Abstract
BACKGROUND AND OBJECTIVE: Diffusion tensor imaging (DTI) can be used to tract-wise map correlates of the sequential disease progression and, therefore, to assess disease stages of amyotrophic lateral sclerosis (ALS) in vivo. According to a threshold-based sequential scheme, a classification of ALS patients into disease stages is possible, however, several patients cannot be staged for methodological reasons. This study aims to implement a multivariate Bayesian classification algorithm for disease stage prediction at an individual ALS patient level based on DTI metrics of involved tract systems to improve disease stage mapping. METHODS: The analysis of fiber tracts involved in each stage of ALS was performed in 325 ALS patients and 130 age- and gender-matched healthy controls. Based on Bayes' theorem and in accordance with the sequential disease progression, a multistage classifier was implemented. Patients were categorized into in vivo DTI stages using the threshold-based method and the Bayesian algorithm. By the margin of confidence, the reliability of the Bayesian categorizations was accessible. RESULTS: Based on the Bayesian multistage classifier, 88% of all ALS patients could be assigned into an ALS stage compared to 77% using the threshold-based staging scheme. Additionally, the confidence of all classifications could be estimated. CONCLUSIONS: By the application of the multi-stage Bayesian classifier, an individualized in vivo cerebral staging of ALS patients was possible based on the sequentially involved tract systems and, furthermore, the reliability of the respective classifications could be determined. The Bayesian classification algorithm is an improvement of the threshold-based staging method and could provide a framework for extending the DTI-based in vivo cerebral staging in ALS.