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Arbizu J, Morbelli S, Minoshima S, Barthel H, Kuo P, Van Weehaeghe D, Horner N, Colletti PM, Guedj E. SNMMI Procedure Standard/EANM Practice Guideline for Brain [ 18F]FDG PET Imaging, Version 2.0. J Nucl Med 2024:jnumed.124.268754. [PMID: 39419552 DOI: 10.2967/jnumed.124.268754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 09/05/2024] [Indexed: 10/19/2024] Open
Abstract
PREAMBLEThe Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The EANM was founded in 1985. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine.The SNMMI and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated.Each practice guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized.These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, both the SNMMI and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines.The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment.Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
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Affiliation(s)
- Javier Arbizu
- Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain;
| | - Silvia Morbelli
- Nuclear Medicine Unit, Citta'della Scenza e della Salute di Torino, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Centre, Leipzig, Germany
| | | | | | - Neil Horner
- Atlantic Health System, Morristown, New Jersey, and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Patrick M Colletti
- Department of Radiology and Nuclear Medicine, University of Southern California, Los Angeles, California; and
| | - Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille University, Marseille, France
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Guedj E, Varrone A, Boellaard R, Albert NL, Barthel H, van Berckel B, Brendel M, Cecchin D, Ekmekcioglu O, Garibotto V, Lammertsma AA, Law I, Peñuelas I, Semah F, Traub-Weidinger T, van de Giessen E, Van Weehaeghe D, Morbelli S. EANM procedure guidelines for brain PET imaging using [ 18F]FDG, version 3. Eur J Nucl Med Mol Imaging 2021; 49:632-651. [PMID: 34882261 PMCID: PMC8803744 DOI: 10.1007/s00259-021-05603-w] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022]
Abstract
The present procedural guidelines summarize the current views of the EANM Neuro-Imaging Committee (NIC). The purpose of these guidelines is to assist nuclear medicine practitioners in making recommendations, performing, interpreting, and reporting results of [18F]FDG-PET imaging of the brain. The aim is to help achieve a high-quality standard of [18F]FDG brain imaging and to further increase the diagnostic impact of this technique in neurological, neurosurgical, and psychiatric practice. The present document replaces a former version of the guidelines that have been published in 2009. These new guidelines include an update in the light of advances in PET technology such as the introduction of digital PET and hybrid PET/MR systems, advances in individual PET semiquantitative analysis, and current broadening clinical indications (e.g., for encephalitis and brain lymphoma). Further insight has also become available about hyperglycemia effects in patients who undergo brain [18F]FDG-PET. Accordingly, the patient preparation procedure has been updated. Finally, most typical brain patterns of metabolic changes are summarized for neurodegenerative diseases. The present guidelines are specifically intended to present information related to the European practice. The information provided should be taken in the context of local conditions and regulations.
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Affiliation(s)
- Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France. .,Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
| | - Andrea Varrone
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Healthcare Services, Stockholm, Sweden
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University, Leipzig, Germany
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany.,German Centre of Neurodegenerative Diseases (DZNE), Site Munich, Bonn, Germany
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Ozgul Ekmekcioglu
- Sisli Hamidiye Etfal Education and Research Hospital, Nuclear Medicine Dept., University of Health Sciences, Istanbul, Turkey
| | - Valentina Garibotto
- NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Iván Peñuelas
- Department of Nuclear Medicine, Clinica Universidad de Navarra, IdiSNA, University of Navarra, Pamplona, Spain
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Lille, France
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Solnes LB, Jacobs AH, Coughlin JM, Du Y, Goel R, Hammoud DA, Pomper MG. Central Nervous System Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mairal E, Doyen M, Rivasseau-Jonveaux T, Malaplate C, Guedj E, Verger A. Clinical impact of digital and conventional PET control databases for semi-quantitative analysis of brain 18F-FDG digital PET scans. EJNMMI Res 2020; 10:144. [PMID: 33258085 PMCID: PMC7704892 DOI: 10.1186/s13550-020-00733-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Digital PET cameras markedly improve sensitivity and spatial resolution of brain 18F-FDG PET images compared to conventional cameras. Our study aimed to assess whether specific control databases are required to improve the diagnostic performance of these recent advances. METHODS We retrospectively selected two groups of subjects, twenty-seven Alzheimer's Disease (AD) patients and twenty-two healthy control (HC) subjects. All subjects underwent a brain 18F-FDG PET on a digital camera (Vereos, Philips®). These two group (AD and HC) are compared, using a Semi-Quantitative Analysis (SQA), to two age and sex matched controls acquired with a digital PET/CT (Vereos, Philips®) or a conventional PET/CT (Biograph 6, Siemens®) camera, at group and individual levels. Moreover, individual visual interpretation of SPM T-maps was provided for the positive diagnosis of AD by 3 experienced raters. RESULTS At group level, SQA using digital controls detected more marked hypometabolic areas in AD (+ 116 cm3 at p < 0.001 uncorrected for the voxel, corrected for the cluster) than SQA using conventional controls. At the individual level, the accuracy of SQA for discriminating AD using digital controls was higher than SQA using conventional controls (86% vs. 80%, p < 0.01, at p < 0.005 uncorrected for the voxel, corrected for the cluster), with higher sensitivity (89% vs. 78%) and similar specificity (82% vs. 82%). These results were confirmed by visual analysis (accuracies of 84% and 82% for digital and conventional controls respectively, p = 0.01). CONCLUSION There is an urgent need to establish specific digital PET control databases for SQA of brain 18F-FDG PET images as such databases improve the accuracy of AD diagnosis.
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Affiliation(s)
- Elise Mairal
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Université de Lorraine, Rue du Morvan, 54500, Vandoeuvre-les-Nancy, France
| | - Matthieu Doyen
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Université de Lorraine, Rue du Morvan, 54500, Vandoeuvre-les-Nancy, France.,IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France
| | - Thérèse Rivasseau-Jonveaux
- Clinical Memory and Research Center, Department of Geriatrics, CHRU Nancy, Université de Lorraine, 2LPN EA 7489, 54000, Nancy, France
| | - Catherine Malaplate
- Department of Biochemistry, Molecular Biology and Nutrition CHRU Nancy, Université de Lorraine, 54000, Nancy, France
| | - Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Université de Lorraine, Rue du Morvan, 54500, Vandoeuvre-les-Nancy, France. .,IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France.
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Lindström E, Oddstig J, Danfors T, Jögi J, Hansson O, Lubberink M. Image reconstruction methods affect software-aided assessment of pathologies of [ 18F]flutemetamol and [ 18F]FDG brain-PET examinations in patients with neurodegenerative diseases. NEUROIMAGE-CLINICAL 2020; 28:102386. [PMID: 32882645 PMCID: PMC7476314 DOI: 10.1016/j.nicl.2020.102386] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022]
Abstract
[18F]Flutemetamol and [18F]FDG image reconstruction. Software-aided assessment of neurodegenerative disease patients. New developments in brain PET image reconstruction affect quantitative measures. Evaluation of SUVR and z-score measures. Normalizing to pons and whole brain induced greater absolute differences between reconstructions.
Purpose To assess how some of the new developments in brain positron emission tomography (PET) image reconstruction affect quantitative measures and software-aided assessment of pathology in patients with neurodegenerative diseases. Methods PET data were grouped into four cohorts: prodromal Alzheimer’s disease patients and controls receiving [18F]flutemetamol, and neurodegenerative disease patients and controls receiving [18F]FDG PET scans. Reconstructed images were obtained by ordered-subsets expectation maximization (OSEM; 3 iterations (i), 16/34 subsets (s), 3/5-mm filter, ±time-of-flight (TOF), ±point-spread function (PSF)) and block-sequential regularized expectation maximization (BSREM; TOF, PSF, β-value 75–300). Standardized uptake value ratios (SUVR) and z-scores were calculated (CortexID Suite, GE Healthcare) using cerebellar gray matter, pons, whole cerebellum and whole brain as reference regions. Results In controls, comparable results to the normal database were obtained with OSEM 3i/16 s 5-mm reconstruction. TOF, PSF and BSREM either increased or decreased the relative uptake difference to the normal subjects’ database within the software, depending on the tracer and chosen reference area, i.e. resulting in increased absolute z-scores. Normalizing to pons and whole brain for [18F]flutemetamol and [18F]FDG, respectively, increased absolute differences between reconstructions methods compared to normalizing to cerebellar gray matter and whole cerebellum when applying TOF, PSF and BSREM. Conclusions Software-aided assessment of patient pathologies should be used with caution when employing other image reconstruction methods than those used for acquisition of the normal database.
