Global scaling for semi-quantitative analysis in FP-CIT SPECT

Summary

Semi-quantitative characterization of dopamine transporter availability from single photon emission computed tomography (SPECT) with ¹²³I-ioflupane (FP-CIT) is based on uptake ratios relative to a reference region. The aim of this study was to evaluate the whole brain as reference region for semiquantitative analysis of FP-CIT SPECT. The rationale was that this might reduce statistical noise associated with the estimation of non-displaceable FP-CIT uptake. Patients, methods: 150 FP-CIT SPECTs were categorized as neurodegenerative or non-neurode- generative by an expert. Semi-quantitative analysis of specific binding ratios (SBR) was performed with a custom-made tool based on the Statistical Parametric Mapping software package using predefined regions of interest (ROIs) in the anatomical space of the Montreal Neurological Institute. The following reference regions were compared: predefined ROIs for frontal and occipital lobe and whole brain (without striata, thalamus and brainstem). Tracer uptake in the reference region was characterized by the mean, median or 75th percentile of its voxel intensities. The area (AUC) under the receiver operating characteristic curve was used as performance measure. Results: The highest AUC of 0.973 was achieved by the SBR of the putamen with the 75^th percentile in the whole brain as reference. The lowest AUC for the putamen SBR of 0.937 was obtained with the mean in the frontal lobe as reference. Conclusion: We recommend the 75^th percentile in the whole brain as reference for semi-quantitative analysis in FP-CIT SPECT. This combination provided the best agreement of the semi-quantitative analysis with visual evaluation of the SPECT images by an expert and, therefore, is appropriate to support less experienced physicians.

Zusammenfassung

Die semi-quantitative Charakterisierung der Verfügbarkeit von Dopamintransportern bei der Einzel-Photonen-Emissions-Tomographie (SPECT) mit ¹²³I-Ioflupan (FP-CIT) basiert auf dem Vergleich des Uptakes in striatalen Regionen mit einer Referenzregion. Ziel dieser Studie war die Evaluierung des gesamten Gehirns als Referenzregion für die semi-quantitative Analyse bei der FP-CIT SPECT. Die Rationale hierfür war, dass dies zu einer Reduktion des statistischen Fehlers bei der Bestimmung der unspezifischen FP-CIT-Aufnahme führen könnte. Patienten, Methoden: 150 FP-CIT SPECTs wurden retrospektiv eingeschlossen und mittels visueller Beurteilung durch einen erfahrenen Befunder als neurodegenerativ oder nicht neurodegenerativ kategorisiert. Für den benutzerunabhängigen Vergleich der verschiedenen Referenzregionen wurden semi-quantitative Analysen von SBR (specific binding ratios) vollautomatisch mit einem eigenen Tool durchgeführt, welches Routinen des Statistical Parametric Mapping SoftwarePakets und im anatomischen Raum des Montreal Neurological Institutes vordefinierte ROIs (regions of interest) verwendet. Es wurden folgende Referenzregionen miteinander verglichen: ROIs für den Frontal- und Okzipitallappen, sowie das gesamte Gehirn (ohne Striatum, Thalamus und Hirnstamm). Der Tracer Uptake in der Referenzregion wurde durch den Mittelwert, Median oder das 75. Perzentil der Voxelintensitäten in der Referenzregion charakterisiert. Die Fläche (AUC) unter der Receiver Operating Characteristic Kurve für die Differenzierung von neu- rodegenerativ und nicht neurodegenerativ wurde als Maß für das diagnostische Potential der semi-quantitativen Analyse verwendet. Ergebnisse: Die größte AUC (0,973) erzielte das SBR des Putamens mit dem 75. Perzentil im gesamten Gehirn als Referenzwert. Die kleinste AUC (0,937) für das Putamen SBR ergab sich mit dem Mittelwert des Frontallappens als Referenz. Schlussfolgerung: Wir empfehlen die Verwendung des 75. Perzentils im gesamten Gehirn als Referenz für die semi-quantitative Analyse von FP-CIT SPECTs. Dieser Referenzwert scheint zur besten Übereinstimmung von semi-quantitativer Analyse mit visueller Beurteilung der SPECT Bilder durch einen erfahrenen Experten zu führen und ist daher für die Unterstützung weniger erfahrener Befunder besonders geeignet.

Keywords

Dopamine transporter scintigraphy - ¹²³I-ioflupane - FP-CIT - DaTSCAN - semi-quantitative analysis - reference region - global scaling

Schlüsselwörter

Dopamintransporter-Szintigrafie - ¹²³I-Ioflupan - FP-CIT - DaTSCAN - semi-quantitative Analyse - Referenzregion - globale Skalierung

^* These authors contributed equally.

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