is observed in the ETc group. These abnormalities may contribute to the pathogenesis of cerebellar signs in ET.

Key Points

• Patients with ET have significant atrophy of bilateral middle and inferior cerebellar peduncles and cerebellar gray matter in comparison with healthy controls.

• Patients of ET with cerebellar signs have significant atrophy of right superior cerebellar peduncle, bilateral middle and inferior cerebellar peduncle, and left cerebellar white matter in comparison with ET without cerebellar signs.

• A multi-variate classifier employing peduncular volumes could discriminate between ET and controls with a test accuracy of 86.66%.

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Abbreviations

AAO:

Age at onset

DTI:

Diffusion tensor imaging

ET:

Essential tremor

ETc:

Essential tremor with cerebellar signs

ETnc:

Essential tremor without cerebellar signs

FTMRS:

Fahn-Tolosa-Marin tremor rating scale

GM:

Gray matter

HC:

Healthy controls

ICP:

Inferior cerebellar peduncle

MCP:

Middle cerebellar peduncle

MRI:

Magnetic resonance imaging

RF:

Random forest

ROC:

Receiver operating characteristics

ROI:

Region of interest

SCP:

Superior cerebellar peduncle

SVM:

Support vector machine

WM:

White matter

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Funding

This study has received funding by Department of Science and Technology – Science and Engineering Research Board (DST-SERB) (ECR/2016/000808) who provided partial funding for setting up the computing facility.

Author information

Authors and Affiliations

  1. Department of Clinical Neurosciences and Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India

    Shweta Prasad

  2. Symbiosis Center for Medical Image Analysis, Symbiosis International (Deemed) University, Lavale, Mulshi, Pune, Maharashtra, 412115, India

    Umang Pandey & Madhura Ingalhalikar

  3. Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India

    Jitender Saini

  4. Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Lavale, Mulshi, Pune, Maharashtra, 412115, India

    Madhura Ingalhalikar

  5. Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India

    Pramod Kumar Pal

Authors
  1. Shweta Prasad
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  2. Umang Pandey
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  3. Jitender Saini
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  4. Madhura Ingalhalikar
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  5. Pramod Kumar Pal
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Corresponding author

Correspondence to Pramod Kumar Pal.

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Guarantor

The scientific guarantor of this publication is Dr. Pramod Kumar Pal.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects are part of the cohort have been part of previous studies from our group:

Prasad S, Shah A, Bhalsing KS, Kumar KJ, Saini J, Ingalhalikar M, Pal PK. Abnormal hippocampal subfields are associated with cognitive impairment in Essential Tremor. Journal of Neural Transmission. 2019 Mar 19:1–0.

Prasad S, Rastogi B, Shah A, Bhalsing KS, Ingalhalikar M, Saini, J, Yadav R, Pal PK. DTI in essential tremor with and without rest tremor: Two sides of the same coin? Movement Disorders. 2018 September 28.

Bhalsing KS, Kumar KJ, Saini J, Yadav R, Gupta AK, Pal PK. White matter correlates of cognitive impairment in essential tremor. AJNR Am J Neuroradiol. 2015;36(3):448–45.

Bhalsing KS, Upadhyay N, Kumar KJ et al (2014) Association between cortical volume loss and cognitive impairments in essential tremor. Eur J Neurol 21:874–883.

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Prasad, S., Pandey, U., Saini, J. et al. Atrophy of cerebellar peduncles in essential tremor: a machine learning–based volumetric analysis. Eur Radiol 29, 7037–7046 (2019). https://doi.org/10.1007/s00330-019-06269-7

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  • DOI: https://doi.org/10.1007/s00330-019-06269-7

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