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Affiliation(s)
- Elin Lindström
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden; Medical Physics, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
| | - Jenny Oddstig
- Radiation Physics, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Torsten Danfors
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Jonas Jögi
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, SE-221 00 Lund, Sweden; Memory Clinic, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Mark Lubberink
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden; Medical Physics, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
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Brugnolo A, De Carli F, Pagani M, Morbelli S, Jonsson C, Chincarini A, Frisoni GB, Galluzzi S, Perneczky R, Drzezga A, van Berckel BNM, Ossenkoppele R, Didic M, Guedj E, Arnaldi D, Massa F, Grazzini M, Pardini M, Mecocci P, Dottorini ME, Bauckneht M, Sambuceti G, Nobili F. Head-to-Head Comparison among Semi-Quantification Tools of Brain FDG-PET to Aid the Diagnosis of Prodromal Alzheimer's Disease. J Alzheimers Dis 2020; 68:383-394. [PMID: 30776000 DOI: 10.3233/jad-181022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several automatic tools have been implemented for semi-quantitative assessment of brain [18]F-FDG-PET. OBJECTIVE We aimed to head-to-head compare the diagnostic performance among three statistical parametric mapping (SPM)-based approaches, another voxel-based tool (i.e., PALZ), and a volumetric region of interest (VROI-SVM)-based approach, in distinguishing patients with prodromal Alzheimer's disease (pAD) from controls. METHODS Sixty-two pAD patients (MMSE score = 27.0±1.6) and one hundred-nine healthy subjects (CTR) (MMSE score = 29.2±1.2) were enrolled in five centers of the European Alzheimer's Disease Consortium. The three SPM-based methods, based on different rationales, included 1) a cluster identified through the correlation analysis between [18]F-FDG-PET and a verbal memory test (VROI-1), 2) a VROI derived from the comparison between pAD and CTR (VROI-2), and 3) visual analysis of individual maps obtained by the comparison between each subject and CTR (SPM-Maps). The VROI-SVM approach was based on 6 VROI plus 6 VROI asymmetry values derived from the pAD versus CTR comparison thanks to support vector machine (SVM). RESULTS The areas under the ROC curves between pAD and CTR were 0.84 for VROI-1, 0.83 for VROI-2, 0.79 for SPM maps, 0.87 for PALZ, and 0.95 for VROI-SVM. Pairwise comparisons of Youden index did not show statistically significant differences in diagnostic performance between VROI-1, VROI-2, SPM-Maps, and PALZ score whereas VROI-SVM performed significantly (p < 0.005) better than any of the other methods. CONCLUSION The study confirms the good accuracy of [18]F-FDG-PET in discriminating healthy subjects from pAD and highlights that a non-linear, automatic VROI classifier based on SVM performs better than the voxel-based methods.
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Affiliation(s)
- Andrea Brugnolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, Italy.,Clinical Psychology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabrizio De Carli
- Institute of Bioimaging and Molecular Physiology, Consiglio Nazionale delle Ricerche (CNR), Genoa, Italy
| | - Marco Pagani
- Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy.,Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Slivia Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Italy.,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cathrine Jonsson
- Medical Radiation Physics and Nuclear Medicine, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Giovanni B Frisoni
- LENITEM Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio-FBF, Brescia, Italy.,University Hospitals and University of Geneva, Geneva, Switzerland
| | - Samantha Galluzzi
- LENITEM Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio-FBF, Brescia, Italy
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany.,Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE) Munich, Germany.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College London of Science, Technology and Medicine, London, UK
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Germany; previously at Department of Nuclear Medicine, Technische Universität, Munich, Germany
| | - Bart N M van Berckel
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mira Didic
- APHM, CHU Timone, Service de Neurologie et Neuropsychologie, Aix-Marseille University, Marseille, France
| | - Eric Guedj
- APHM, CHU Timone, Service de Médecine Nucléaire, CERIMED, Institut Fresnel, CNRS, Ecole Centrale Marseille, Aix-Marseille University, France
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, Italy.,Neurology Clinics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, Italy
| | - Matteo Grazzini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, Italy.,Neurology Clinics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Patrizia Mecocci
- Section of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Massimo E Dottorini
- Department of Diagnostic Imaging, Nuclear Medicine Unit, Perugia General Hospital, Perugia, Italy
| | - Matteo Bauckneht
- Department of Health Sciences (DISSAL), University of Genoa, Italy.,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianmario Sambuceti
- Department of Health Sciences (DISSAL), University of Genoa, Italy.,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, Italy.,Neurology Clinics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Niñerola-Baizán A, Aguiar P, Cabrera-Martín M, Vigil C, Gómez-Grande A, Lorenzo C, Rubí S, Sopena P, Camacho V. Relevance of quantification in brain PET studies with 18F-FDG. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Niñerola-Baizán A, Aguiar P, Cabrera-Martín MN, Vigil C, Gómez-Grande A, Lorenzo C, Rubí S, Sopena P, Camacho V. Relevance of quantification in brain PET studies with 18F-FDG. Rev Esp Med Nucl Imagen Mol 2020; 39:184-192. [PMID: 32345572 DOI: 10.1016/j.remn.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
The inclusion of 18F-FDG PET as a biomarker in the diagnostic criteria of neurodegenerative diseases and its indication in the presurgical assessment for drug-resistant epilepsies allow to improve specificity of these diagnosis. The traditional interpretation of neurological PET studies has been performed qualitatively, although in the last decade, several quantitative evaluation methods have emerged. This technical development has become relevant in clinical practice, improving specificity, reproducibility and reducing the interrater reliability derived from visual analysis. In this article we update/review the main imaging processing techniques currently used. This may allow the Nuclear Medicine physician to know their advantages and disadvantages when including these procedures in daily clinical practice.
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Affiliation(s)
- A Niñerola-Baizán
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España; Grupo de Imagen Biomédica, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, España
| | - P Aguiar
- Grupo de Imaxe Molecular e Física Médica, Departamento de Radioloxía, Facultade de Medicina, Universidade de Santiago de Compostela, Santiago de Compostela, España; Servicio de Medicina Nuclear, Hospital Clínico de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, España
| | - M N Cabrera-Martín
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, España
| | - C Vigil
- Servicio Medicina Nuclear, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | - A Gómez-Grande
- Servicio de Medicina Nuclear, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Lorenzo
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - S Rubí
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, España
| | - P Sopena
- Servicio de Medicina Nuclear, Hospital Vithas-Nisa 9 de Octubre, Valencia, España; Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - V Camacho
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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9
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Yee E, Popuri K, Beg MF, the Alzheimer's Disease Neuroimaging Initiative. Quantifying brain metabolism from FDG-PET images into a probability of Alzheimer's dementia score. Hum Brain Mapp 2020; 41:5-16. [PMID: 31507022 PMCID: PMC7268066 DOI: 10.1002/hbm.24783] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 07/27/2019] [Accepted: 08/18/2019] [Indexed: 01/31/2023] Open
Abstract
18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) enables in-vivo capture of the topographic metabolism patterns in the brain. These images have shown great promise in revealing the altered metabolism patterns in Alzheimer's disease (AD). The AD pathology is progressive, and leads to structural and functional alterations that lie on a continuum. There is a need to quantify the altered metabolism patterns that exist on a continuum into a simple measure. This work proposes a 3D convolutional neural network with residual connections that generates a probability score useful for interpreting the FDG-PET images along the continuum of AD. This network is trained and tested on images of stable normal control and stable Dementia of the Alzheimer's type (sDAT) subjects, achieving an AUC of 0.976 via repeated fivefold cross-validation. An independent test set consisting of images in between the two extreme ends of the DAT spectrum is used to further test the generalization performance of the network. Classification performance of 0.811 AUC is achieved in the task of predicting conversion of mild cognitive impairment to DAT for conversion time of 0-3 years. The saliency and class activation maps, which highlight the regions of the brain that are most important to the classification task, implicate many known regions affected by DAT including the posterior cingulate cortex, precuneus, and hippocampus.
