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CC BY 4.0 · World J Nucl Med 2023; 22(01): 015-021
DOI: 10.1055/s-0042-1757290
Original Article

Semiquantitative Approach to Amyloid Positron Emission Tomography Interpretation in Clinical Practice

Ana M. Franceschi 
1   Neuroradiology Section, Department of Radiology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
David R. Petrover 
1   Neuroradiology Section, Department of Radiology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
,
Luca Giliberto
2   Institute for Neurology and Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
3   Litwin-Zucker Research Center, Feinstein Institutes for Medical Research, Northwell Health, New York, United States
,
Sean A. P. Clouston
4   Department of Family, Population and Preventative Medicine and Program in Public Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
,
Marc L. Gordon 
3   Litwin-Zucker Research Center, Feinstein Institutes for Medical Research, Northwell Health, New York, United States
5   Departments of Neurology and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, United States
› Institutsangaben Funding None.
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Abstract

Objective Amyloid positron emission tomography (PET) plays a vital role in the in vivo detection of β-amyloid accumulation in Alzheimer's disease. Increasingly, trainees and infrequent readers are relying on semiquantitative analyses to support clinical diagnostic efforts. Our objective was to determine if the visual assessment of amyloid PET may be facilitated by relying on semiquantitative analysis.

Methods We conducted a retrospective review of [18F]-florbetaben PET/computed tomographies (CTs) from 2016 to 2018. Visual interpretation to determine Aβ+ status was conducted by two readers blinded to each other's interpretation. Scans were then post-processed utilizing the MIMneuro software, which generated regional-based semiquantitative Z-scores indicating cortical Aβ-burden.

Results Of 167 [18F]-florbetaben PET/CTs, 92/167 (reader-1) and 101/167 (reader-2) were positive for amyloid deposition (agreement = 92.2%, κ = 0.84). Additional nine scans were identified as possible Aβ-positive based solely on semiquantitative analyses. Largest semiquantitative differences were identified in the left frontal lobe (Z = 7.74 in Aβ + ; 0.50 in Aβ − ). All unilateral regions showed large statistically significant differences in Aβ-burden (P ≤ 2.08E-28). Semiquantitative scores were highly sensitive to Aβ+ status and accurate in their ability to identify amyloid positivity, defined as a positive scan by both readers (AUC ≥ 0.90 [0.79–1.00]). Spread analyses suggested that amyloid deposition was most severe in the left posterior cingulate gyrus. The largest differences between Aβ +/Aβ− were in the left frontal lobe. Analyses using region-specific cutoffs indicated that the presence of amyloid in the temporal and anterior cingulate cortex, while exhibiting relatively low Z-scores, was most common.

Conclusion Visual assessment and semiquantitative analysis provide highly congruent results, thereby enhancing reader confidence and improving scan interpretation. This is particularly relevant, given recent advances in amyloid-targeting disease-modifying therapeutics.

Keywords

β-amyloid - 18F-florbetaben - PET/CT - brain PET - Alzheimer's disease


Publikationsverlauf

Artikel online veröffentlicht:
28. Oktober 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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