{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:47:49Z","timestamp":1791978469711,"version":"4.4.0"},"reference-count":112,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple system atrophy (MSA) is frequently misdiagnosed as Parkinson's disease (PD) or progressive supranuclear palsy (PSP), posing significant diagnostic challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of the study was to systematically evaluate the efficacy of machine learning (ML) in differentiating MSA from other neurodegenerative disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic search in PubMed, Embase, Cochrane Library, and Web of Science (up to July 5, 2025), including ML\u2010based MSA diagnostic studies. QUADAS\u20102 assessed bias risk, and a bivariate mixed\u2010effects model synthesized diagnostic metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 51 studies (comprising 3595 MSA patients and 18,189 total cases) were included in the systematic review. Of these, 38 studies contributed to the quantitative synthesis, whereas the remaining 13 studies were summarized qualitatively. In the primary analysis comparing MSA with PD, the pooled sensitivity was 0.86 (95% confidence interval [CI]: 0.81\u20130.90), specificity 0.87 (95% CI: 0.83\u20130.90), and the area under the summary receiver operating characteristic (SROC) curve (AUC) 0.93 (95% CI: 0.90\u20130.95). Overall, pooled sensitivity was 0.85 (95% CI: 0.82\u20130.88), specificity 0.92 (95% CI: 0.89\u20130.94), and AUC 0.94 (95% CI: 0.92\u20130.96). Positron emission tomography (PET)\u2010based models achieved optimal performance (sensitivity: 0.90, specificity: 0.96, AUC: 0.97), whereas deep learning models outperformed others (sensitivity: 0.93, specificity: 0.98, AUC: 0.99).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ML models integrating PET\/magnetic resonance imaging (MRI) data demonstrate high diagnostic accuracy for MSA. Future work should prioritize prospective multicenter validation and standardized external testing to facilitate clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70857","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:02:51Z","timestamp":1791975771000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Accuracy of Machine Learning in Differential Diagnosis of Multiple System Atrophy: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0962-459X","authenticated-orcid":false,"given":"Guisheng","family":"Wang","sequence":"first","affiliation":[{"name":"School of Clinical Medicine Ningxia Medical University  Yinchuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Nie","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine Nanchang University  Nanchang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meichen","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine Nanchang University  Nanchang China"},{"name":"School of Clinical Medicine Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"12","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1016\/S1474-4422(24)00396-X","article-title":"Multiple system atrophy: advances in pathophysiology, diagnosis, and treatment","volume":"23","author":"Krismer F","year":"2024","journal-title":"Lancet Neurol"},{"issue":"3","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1056\/NEJMra1311488","article-title":"Multiple\u2010system atrophy","volume":"372","author":"Fanciulli A","year":"2015","journal-title":"N Engl J Med"},{"issue":"1","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s41572-022-00382-6","article-title":"Multiple system atrophy","volume":"8","author":"Poewe W","year":"2022","journal-title":"Nat Rev Dis Primers"},{"issue":"5","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1212\/WNL.0000000000000641","article-title":"Low clinical diagnostic accuracy of early vs advanced Parkinson disease: clinicopathologic study","volume":"83","author":"Adler CH","year":"2014","journal-title":"Neurology"},{"issue":"3","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1046\/j.1468-1331.9.s3.3.x","article-title":"The differential diagnosis of Parkinson's disease","volume":"9","author":"Poewe W","year":"2002","journal-title":"Eur J Neurol"},{"issue":"10","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1212\/WNL.0000000000004311","article-title":"Clinical and genetic characteristics of sporadic adult\u2010onset degenerative ataxia","volume":"89","author":"Giordano I","year":"2017","journal-title":"Neurology"},{"issue":"6","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1002\/mds.29005","article-title":"The Movement Disorder Society criteria for the diagnosis of multiple system atrophy","volume":"37","author":"Wenning GK","year":"2022","journal-title":"Mov Disord"},{"issue":"10","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1002\/mds.29195","article-title":"Diffusion magnetic resonance imaging microstructural abnormalities in multiple system atrophy: a comprehensive review","volume":"37","author":"Pasquini J","year":"2022","journal-title":"Mov Disord"},{"issue":"7","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.3233\/JPD-223392","article-title":"A guide for the differential diagnosis of multiple system atrophy in clinical practice","volume":"12","author":"Kauppila LA","year":"2022","journal-title":"J Parkinsons Dis"},{"issue":"5","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s12311-022-01453-w","article-title":"A review on the clinical diagnosis of multiple system atrophy","volume":"22","author":"Stankovic I","year":"2023","journal-title":"Cerebellum"},{"issue":"4","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1007\/s00415-018-9121-3","article-title":"An update on advances in magnetic resonance imaging of multiple system atrophy","volume":"266","author":"Chelban V","year":"2019","journal-title":"J Neurol"},{"issue":"7","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1002\/mdc3.13052","article-title":"Can autonomic testing and imaging contribute to the early diagnosis of multiple system atrophy? 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