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Affiliation(s)
- Evangeline Yee
- School of Engineering ScienceSimon Fraser UniversityBurnabyBCCanada
| | - Karteek Popuri
- School of Engineering ScienceSimon Fraser UniversityBurnabyBCCanada
| | - Mirza Faisal Beg
- School of Engineering ScienceSimon Fraser UniversityBurnabyBCCanada
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Nobili F, Festari C, Altomare D, Agosta F, Orini S, Van Laere K, Arbizu J, Bouwman F, Drzezga A, Nestor P, Walker Z, Boccardi M. Automated assessment of FDG-PET for differential diagnosis in patients with neurodegenerative disorders. Eur J Nucl Med Mol Imaging 2018; 45:1557-1566. [PMID: 29721650 DOI: 10.1007/s00259-018-4030-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To review literature until November 2015 and reach a consensus on whether automatic semi-quantification of brain FDG-PET is useful in the clinical setting for neurodegenerative disorders. METHODS A literature search was conducted in Medline, Embase, and Google Scholar. Papers were selected with a lower limit of 30 patients (no limits with autopsy confirmation). Consensus recommendations were developed through a Delphi procedure, based on the expertise of panelists, who were also informed about the availability and quality of evidence, assessed by an independent methodology team. RESULTS Critical outcomes were available in nine among the 17 papers initially selected. Only three papers performed a direct comparison between visual and automated assessment and quantified the incremental value provided by the latter. Sensitivity between visual and automatic analysis is similar but automatic assessment generally improves specificity and marginally accuracy. Also, automated assessment increases diagnostic confidence. As expected, performance of visual analysis is reported to depend on the expertise of readers. CONCLUSIONS Tools for semi-quantitative evaluation are recommended to assist the nuclear medicine physician in reporting brain FDG-PET pattern in neurodegenerative conditions. However, heterogeneity, complexity, and drawbacks of these tools should be known by users to avoid misinterpretation. Head-to-head comparisons and an effort to harmonize procedures are encouraged.
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Affiliation(s)
- Flavio Nobili
- Department of Neuroscience (DINOGMI), University of Genoa and Polyclinic San Martino Hospital, Genoa, Italy.
| | - Cristina Festari
- LANE - Laboratory of Alzheimer's Neuroimaging & Epidemiology, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Daniele Altomare
- LANE - Laboratory of Alzheimer's Neuroimaging & Epidemiology, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Orini
- Alzheimer Operative Unit, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Koen Van Laere
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Javier Arbizu
- Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Femke Bouwman
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Cologne, Germany
| | - Peter Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Queensland Brain Institute, University of Queensland and Mater Hospital, Brisbane, Australia
| | - Zuzana Walker
- Division of Psychiatry & Essex Partnership University, University College London, London, UK
| | - Marina Boccardi
- LANE - Laboratory of Alzheimer's Neuroimaging & Epidemiology, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy. .,LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry, University of Geneva, Chemin du Petit-Bel-Air, 2, 1225, Chene-Bourg, Geneva, Switzerland.
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11
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Garibotto V, Herholz K, Boccardi M, Picco A, Varrone A, Nordberg A, Nobili F, Ratib O. Clinical validity of brain fluorodeoxyglucose positron emission tomography as a biomarker for Alzheimer's disease in the context of a structured 5-phase development framework. Neurobiol Aging 2017; 52:183-195. [PMID: 28317648 DOI: 10.1016/j.neurobiolaging.2016.03.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/09/2016] [Accepted: 03/22/2016] [Indexed: 10/19/2022]
Abstract
The use of Alzheimer's disease (AD) biomarkers is supported in diagnostic criteria, but their maturity for clinical routine is still debated. Here, we evaluate brain fluorodeoxyglucose positron emission tomography (FDG PET), a measure of cerebral glucose metabolism, as a biomarker to identify clinical and prodromal AD according to the framework suggested for biomarkers in oncology, using homogenous criteria with other biomarkers addressed in parallel reviews. FDG PET has fully achieved phase 1 (rational for use) and most of phase 2 (ability to discriminate AD subjects from healthy controls or other forms of dementia) aims. Phase 3 aims (early detection ability) are partly achieved. Phase 4 studies (routine use in prodromal patients) are ongoing, and only preliminary results can be extrapolated from retrospective observations. Phase 5 studies (quantify impact and costs) have not been performed. The results of this study show that specific efforts are needed to complete phase 3 evidence, in particular comparing and combining FDG PET with other biomarkers, and to properly design phase 4 prospective studies as a basis for phase 5 evaluations.
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Affiliation(s)
- Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva University, Geneva, Switzerland.
| | - Karl Herholz
- Wolfson Molecular Imaging Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Marina Boccardi
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; LANVIE (Laboratory of Neuroimaging of Aging), Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Agnese Picco
- LANVIE (Laboratory of Neuroimaging of Aging), Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Andrea Varrone
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Nordberg
- Department of Geriatric Medicine, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Flavio Nobili
- Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Osman Ratib
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva University, Geneva, Switzerland
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12
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13
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Normal model construction for statistical image analysis of torso FDG-PET images based on anatomical standardization by CT images from FDG-PET/CT devices. Int J Comput Assist Radiol Surg 2017; 12:777-787. [DOI: 10.1007/s11548-017-1526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
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14
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Fällmar D, Haller S, Lilja J, Danfors T, Kilander L, Tolboom N, Egger K, Kellner E, Croon PM, Verfaillie SCJ, van Berckel BNM, Ossenkoppele R, Barkhof F, Larsson EM. Arterial spin labeling-based Z-maps have high specificity and positive predictive value for neurodegenerative dementia compared to FDG-PET. Eur Radiol 2017; 27:4237-4246. [PMID: 28374078 PMCID: PMC5579184 DOI: 10.1007/s00330-017-4784-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/23/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
Objective Cerebral perfusion analysis based on arterial spin labeling (ASL) MRI has been proposed as an alternative to FDG-PET in patients with neurodegenerative disease. Z-maps show normal distribution values relating an image to a database of controls. They are routinely used for FDG-PET to demonstrate disease-specific patterns of hypometabolism at the individual level. This study aimed to compare the performance of Z-maps based on ASL to FDG-PET. Methods Data were combined from two separate sites, each cohort consisting of patients with Alzheimer’s disease (n = 18 + 7), frontotemporal dementia (n = 12 + 8) and controls (n = 9 + 29). Subjects underwent pseudocontinuous ASL and FDG-PET. Z-maps were created for each subject and modality. Four experienced physicians visually assessed the 166 Z-maps in random order, blinded to modality and diagnosis. Results Discrimination of patients versus controls using ASL-based Z-maps yielded high specificity (84%) and positive predictive value (80%), but significantly lower sensitivity compared to FDG-PET-based Z-maps (53% vs. 96%, p < 0.001). Among true-positive cases, correct diagnoses were made in 76% (ASL) and 84% (FDG-PET) (p = 0.168). Conclusion ASL-based Z-maps can be used for visual assessment of neurodegenerative dementia with high specificity and positive predictive value, but with inferior sensitivity compared to FDG-PET. Key points • ASL-based Z-maps yielded high specificity and positive predictive value in neurodegenerative dementia. • ASL-based Z-maps had significantly lower sensitivity compared to FDG-PET-based Z-maps. • FDG-PET might be reserved for ASL-negative cases where clinical suspicion persists. • Findings were similar at two study sites.
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Affiliation(s)
- David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
| | - Sven Haller
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Affidea CDRC - Centre Diagnostique Radiologique de Carouge, Carouge, Switzerland
| | - Johan Lilja
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden.,Hermes Medical Solutions, Stockholm, Sweden
| | - Torsten Danfors
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - Karl Egger
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Radiology, Medical Physics, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Philip M Croon
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - Sander C J Verfaillie
- Department of Neurology, Alzheimer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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15
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Presotto L, Ballarini T, Caminiti SP, Bettinardi V, Gianolli L, Perani D. Validation of 18F–FDG-PET Single-Subject Optimized SPM Procedure with Different PET Scanners. Neuroinformatics 2017; 15:151-163. [DOI: 10.1007/s12021-016-9322-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Kim J, Cho SG, Song M, Kang SR, Kwon SY, Choi KH, Choi SM, Kim BC, Song HC. Usefulness of 3-dimensional stereotactic surface projection FDG PET images for the diagnosis of dementia. Medicine (Baltimore) 2016; 95:e5622. [PMID: 27930593 PMCID: PMC5266065 DOI: 10.1097/md.0000000000005622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To compare diagnostic performance and confidence of a standard visual reading and combined 3-dimensional stereotactic surface projection (3D-SSP) results to discriminate between Alzheimer disease (AD)/mild cognitive impairment (MCI), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD).[F]fluorodeoxyglucose (FDG) PET brain images were obtained from 120 patients (64 AD/MCI, 38 DLB, and 18 FTD) who were clinically confirmed over 2 years follow-up. Three nuclear medicine physicians performed the diagnosis and rated diagnostic confidence twice; once by standard visual methods, and once by adding of 3D-SSP. Diagnostic performance and confidence were compared between the 2 methods.3D-SSP showed higher sensitivity, specificity, accuracy, positive, and negative predictive values to discriminate different types of dementia compared with the visual method alone, except for AD/MCI specificity and FTD sensitivity. Correction of misdiagnosis after adding 3D-SSP images was greatest for AD/MCI (56%), followed by DLB (13%) and FTD (11%). Diagnostic confidence also increased in DLB (visual: 3.2; 3D-SSP: 4.1; P < 0.001), followed by AD/MCI (visual: 3.1; 3D-SSP: 3.8; P = 0.002) and FTD (visual: 3.5; 3D-SSP: 4.2; P = 0.022). Overall, 154/360 (43%) cases had a corrected misdiagnosis or improved diagnostic confidence for the correct diagnosis.The addition of 3D-SSP images to visual analysis helped to discriminate different types of dementia in FDG PET scans, by correcting misdiagnoses and enhancing diagnostic confidence in the correct diagnosis. Improvement of diagnostic accuracy and confidence by 3D-SSP images might help to determine the cause of dementia and appropriate treatment.
