ArticleFrontiers in neurology2026
Exploratory radiomics analysis of T1-weighted and FLAIR MRI in relation to Parkinson's disease motor subtypes.
Article in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Parkinson's disease motor subtypes, tremor-dominant (TD) and postural instability/gait difficulty (PIGD), differ in disease trajectory and prognosis, yet their classification depends on MDS-UPDRS-based clinical ratings that are susceptible to inter-rater variability and medication state. Purpose: This exploratory study investigated whether T1-weighted and FLAIR MRI radiomics show differential associations with TD and PIGD motor subtypes in Parkinson's disease, and whether the two sequences contribute complementary subtype-relevant information when combined in a multimodal framework. Methods: Baseline 3 T MRI data from 568 patients with Parkinson's disease in the PPMI cohort were analyzed (448 TD; 120 PIGD). Radiomics features were extracted from predefined basal ganglia and brainstem regions on T1-weighted and FLAIR images using PyRadiomics. Participants with only T1-weighted or only FLAIR MRI were used as sequence-specific development cohorts; those with both sequences formed a common evaluation cohort. ComBat harmonization was applied within each modality before cohort separation, followed by development-cohort-based feature selection and model fitting. L1-regularized logistic regression models were trained independently for each sequence and evaluated in the common cohort. A stacking model combined T1- and FLAIR-derived probability scores. Model performance was assessed using the area under the precision-recall curve (PR-AUC), balanced accuracy, and F1-score, and Shapley Additive Explanations (SHAP) analysis was used for interpretation. Results: In the common evaluation cohort ( Conclusion: T1-weighted and FLAIR MRI radiomics showed distinct subtype-associated error profiles and preliminary evidence of cross-sequence complementarity in this PPMI-based exploratory analysis. These findings require external validation before clinical interpretation, but provide a hypothesis-generating framework for multimodal structural radiomics research in Parkinson's disease motor subtype characterization.
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