IBZM SPECT and FDG PET in the differential diagnosis of Parkinsonian syndromes

Summary

Aim: Both IBZM SPECT and FDG PET may be used for differentiation between Parkinson's disease (PD) and atypical neurodegenerative parkinsonian syndromes (APS). However, there are only very limited data of both modalities in the same subjects. The present study compared both modalities with respect to inter-rater agreement in 30 patients with neurodegenerative parkinsonian syndromes (PS) confirmed by FP-CIT SPECT. Methods: IBZM SPECT and FDG PET were categorized as PD or APS by visual inspection of standardized report pages and statistical parametric maps (SPMs). Categorization was performed independently by five readers. Inter-rater agreement was quantified using Cohen's kappa κ. Results: IBZM SPECT resulted in PD and APS in 11 and 19 cases, respectively (majoritarian categorization). Inter-rater agreement was κ = 0.64 ± 0.10. FDG PET resulted in PD and APS in 12 and 18 cases, respectively (majoritarian categorization). Inter-rater agreement was κ = 0.68 ± 0.07. Majoritarian diagnosis disagreed between IBZM SPECT and FDG PET in 13 cases (43%). Semi-quantitative analysis of IBZM SPECT using the striatum-to-reference distribution volume ratio was in good agreement with visual categorization (area under ROC curve 0.92). Conclusion: In neurodegenerative PS, inter-rater agreement of visual analysis is substantial in both IBZM SPECT and FDG PET. Furthermore, (I) visual analysis of IBZM SPECT is reliable if adequate standardized image display is used, (II) visual analysis of FDG SPMs allows unique categorization as either PD or APS in most subjects, and (III) IBZM SPECT and FDG PET are discordant in a significant fraction of cases.

Zusammenfassung

IBZM SPECT und FDG PET können zur Differenzierung von Morbus Parkinson (PD) und atypischen neurodegenerativen Parkinson-Syndromen (APS) eingesetzt werden. Dennoch liegen nur wenige vergleichende Daten in denselben Patienten vor. Die vorliegende Studie vergleicht beide Modalitäten hinsichtlich Interrater-Reliabilität in 30 Patienten mit neurodegenerativen Parkinsonsyndrom (PS), das mittels FPCIT SPECT bestätigt wurde. Methodik: IBZM SPECT und FDG PET wurden nach visueller Befundung standardisierter Darstellungen als PD oder APS kategorisiert. Die Kategorisierung erfolgte durch fünf unabhängige Auswerter. Interrater-Reliabilität wurde mit Cohen's kappa κ gemessen. Ergebnisse: IBZM SPECT ergab PD in 11 Fällen, APS in 19 Fällen (Mehrheitsdiagnose). Die Interrater-Reliabilität war κ = 0,64 ± 0,10. FDG PET resultierte in PD in 12 Fällen, in APS in 18 Fällen (Mehrheitsdiagnose). Die Interrater-Reliabilität war κ = 0,68 ± 0,07. IBZM SPECT und FDG PET lieferten diskordante Ergebnisse in 13 Fällen (43%). Semiquantitative Analyse der IBZM SPECT mittels striatum-to-reference distribution volume ratio zeigte eine gute Übereinstimmung mit der visuellen Kategorisierung (Fläche unter der ROC Kurve 0,92). Schlussfolgerung: Bei neurodegenerativen PS (I) ist die visuelle Analyse der IBZM SPECT zuverlässig, sofern eine adäquate standardisierte Darstellung verwendet wird, (II) erlaubt die visuelle Analyse von FDG PET Statistical Parametric Maps in den meisten Fällen eine klare Kategorisierung als PD oder APS, (III) ist die Interrater-Reliabilität der visuellen Analyse substanziell, gleichermaßen für die IBZM SPECT als auch für die FDG PET, und (IV) liefern IBZM SPECT und FDG PET in einer signifikanten Zahl der Fälle diskordante Ergebnisse.

Keywords

Parkinsonian syndrome - SPECT - IBZM - PET - FDG - inter-rater agreement

Schlüsselwörter

Parkinson-Syndrom - SPECT - IBZM - PET - FDG - Interrater-Reliabilität

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