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Affiliation(s)
| | | | | | | | | | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Donggu, Gwangju, Republic of Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Hospital, Donggu, Gwangju, Republic of Korea
| | - Byeong-Chae Kim
- Department of Neurology, Chonnam National University Hospital, Donggu, Gwangju, Republic of Korea
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17
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Wang K, Liu T, Zhao X, Xia X, Zhang K, Qiao H, Zhang J, Meng F. Comparative Study of Voxel-Based Epileptic Foci Localization Accuracy between Statistical Parametric Mapping and Three-dimensional Stereotactic Surface Projection. Front Neurol 2016; 7:164. [PMID: 27729898 PMCID: PMC5037321 DOI: 10.3389/fneur.2016.00164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) is widely used to help localize the hypometabolic epileptogenic focus for presurgical evaluation of drug-refractory epilepsy patients. Two voxel-based brain mapping methods to interpret 18F-FDG-PET, statistical parametric mapping (SPM) and three-dimensional stereotactic surface projection (3D-SSP), improve the detection rate of seizure foci. This study aimed to compare the consistency of epileptic focus detection between SPM and 3D-SSP for 18F-FDG-PET brain mapping analysis. Methods We retrospectively reviewed the clinical, electroecephalographic, and brain imaging results of 35 patients with refractory epilepsy. 18F-FDG-PET studies were revaluated by SPM, 3D-SSP, and visual assessment, and the results were compared to the magnetic resonance imaging (MRI) lesion location and to the presumed epileptogenic zone (PEZ) defined by video-electroencephalogram and other clinical data. A second consistency study compared PET analyses to histopathology and surgical outcomes in the 19 patients who underwent lesion resection surgery. Results Of the 35 patients, consistency with the PEZ was 29/35 for SPM, 25/35 for 3D-SSP, 14/35 for visual assessment, and 10/35 for MRI. Concordance rates with the PEZ were significantly higher for SPM and 3D-SSP than for MRI (P < 0.05) and visual assessment (P < 0.05). Differences between SPM and 3D-SSP and between visual assessment and MRI were not significant. In the 19 surgical patients, concordance with histopathology/clinical outcome was 14/19 for SPM, 15/19 for 3D-SSP, 14/19 for visual assessment, and 9/19 for MRI (P > 0.05). A favorable Engel outcome (class I/II) was found in 16 of 19 cases (84%), and failure of seizure control was found in 3 of 19 patients (class III/IV). Conclusion Voxel-based 18F-FDG-PET brain mapping analysis using SPM or 3D-SSP can improve the detection rate of the epileptic focus compared to visual assessment and MRI. Consistency with PEZ was similar between SPM and 3D-SSP; according to their own characteristics, 3D-SSP is recommended for primary evaluation due to greater efficiency and operability of the software, while SPM is recommended for high-accuracy localization of complex lesions. Therefore, joint application of both software packages may be the best solution for FDG-PET analysis of epileptic focus localization.
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Affiliation(s)
- Kailiang Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Tinghong Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiaobin Zhao
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - XiaoTong Xia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Kai Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qiao
- Beijing Neurosurgical Institute, Capital Medical University , Beijing , China
| | - Jianguo Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
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Kato T, Inui Y, Nakamura A, Ito K. Brain fluorodeoxyglucose (FDG) PET in dementia. Ageing Res Rev 2016; 30:73-84. [PMID: 26876244 DOI: 10.1016/j.arr.2016.02.003] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 12/31/2022]
Abstract
The purpose of this article is to present a selective and concise summary of fluorodeoxyglucose (FDG) positron emission tomography (PET) in dementia imaging. FDG PET is used to visualize a downstream topographical marker that indicates the distribution of neural injury or synaptic dysfunction, and can identify distinct phenotypes of dementia due to Alzheimer's disease (AD), Lewy bodies, and frontotemporal lobar degeneration. AD dementia shows hypometabolism in the parietotemporal association area, posterior cingulate, and precuneus. Hypometabolism in the inferior parietal lobe and posterior cingulate/precuneus is a predictor of cognitive decline from mild cognitive impairment (MCI) to AD dementia. FDG PET may also predict conversion of cognitively normal individuals to those with MCI. Age-related hypometabolism is observed mainly in the anterior cingulate and anterior temporal lobe, along with regional atrophy. Voxel-based statistical analyses, such as statistical parametric mapping or three-dimensional stereotactic surface projection, improve the diagnostic performance of imaging of dementias. The potential of FDG PET in future clinical and methodological studies should be exploited further.
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Affiliation(s)
- Takashi Kato
- Department of Radiology, National Center for Geriatrics and Gerontology, Japan; Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Japan.
| | - Yoshitaka Inui
- Department of Radiology, National Center for Geriatrics and Gerontology, Japan
| | - Akinori Nakamura
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Japan
| | - Kengo Ito
- Department of Radiology, National Center for Geriatrics and Gerontology, Japan; Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Japan; Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Japan
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19
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Garali I, Adel M, Bourennane S, Guedj E. Brain region ranking for 18FDG-PET computer-aided diagnosis of Alzheimer's disease. Biomed Signal Process Control 2016. [DOI: 10.1016/j.bspc.2016.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Garali I, Adel M, Bourennane S, Ceccaldi M, Guedj E. Brain region of interest selection for 18FDG positrons emission tomography computer-aided image classification. Ing Rech Biomed 2016. [DOI: 10.1016/j.irbm.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Eisenmenger LB, Huo EJ, Hoffman JM, Minoshima S, Matesan MC, Lewis DH, Lopresti BJ, Mathis CA, Okonkwo DO, Mountz JM. Advances in PET Imaging of Degenerative, Cerebrovascular, and Traumatic Causes of Dementia. Semin Nucl Med 2016; 46:57-87. [DOI: 10.1053/j.semnuclmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Abstract
Young-onset dementia is a broad category of diseases that affect adults before the age of 65, with devastating effects on individuals and families. Neuroimaging plays a clear and ever-expanding role in the workup of these diseases. MRI demonstrates classic patterns of atrophy that help to confirm the clinical diagnosis and may predict the underlying disease. Functional nuclear imaging, such as PET, demonstrates areas of brain dysfunction even in the absence of visible atrophy. These techniques can inform important aspects of the care of young-onset dementia, such as the underlying pathologic condition, treatment, and prognosis.
