Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2012; 51(06): 244-251
DOI: 10.3413/Nukmed-0449-11-12

Original article

Schattauer GmbH

¹²³I-FP-CIT SPECT imaging of the dopaminergic state

Visual assessment of dopaminergic degeneration patterns reflects quantitative 2D operator-dependent and 3D operator-independent techniques ¹²³I-FP-CIT-SPECT zur Darstellung des Dopamin-statusVergleich der visuellen Beurteilung des dopaminergen Degenerationsmusters und der quantitiativen Auswertung mit 2D-manueller und 3D-automatisierter Methode

D. Kahraman

¹Department of Nuclear Medicine, University Hospital of Cologne, Germany

,

C. Eggers

²Department of Neurology, University Hospital of Cologne, Germany

,

A. Holstein

¹Department of Nuclear Medicine, University Hospital of Cologne, Germany

,

C. Schneider

¹Department of Nuclear Medicine, University Hospital of Cologne, Germany

,

D. J. Pedrosa

²Department of Neurology, University Hospital of Cologne, Germany

,

M. Dietlein

¹Department of Nuclear Medicine, University Hospital of Cologne, Germany

,

C. Kobe

¹Department of Nuclear Medicine, University Hospital of Cologne, Germany

,

L. Timmermann

²Department of Neurology, University Hospital of Cologne, Germany

,

M. Schmidt

¹Department of Nuclear Medicine, University Hospital of Cologne, Germany

› Author Affiliations

Summary

¹²³I-N-ω-fluoropropyl-2β-carbomethoxy-3β- (4-iodophenyl)nortropan (¹²³I-FP-CIT) single photon emission computed tomography (SPECT) can be evaluated by both visual assessment and quantitative analysis to assess the striatal dopamine state in vivo. The aim of our study was to investigate if visual assessment according to a predefined image grading scale reflects the results of quantitative assessment techniques. Patients, methods: 195 patients with a clinical diagnosis of idiopathic Parkinson's disease (n = 134), atypical parkinsonian syndrome (n = 47) or essential tremor (n = 14) were examined with ¹²³I-FP-CIT SPECT and included in this retrospective study. Results were analysed according to predefined visual patterns of dopaminergic degeneration and graded as normal (grade 5) or abnormal (grade 1–4) independently by three raters. Quantitative two-dimensional (2D) operator-dependent, manual and three-dimensional (3D) operator- independent, automated approaches were used for quantitative analysis of the specific ¹²³I-FP-CIT tracer binding ratio (SBR) for caudate and putamen. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of visual assessment of ¹²³I-FP-CIT SPECT for the diagnosis of a neuro degenerative Parkinson's syndrome were 99%, 86%, 99%, 86% and 98%, respectively. Visual assessment and quantitative analysis agreed well in evaluating the degree of dopaminergic degeneration. Significant differences (p < 0.001) were found between degeneration patterns. Only between the so-called eagle wing degeneration and the normal pattern no significant differences in SBR caudate and putamen were found, neither by the quantitative manual (p = 1.00; p = 0.196) nor by the quantitative automated method (p = 1.0; p = 0.785). Inter-rater agreement for visual assessment was substantial for all possible pairs of the three raters (κ = 0.70 to 0.74). Strong correlations were observed between the quantitative manual and quantitative automated methods for quantification of SBR caudatum (r = 0.920, r² = 0.846, p < 0.001) and SBR putamen (r = 0.908, r² = 0.824, p < 0.001). Conclusion: Visual assessment was highly consistent with the results obtained by quantitative analysis and showed a substantial inter-rater agreement between experienced and inexperienced raters. Our findings indicate that visual assessment might be a reliable analysis approach for clinical routine.

Zusammenfassung

Der Dopaminstatus in vivo kann mit der ¹²³I-FPCIT SPECT visuell und auch quantitativ untersucht werden. Ziel dieser Arbeit war es zu untersuchen, inwiefern die visuelle Beurteilung anhand einer definierten Skala die quantitativen Ergebnisse widerspiegelt. Patienten, Methoden: Insgesamt wurden 195 Patienten mit der klinischen Diagnose eines idiopathischen M. Parkinson (n = 134), eines atypischen Parkinson Syndroms (n = 47) oder mit essenziellem Tremor (n = 14) mittels ¹²³I-FP-CIT SPECT in die retrospektive Analyse eingeschlossen. Die Ergebnisse der ¹²³I-FP-CIT SPECT wurden visuell und quantitativ analysiert. Zur visuellen Beurteilung erfolgte die Einteilung der Ergebnisse anhand einer 5-stufigen Skala in normale (Grad 5) oder nicht normale Befunde (Grad 1–4) durch drei unabhängige Untersucher. Zusätzlich wurden die spezifischen striatalen Bindungswerte mittels einer zwei-dimensionalen (2D) manuellen Methode und einer drei-dimensionalen (3D) automatisierten Methode quantitativ ausgewertet. Ergebnisse: Sensitivität, Spezifität, PPV, NPV und diagnostische Genauigkeit der visuellen Analyse zur Diagnose eines neurodegenerativen Parkinson-Syndroms sind 99%, 86%, 99%, 86% und 98%. Weiterhin stimmten visuelle und quantitative Auswertung bei der Beurteilung des Ausmaßes der dopaminergen Neurodegeneration gut überein. Die visuellen Degnerationsmuster zeigten signifikant unterschiedliche striatale spezifische Bindungswerte (p < 0.001). Nur für das so genannte Eagle-wing-Degenerations- muster und Normalbefund konnten weder mit der quantitativ manuellen noch mit der quantitativ automatisierten Methode signifikanten Unterschiede in den spezifischen striatalen Bindungswerten gezeigt werden. Die Inter rater-Reliabilität für die visuelle Analyse war substanziell für alle möglichen Paare der drei Untersucher (κ zwischen 0.70 und 0.74). Die quantitative manuelle und quantitativ automatisierte Auswertung zeigten eine hohe Korrelation für die spezifischen striatalen Bindungswerte sowohl für das Caudatum (r = 0.920, r² = 0.846 p < 0.001) als auch für das Putamen (r = 0.908, r² = 0.824, p < 0.001). Schlussfolgerung: Die visuelle Analyse der ¹²³I-FP-CIT SPECT stimmte gut mit den Resultaten der quantitativen Auswertung überein bei substanzieller Interrater-Reliabilität. Diese Ergebnisse weisen daraufhin, dass die visuelle Auswertung, orientiert an einer vordefinierten Bewertungsskala, eine verlässliche Methode für die klinische Routine darstellt.

Keywords

Keywords

¹²³I-FP-CIT SPECT - Parkinson disease - visual assessment - quantitative analysis - dopaminergic degeneration pattern

Schlüsselwörter

Schlüsselwörter

¹²³I-FP-CIT-SPECT - Parkinson-Syndrom - visuelle Analyse - quantitative Analyse - dopaminerge Neurodegenerationsmuster

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