Image-based machine learning model as a tool for classification of [18F]PR04.MZ PET images in patients with parkinsonian syndrome

Abstract

Parkinsonian syndrome (PS) is characterized by bradykinesia, resting tremor, rigidity, and encapsulates the clinical manifestation observed in various neurodegenerative disorders. Positron emission tomography (PET) imaging plays an important role in diagnosing PS by detecting the progressive loss of dopaminergic neurons. This study aimed to develop and compare five machine-learning models for the automatic classification of 204 [18F]PR04.MZ PET images, distinguishing between patients with PS and subjects without clinical evidence for dopaminergic deficit (SWEDD). Previously analyzed and classified by three expert blind readers into PS compatible (1) and SWEDDs (0), the dataset was processed in both two-dimensional and three-dimensional formats. Five widely used pattern recognition algorithms were trained and validated their performance. These algorithms were compared against the majority reading of expert diagnosis, considered the gold standard. Comparing the accuracy of 2D and 3D format images suggests that, without the depth dimension, a single image may overemphasize specific regions. Overall, three models outperformed with an accuracy greater than 98 %, demonstrating that machine-learning models trained with [18F]PR04.MZ PET images can provide a highly accurate and precise tool to support clinicians in automatic PET image analysis. This approach may be a first step in reducing the time required for interpretation, as well as increase certainty in the diagnostic process. © 2025 The Authors