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Affiliation(s)
- HyungSub Shim
- Department of Neurology, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Maria J Ly
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Sarah K Tighe
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
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23
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Pagani M, De Carli F, Morbelli S, Öberg J, Chincarini A, Frisoni GB, Galluzzi S, Perneczky R, Drzezga A, van Berckel BNM, Ossenkoppele R, Didic M, Guedj E, Brugnolo A, Picco A, Arnaldi D, Ferrara M, Buschiazzo A, Sambuceti G, Nobili F. Volume of interest-based [18F]fluorodeoxyglucose PET discriminates MCI converting to Alzheimer's disease from healthy controls. A European Alzheimer's Disease Consortium (EADC) study. NEUROIMAGE-CLINICAL 2014; 7:34-42. [PMID: 25610765 PMCID: PMC4299956 DOI: 10.1016/j.nicl.2014.11.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/14/2014] [Accepted: 11/11/2014] [Indexed: 01/18/2023]
Abstract
An emerging issue in neuroimaging is to assess the diagnostic reliability of PET and its application in clinical practice. We aimed at assessing the accuracy of brain FDG-PET in discriminating patients with MCI due to Alzheimer's disease and healthy controls. Sixty-two patients with amnestic MCI and 109 healthy subjects recruited in five centers of the European AD Consortium were enrolled. Group analysis was performed by SPM8 to confirm metabolic differences. Discriminant analyses were then carried out using the mean FDG uptake values normalized to the cerebellum computed in 45 anatomical volumes of interest (VOIs) in each hemisphere (90 VOIs) as defined in the Automated Anatomical Labeling (AAL) Atlas and on 12 meta-VOIs, bilaterally, obtained merging VOIs with similar anatomo-functional characteristics. Further, asymmetry indexes were calculated for both datasets. Accuracy of discrimination by a Support Vector Machine (SVM) and the AAL VOIs was tested against a validated method (PALZ). At the voxel level SMP8 showed a relative hypometabolism in the bilateral precuneus, and posterior cingulate, temporo-parietal and frontal cortices. Discriminant analysis classified subjects with an accuracy ranging between .91 and .83 as a function of data organization. The best values were obtained from a subset of 6 meta-VOIs plus 6 asymmetry values reaching an area under the ROC curve of .947, significantly larger than the one obtained by the PALZ score. High accuracy in discriminating MCI converters from healthy controls was reached by a non-linear classifier based on SVM applied on predefined anatomo-functional regions and inter-hemispheric asymmetries. Data pre-processing was automated and simplified by an in-house created Matlab-based script encouraging its routine clinical use. Further validation toward nonconverter MCI patients with adequately long follow-up is needed. 18F-FDG-PET/CT analysis of metabolic differences between MCI converting to AD and HC Large and very well controlled cohorts from EADC-Consortium were investigated. Data were analyzed by a friendly-to-use Matlab-based script and Support Vector Machine. Excellent discrimination between MCI and HC (sensitivity 92%; specificity 91%) Highest accuracy reported so far in MCI and promising implementation in clinical routine
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Affiliation(s)
- M Pagani
- Institute of Cognitive Sciences and Technologies, Rome, Italy ; Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - F De Carli
- Institute of Bioimaging and Molecular Physiology, Consiglio Nazionale delle Ricerche (CNR), Genoa, Italy
| | - S Morbelli
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J Öberg
- Department of Hospital Physics, Karolinska Hospital, Stockholm, Sweden
| | - A Chincarini
- National Institute for Nuclear Physics (INFN), Genoa, Italy
| | - G B Frisoni
- LENITEM Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio-FBF, Brescia, Italy ; University Hospitals and University of Geneva, Geneva, Switzerland
| | - S Galluzzi
- LENITEM Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio-FBF, Brescia, Italy
| | - R Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College London of Science, Technology and Medicine, London, UK ; West London Cognitive Disorders Treatment and Research Unit, London, UK ; Department of Psychiatry and Psychotherapy, Technische Universität, Munich, Germany
| | - A Drzezga
- Department of Nuclear Medicine, Technische Universität, Munich, Germany
| | - B N M van Berckel
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R Ossenkoppele
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - M Didic
- APHM, CHU Timone, Service de Neurologie et Neuropsychologie, Aix-Marseille University, INSERM U 1106, Marseille, France
| | - E Guedj
- APHM, CHU Timone, Service de Médecine Nucléaire, CERIMED, INT CNRS UMR7289 , Aix-Marseille University, Marseille 13005, France
| | - A Brugnolo
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - A Picco
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - D Arnaldi
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - M Ferrara
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - A Buschiazzo
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - G Sambuceti
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - F Nobili
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
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Yamauchi M, Imabayashi E, Matsuda H, Nakagawara J, Takahashi M, Shimosegawa E, Hatazawa J, Suzuki M, Iwanaga H, Fukuda K, Iihara K, Iida H. Quantitative assessment of rest and acetazolamide CBF using quantitative SPECT reconstruction and sequential administration of (123)I-iodoamphetamine: comparison among data acquired at three institutions. Ann Nucl Med 2014; 28:836-50. [PMID: 25001261 PMCID: PMC4244544 DOI: 10.1007/s12149-014-0879-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/29/2014] [Indexed: 10/27/2022]
Abstract
PURPOSE A recently developed technique which reconstructs quantitative images from original projection data acquired using existing single-photon emission computed tomography (SPECT) devices enabled quantitative assessment of cerebral blood flow (CBF) at rest and after acetazolamide challenge. This study was intended to generate a normal database and to investigate its inter-institutional consistency. METHODS The three institutions carried out a series of SPECT scanning on 32 healthy volunteers, following a recently proposed method that involved dual administration of (123)I-iodoamphetamine during a single SPECT scan. Intra-institute and inter-institutional variations of regional CBF values were evaluated both at rest and after acetazolamide challenge. Functional images were pooled for both rest and acetazolamide CBF, and inter-institutional difference was evaluated among these images using two independent software programs. RESULTS Quantitative assessment of CBF images at rest and after acetazolamide was successfully achieved with the given protocol in all institutions. Intra-institutional variation of CBF values at rest and after acetazolamide was consistent with previously reported values. Quantitative CBF values showed no significant difference among institutions in all regions, except for a posterior cerebral artery region after acetazolamide challenge in one institution which employed SPECT device with lowest spatial resolution. Pooled CBF images at rest and after acetazolamide generated using two software programs showed no institutional differences after equalization of the spatial resolution. CONCLUSIONS SPECT can provide reproducible images from projection data acquired using different SPECT devices. A common database acquired at different institutions may be shared among institutions, if images are reconstructed using a quantitative reconstruction program, and acquired by following a standardized protocol.
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Affiliation(s)
- Miho Yamauchi
- Department of Investigative Radiology, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
| | - Etsuko Imabayashi
- Department of Nuclear Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298 Japan
- Present Address: Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551 Japan
| | - Hiroshi Matsuda
- Department of Nuclear Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298 Japan
- Present Address: Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551 Japan
| | - Jyoji Nakagawara
- Nakamura Memorial Hospital, 2 Kawazoe, Minami, Sapporo, Hokkaido 005-0802 Japan
- Present Address: Department of Neurosurgery, Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
| | - Masaaki Takahashi
- Nakamura Memorial Hospital, 2 Kawazoe, Minami, Sapporo, Hokkaido 005-0802 Japan
| | - Eku Shimosegawa
- Department of Nuclear Medicine, Osaka University School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine, Osaka University School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Michiyasu Suzuki
- Department of Neurosurgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505 Japan
| | - Hideyuki Iwanaga
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505 Japan
| | - Kenji Fukuda
- Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
- Present Address: Department of Neurosurgery, Fukuoka University School of Medicine, Fukuoka, Kyushu 814-0180 Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
- Present Address: Department of Neurosurgery, Kyushu University School of Medicine, Fukuoka, Kyushu 812-8582 Japan
| | - Hidehiro Iida
- Department of Investigative Radiology, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
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Brown RKJ, Bohnen NI, Wong KK, Minoshima S, Frey KA. Brain PET in Suspected Dementia: Patterns of Altered FDG Metabolism. Radiographics 2014; 34:684-701. [DOI: 10.1148/rg.343135065] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Evaluation of the difference-correction effect of the gamma camera systems used by easy Z-score Imaging System (eZIS) analysis. Ann Nucl Med 2014; 28:263-75. [PMID: 24464392 PMCID: PMC3988514 DOI: 10.1007/s12149-014-0807-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/21/2013] [Indexed: 11/24/2022]
Abstract
Objective
We examined the difference of the effect by data to revise a gamma camera difference. The difference-correction method of the camera is incorporated in eZIS analysis. Methods We acquired single photon emission computed tomography (SPECT) data from the three-dimensional (3D) Hoffman brain phantom (Hoffman), the three-dimensional brain phantom (3D-Brain), Pool phantom (pool) and from normal subjects (Normal-SPECT) to investigate compensating for a difference in gamma camera systems. We compared SPECT counts of standard camera with the SPECT counts that revised the difference of the gamma camera system (camera). Furthermore, we compared the “Z-score map (Z-score)”. To verify the effect of the compensation, we examined digitally simulated data designed to represent a patient with Alzheimer’s dementia. We carried out both eZIS analysis and “Specific Volume of interest Analysis (SVA)”. Results There was no great difference between the correction effect using Hoffman phantom data and that using 3D-Brain phantom data. Furthermore, a good compensation effect was obtained only over a limited area. The compensation based on the pool was found to be less satisfactory than any of the other compensations according to all results of the measurements examined in the study. The compensation based on the Normal-SPECT data resulted in a Z-score map (Z-score) for the result that approximated that from the standard camera. Therefore, we concluded that the effect of the compensation based on Normal-SPECT data was the best of the four methods tested. Conclusions Based on eZIS analysis, the compensation using the pool data was inferior to the compensations using the other methods tested. Based on the results of the SAV analysis, the effect of the compensation using the Hoffman data was better than the effect of the compensation using the 3D-Brain data. By all end-point measures, the compensation based on the Normal-SPECT data was more accurate than the compensation based on any of the other three phantoms.
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Abstract
There is increasing use of neuroimaging modalities, including PET, for diagnosing dementia. For example, FDG-PET demonstrates hypometabolic regions in the posterior cingulate gyri, precuneus, and parietotemporal association cortices, while amyloid PET indicates amyloid deposition in Alzheimer disease and mild cognitive impairment due to Alzheimer disease. Furthermore, the use of combination PET with structural MR imaging can improve the diagnostic accuracy of dementia. In other neurodegenerative dementias, each disease exhibits a specific metabolic reduction pattern. In dementia with Lewy bodies, occipital glucose metabolism is decreased, while in frontotemporal dementia, frontal and anterior temporal metabolism is predominantly decreased. These FDG-PET findings and positive or negative amyloid deposits are important biomarkers for various neurodegenerative dementias.
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Affiliation(s)
- K Ishii
- From the Neurocognitive Disorders Center, Kinki University Hospital, Osaka, Japan.
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28
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Computer-aided diagnosis of Alzheimer’s type dementia combining support vector machines and discriminant set of features. Inf Sci (N Y) 2013. [DOI: 10.1016/j.ins.2009.05.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Illán IA, Górriz JM, Ramírez J, Lang EW, Salas-Gonzalez D, Puntonet CG. Bilateral symmetry aspects in computer-aided Alzheimer's disease diagnosis by single-photon emission-computed tomography imaging. Artif Intell Med 2012; 56:191-8. [PMID: 23158839 DOI: 10.1016/j.artmed.2012.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/27/2012] [Accepted: 09/28/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This paper explores the importance of the latent symmetry of the brain in computer-aided systems for diagnosing Alzheimer's disease (AD). Symmetry and asymmetry are studied from two points of view: (i) the development of an effective classifier within the scope of machine learning techniques, and (ii) the assessment of its relevance to the AD diagnosis in the early stages of the disease. METHODS The proposed methodology is based on eigenimage decomposition of single-photon emission-computed tomography images, using an eigenspace extension to accommodate odd and even eigenvectors separately. This feature extraction technique allows for support-vector-machine classification and image analysis. RESULTS Identification of AD patterns is improved when the latent symmetry of the brain is considered, with an estimated 92.78% accuracy (92.86% sensitivity, 92.68% specificity) using a linear kernel and a leave-one-out cross validation strategy. Also, asymmetries may be used to define a test for AD that is very specific (90.24% specificity) but not especially sensitive. CONCLUSIONS Two main conclusions are derived from the analysis of the eigenimage spectrum. Firstly, the recognition of AD patterns is improved when considering only the symmetric part of the spectrum. Secondly, asymmetries in the hypo-metabolic patterns, when present, are more pronounced in subjects with AD.
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Affiliation(s)
- Ignacio Alvarez Illán
- Department of Signal Theory, Networking and Communications, Escuela Técnica Superior de Ingeniería Informática y Telecomunicaciones, University of Granada, Spain.
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Visual Assessment Versus Quantitative Three-Dimensional Stereotactic Surface Projection Fluorodeoxyglucose Positron Emission Tomography for Detection of Mild Cognitive Impairment and Alzheimer Disease. Clin Nucl Med 2012; 37:721-6. [DOI: 10.1097/rlu.0b013e3182478d89] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Padilla P, López M, Górriz JM, Ramírez J, Salas-González D, Álvarez I. NMF-SVM based CAD tool applied to functional brain images for the diagnosis of Alzheimer's disease. IEEE TRANSACTIONS ON MEDICAL IMAGING 2012; 31:207-216. [PMID: 21914569 DOI: 10.1109/tmi.2011.2167628] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper presents a novel computer-aided diagnosis (CAD) technique for the early diagnosis of the Alzheimer's disease (AD) based on nonnegative matrix factorization (NMF) and support vector machines (SVM) with bounds of confidence. The CAD tool is designed for the study and classification of functional brain images. For this purpose, two different brain image databases are selected: a single photon emission computed tomography (SPECT) database and positron emission tomography (PET) images, both of them containing data for both Alzheimer's disease (AD) patients and healthy controls as a reference. These databases are analyzed by applying the Fisher discriminant ratio (FDR) and nonnegative matrix factorization (NMF) for feature selection and extraction of the most relevant features. The resulting NMF-transformed sets of data, which contain a reduced number of features, are classified by means of a SVM-based classifier with bounds of confidence for decision. The proposed NMF-SVM method yields up to 91% classification accuracy with high sensitivity and specificity rates (upper than 90%). This NMF-SVM CAD tool becomes an accurate method for SPECT and PET AD image classification.
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Affiliation(s)
- P Padilla
- Department of Signal Theory, Telematics and Communications, University of Granada, 18071 Granada, Spain.
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Onishi H, Hatazawa J, Nakagawara J, Ito K, Ha-Kawa SK, Masuda Y, Sugibayashi K, Takahashi M, Kikuchi K, Katsuta N. [Availability of normal database by single photon emission computed tomography system with use of 3 dimensional-stereotactic surface projections]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2012; 68:1608-1616. [PMID: 23257590 DOI: 10.6009/jjrt.2012_jsrt_68.12.1608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The present study aims to quantitatively investigate a normal database (NDB) created under the same acquisition and reconstruction conditions for three gamma camera systems (four types of collimator systems) with use of three-dimensional stereotactic surface projections (3D-SSP). We rebuilt a NDB with use of the N-isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) SPECT data derived from 30 healthy individuals at 20 institutions nationwide. We standardized the acquisition and reconstruction conditions, evaluated Z scores using patient data (PD) and examined each compensation effect. RESULTS Z scores determined using the advanced NDB were the same value. Artifacts were often generated in Z score maps derived from the conventional NDB (CONDB). The Z score of the own site NDB (OWNDB) was 70% of that calculated based on the CONDB. The combinatorial difference in compensation (scatter and attenuation) resulted in many artifacts being generated in Z score map images. DISCUSSIONS More artifacts were generated in Z score map images using the novel NDB compared with the CONDB. The novel NDB was comparable to the performance of OWNB. The accuracy of brain function image analysis can be improved the reconstruction conditions and correcting for scatter and attenuation on both the novel NDB and PD.
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Affiliation(s)
- Hideo Onishi
- Prefectual University of Hiroshima Graduate School of Comprehensive Scientific Research
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33
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Yoshida H, Kanda Y, Takahashi H, Miyamoto I, Chiba K. Observation of cortical activity during speech stimulation in prelingually deafened adults with cochlear implantation by positron emission tomography-computed tomography. Ann Otol Rhinol Laryngol 2011; 120:499-504. [PMID: 21922972 DOI: 10.1177/000348941112000802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We evaluated the cortical activity of 2 successful prelingually deafened adult cochlear implant (CI) users who have been trained by auditory-verbal/oral communication since childhood. METHODS Changes in regional cerebral blood flow were measured by positron emission tomography using '8F-fluorodeoxyglucose while the subjects were receiving auditory language stimuli by listening to a story. Ten normal-hearing volunteers were observed as age-matched control subjects. RESULTS In both cases, the auditory-related regions, when compared to same regions in the control subjects, showed hypermetabolism in the left dorsolateral prefrontal cortex and the left precentral gyrus--similar to that in successful CI users who are prelingually deafened children or postlingually deafened adults. Both subjects had the ability to activate these areas, and this ability might be one of the reasons that accounts for such exceptionally good performance in older prelingually deaf CI users. As for the visual-related regions, hypometabolism was observed in Brodmann areas 18 and 19, and this finding might be related to the intensive auditory-verbal/oral education that the subjects had received since childhood. CONCLUSIONS Despite the limits imposed by the small sample size and the spatial resolution of positron emission tomography, this study yielded insights into the nature of the brain plasticity in prelingually deafened adults who are successful CI users.
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Affiliation(s)
- Haruo Yoshida
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Onishi H, Matsutomo N, Kai Y, Kangai Y, Amijima H, Yamaguchi T. Evaluation of a novel normal database with matched SPECT systems and optimal pre-filter parameters for 3D-SSP. Ann Nucl Med 2011; 26:16-25. [DOI: 10.1007/s12149-011-0534-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/16/2011] [Indexed: 11/29/2022]
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Abstract
Both perfusion SPECT and FDG-PET provide images that closely reflect neuronal activity. There is a characteristic regional impairment in Alzheimer’s disease (AD) that involves mainly the temporo-parietal association cortices, mesial temporal structures and to a more variable degree also the frontal association cortex. This pattern of functional impairment can provide a biomarker for diagnosis of AD and other neurodegenerative dementias at the clinical stage of mild cognitive impairment, and for monitoring of progression. FDG-PET is quantitatively more accurate and thus better suited to multicenter studies than perfusion SPECT. Regional metabolic and blood flow changes are closely related to clinical symptoms, and most areas involved in these changes will also develop significant cortical atrophy. FDG-PET is complementary to amyloid PET, which targets a molecular marker that does not have a close relation to current symptoms. Current restrictions in the availability and cost of FDG-PET are being reduced, as oncological FDG-PET is being adopted as a standard clinical service in most countries. Limitations in the availability of trained staff should be overcome by training programs set up by professional organizations. Against the background of the development of new criteria for diagnosing AD before the onset of dementia, FDG-PET is expected to play an increasing role in diagnosing patients at an early stage of AD and in clinical trials of drugs aimed at preventing or delaying the onset of dementia.
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Affiliation(s)
- Karl Herholz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.
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36
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Chaves R, Górriz JM, Ramírez J, Illán IA, Salas-Gonzalez D, Gómez-Río M. Efficient mining of association rules for the early diagnosis of Alzheimer's disease. Phys Med Biol 2011; 56:6047-63. [DOI: 10.1088/0031-9155/56/18/017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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37
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Shima K, Matsunari I, Samuraki M, Chen WP, Yanase D, Noguchi-Shinohara M, Takeda N, Ono K, Yoshita M, Miyazaki Y, Matsuda H, Yamada M. Posterior cingulate atrophy and metabolic decline in early stage Alzheimer's disease. Neurobiol Aging 2011; 33:2006-17. [PMID: 21855172 DOI: 10.1016/j.neurobiolaging.2011.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 06/23/2011] [Accepted: 07/12/2011] [Indexed: 11/25/2022]
Abstract
To test the hypothesis that Alzheimer's disease (AD) patients with posterior cingulate/precuneus (PCP) atrophy would be a distinct disease form in view of metabolic decline. Eighty-one AD patients underwent (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and structural magnetic resonance imaging (MRI). Positron emission tomography and voxel-based morphometry (VBM) Z-score maps were generated for the individual patients using age-specific normal databases. The patients were classified into 3 groups based on atrophic patterns (no-Hipp-PCP, atrophy in neither hippocampus nor PCP; Hipp, hippocampal atrophy; PCP, PCP atrophy). There were 16 patients classified as no-Hipp-PCP, 55 as Hipp, and 10 as PCP. The Mini Mental State Examination (MMSE) score was similar among the groups. The greater FDG decline than atrophy was observed in all groups, including the no-Hipp-PCP. The PCP group was younger, and was associated with a greater degree of FDG decline in PCP than the others. There are diverse atrophic patterns in a spectrum of AD. In particular, a subset of patients show PCP atrophy, which is associated with greater metabolic burden.
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Affiliation(s)
- Keisuke Shima
- Department of Neurology and Neurobiology of Aging, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
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Illán I, Górriz J, López M, Ramírez J, Salas-Gonzalez D, Segovia F, Chaves R, Puntonet C. Computer aided diagnosis of Alzheimer’s disease using component based SVM. Appl Soft Comput 2011. [DOI: 10.1016/j.asoc.2010.08.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Uemura T, Ishii K, Miyamoto N, Yoshikawa T. Computer-assisted system for diagnosis of Alzheimer disease using data base- independent estimation and fluorodeoxyglucose- positron-emission tomography and 3D-stereotactic surface projection. AJNR Am J Neuroradiol 2011; 32:556-9. [PMID: 21292796 DOI: 10.3174/ajnr.a2342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recently, voxel-based statistical parametric images have been developed as additional diagnostic tools for AD. However these methods require the generation of a data base of healthy brain images. The purpose of this study was to produce and evaluate an automatic method using a data base-independent estimation system for the diagnosis of mild AD. MATERIALS AND METHODS We retrospectively selected 66 subjects, including 33 patients with early AD and 33 age-matched healthy volunteers. Individual brain metabolic images were obtained by using FDG-PET. These were transformed by using 3D-SSP. We then produced CADDIES, which compares the parietal and sensorimotor metabolic counts by using t tests. If parietal metabolism was significantly lower than the sensorimotor metabolism, the subject was automatically diagnosed as having AD. The FDG-PET images were also analyzed by using a previous automatic diagnosis system (CAAD) that is dependent on the construction of a "normal data base" of healthy brain images. Diagnostic performance was compared between the 2 methods. RESULTS The CADDIES demonstrated a sensitivity of 88%, specificity of 79%, and accuracy of 85%, while the CAAD system demonstrated a sensitivity of 70%, specificity of 94%, and accuracy of 82%. The area under the ROC curve of CADDIES was 0.964. The areas under ROC curves of the CAAD method in the parietal and posterior cingulate gyri were 0.843 and 0.939, respectively. CONCLUSIONS The CADDIES method demonstrated a diagnostic accuracy similar to that of the CAAD system. Our results indicate that this method can be applied to the detection of patients with early AD in routine clinical examinations, with the benefit of not requiring the generation of a normal data base.
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Affiliation(s)
- T Uemura
- Department of Radiology and Nuclear Medicine, Hyogo Brain and Heart Center, Himeji, Japan
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40
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Onishi H, Matsutake Y, Kawashima H, Matsutomo N, Amijima H. Comparative study of anatomical normalization errors in SPM and 3D-SSP using digital brain phantom. Ann Nucl Med 2010; 25:59-67. [PMID: 21153453 DOI: 10.1007/s12149-010-0448-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 09/15/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In single photon emission computed tomography (SPECT) cerebral blood flow studies, two major algorithms are widely used statistical parametric mapping (SPM) and three-dimensional stereotactic surface projections (3D-SSP). The aim of this study is to compare an SPM algorithm-based easy Z score imaging system (eZIS) and a 3D-SSP system in the errors of anatomical standardization using 3D-digital brain phantom images. METHODS We developed a 3D-brain digital phantom based on MR images to simulate the effects of head tilt, perfusion defective region size, and count value reduction rate on the SPECT images. This digital phantom was used to compare the errors of anatomical standardization by the eZIS and the 3D-SSP algorithms. RESULTS While the eZIS allowed accurate standardization of the images of the phantom simulating a head in rotation, lateroflexion, anteflexion, or retroflexion without angle dependency, the standardization by 3D-SSP was not accurate enough at approximately 25° or more head tilt. When the simulated head contained perfusion defective regions, one of the 3D-SSP images showed an error of 6.9% from the true value. Meanwhile, one of the eZIS images showed an error as large as 63.4%, revealing a significant underestimation. CONCLUSION When required to evaluate regions with decreased perfusion due to such causes as hemodynamic cerebral ischemia, the 3D-SSP is desirable. In a statistical image analysis, we must reconfirm the image after anatomical standardization by all means.
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Affiliation(s)
- Hideo Onishi
- Prefectural University of Hiroshima, Mihara, Japan.
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Analysis of SPECT brain images for the diagnosis of Alzheimer's disease based on NMF for feature extraction. Neurosci Lett 2010; 479:192-6. [PMID: 20641163 DOI: 10.1016/j.neulet.2010.05.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This letter presents a novel computer-aided diagnosis (CAD) technique for the early diagnosis of Alzheimer's disease (AD) based on non-negative matrix factorization (NMF) analysis applied to single photon emission computed tomography (SPECT) images. A baseline normalized SPECT database containing normalized data for both AD patients and healthy reference patients is selected for this study. The SPECT database is analyzed by applying the Fisher discriminant ratio (FDR) for feature selection and NMF for feature extraction of relevant components of each subject. The main goal of these preprocessing steps is to reduce the large dimensionality of the input data and to relieve the so called "curse of dimensionality" problem. The resulting NMF-transformed set of data, which contains a reduced number of features, is classified by means of a support vector machines based classification technique (SVM). The proposed NMF + SVM method yields up to 94% classification accuracy, with high sensitivity and specificity values (upper than 90%), becoming an accurate method for SPECT image classification. For the sake of completeness, comparison between another recently developed principal component analysis (PCA) plus SVM method and the proposed method is also provided, yielding results for the NMF + SVM approach that outperform the behavior of the reference PCA + SVM or conventional voxel-as-feature (VAF) plus SVM methods.
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Computer aided diagnosis system for the Alzheimer's disease based on partial least squares and random forest SPECT image classification. Neurosci Lett 2010; 472:99-103. [PMID: 20117177 DOI: 10.1016/j.neulet.2010.01.056] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 01/22/2010] [Accepted: 01/25/2010] [Indexed: 11/21/2022]
Abstract
This letter shows a computer aided diagnosis (CAD) technique for the early detection of the Alzheimer's disease (AD) by means of single photon emission computed tomography (SPECT) image classification. The proposed method is based on partial least squares (PLS) regression model and a random forest (RF) predictor. The challenge of the curse of dimensionality is addressed by reducing the large dimensionality of the input data by downscaling the SPECT images and extracting score features using PLS. A RF predictor then forms an ensemble of classification and regression tree (CART)-like classifiers being its output determined by a majority vote of the trees in the forest. A baseline principal component analysis (PCA) system is also developed for reference. The experimental results show that the combined PLS-RF system yields a generalization error that converges to a limit when increasing the number of trees in the forest. Thus, the generalization error is reduced when using PLS and depends on the strength of the individual trees in the forest and the correlation between them. Moreover, PLS feature extraction is found to be more effective for extracting discriminative information from the data than PCA yielding peak sensitivity, specificity and accuracy values of 100%, 92.7%, and 96.9%, respectively. Moreover, the proposed CAD system outperformed several other recently developed AD CAD systems.
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Haense C, Herholz K, Jagust WJ, Heiss WD. Performance of FDG PET for detection of Alzheimer's disease in two independent multicentre samples (NEST-DD and ADNI). Dement Geriatr Cogn Disord 2010; 28:259-66. [PMID: 19786778 PMCID: PMC7077083 DOI: 10.1159/000241879] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2009] [Indexed: 11/19/2022] Open
Abstract
AIM We investigated the performance of FDG PET using an automated procedure for discrimination between Alzheimer's disease (AD) and controls, and studied the influence of demographic and technical factors. METHODS FDG PET data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) [102 controls (76.0 +/- 4.9 years) and 89 AD patients (75.7 +/- 7.6 years, MMSE 23.5 +/- 2.1) and the Network for Standardisation of Dementia Diagnosis (NEST-DD) [36 controls (62.2 +/- 5.0 years) and 237 AD patients (70.8 +/- 8.3 years, MMSE 20.9 +/- 4.4). The procedure created t-maps of abnormal voxels. The sum of t-values in predefined areas that are typically affected by AD (AD t-sum) provided a measure of scan abnormality associated with a preset threshold for discrimination between patients and controls. RESULTS AD patients had much higher AD t-sum scores compared to controls (p < 0.01), which were significantly related to dementia severity (ADNI: r = -0.62, p < 0.01; NEST-DD: r = -0.59, p < 0.01). Early-onset AD patients had significantly higher AD t-sum scores than late-onset AD patients (p < 0.01). Differences between databases were mainly due to different age distributions. The predefined AD t-sum threshold yielded a sensitivity and specificity of 83 and 78% in ADNI and 78 and 94% in NEST-DD, respectively. CONCLUSION The automated FDG PET analysis procedure provided good discrimination power, and was most accurate for early-onset AD.
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Affiliation(s)
- C Haense
- Max Planck Institute for Neurological Research, Cologne, Germany
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Diagnostic performance of Tc-99m HMPAO SPECT for early and late onset Alzheimer's disease: a clinical evaluation of linearization correction. Ann Nucl Med 2009; 23:487-95. [PMID: 19575281 DOI: 10.1007/s12149-009-0266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study examined the influence of linearization correction (LC) on brain perfusion single-photon emission computed tomography (SPECT) for the diagnosis of Alzheimer's disease (AD). METHODS The early onset group (<65 years old) consisted of 10 patients with AD, and the late onset group (>/=65 years old) of 13 patients with AD. Age-matched controls included seven younger and seven older normal volunteers. Tc-99m hexamethyl propyleneamine oxine (HMPAO) SPECT images were reconstructed with or without LC [LC (+) or LC (-)] and a statistical analysis was performed using a three-dimensional stereotactic surface projection (3D-SSP). In addition, a fully automatic diagnostic system was developed, which calculated the proportion of the number of abnormal pixels in the superior and inferior parietal lobule, as well as in the precuneus and posterior cingulate gyrus. RESULTS The areas under the receiver-operating characteristic curve (AUCs) of the early onset group for conventional axial SPECT images, SPECT + 3D-SSP images and the fully automatic diagnostic system were 0.71, 0.88, and 0.92 in LC (-) and 0.67, 0.85, and 0.91 in LC (+), respectively. The AUCs of the late onset group were 0.50, 0.61, and 0.79 in LC (-) and 0.49, 0.67, and 0.85 in LC (+), respectively. CONCLUSION LC on Tc-99m HMPAO SPECT did not significantly influence the diagnostic performance for differentiating between AD and normal controls in either early or late onset AD. Further examination with individuals suffering from very mild dementia is, therefore, expected to elucidate the effect of LC on minimally hypoperfused areas.
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Ishii K, Kanda T, Uemura T, Miyamoto N, Yoshikawa T, Shimada K, Ohkawa S, Minoshima S. Computer-assisted diagnostic system for neurodegenerative dementia using brain SPECT and 3D-SSP. Eur J Nucl Med Mol Imaging 2009; 36:831-40. [PMID: 19148640 DOI: 10.1007/s00259-008-1051-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 12/05/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop a computer-assisted automated diagnostic system to distinguish among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and other degenerative disorders in patients with mild dementia. METHODS Single photon emission computed tomography (SPECT) images with injection of N-Isopropyl-p-[(123)I]iodoamphetamine (IMP) were obtained from patients with mild degenerative dementia. First, datasets from 20 patients mild AD, 15 patients with dementia with DLB, and 17 healthy controls were used to develop an automated diagnosing system based on three-dimensional stereotactic surface projections (3D-SSP). AD- and DLB-specific regional templates were created using 3D-SSP, and critical Z scores in the templates were established. Datasets from 50 AD patients, 8 DLB patients, and 10 patients with non-AD/DLB type degenerative dementia (5 with frontotemporal dementia and 5 with progressive supranuclear palsy) were then used to test the diagnostic accuracy of the optimized automated system in comparison to the diagnostic interpretation of conventional IMP-SPECT images. These comparisons were performed to differentiate AD and DLB from non-AD/DLB and to distinguish AD from DLB. A receiver operating characteristic (ROC) analysis was performed. RESULTS The area under the ROC curve (Az) and the accuracy of the automated diagnosis system were 0.89 and 82%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 65%, respectively, for AD vs. DLB patients. The mean Az and the accuracy of the visual inspection were 0.84 and 77%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 65%, respectively, for AD vs. DLB patients. The mean Az and the accuracy of the combination of visual inspection and this system were 0.96 and 91%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 66%, respectively, for AD vs. DLB patients. CONCLUSION The system developed in the present study achieved as good discrimination of AD, DLB, and other degenerative disorders in patients with mild dementia as the commonly performed visual inspection of conventional SPECT images. A combination of visual inspection and this system is helpful in the differential diagnosis of patients with mild dementia.
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Affiliation(s)
- Kazunari Ishii
- Department of Radiology and Nuclear Medicine, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan.
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Abstract
This study investigated the role of visuospatial tasks in identifying cognitive decline in patients with Alzheimer's disease (AD), by correlating neuropsychological performance with cerebral perfusion measures. There were 157 participants: 29 neurologically healthy controls (age: 70.3 +/- 6.6, MMSE > or = 27), 86 patients with mild AD (age: 69.18 +/- 8.28, MMSE > or = 21) and 42 patients moderate/severe AD (age: 68.86 +/- 10.69, MMSE 8-20). Single Photon Emission Computerized Tomography (SPECT) was used to derive regional perfusion ratios, and correlated using partial least squares (PLS) with neuropsychological test scores from the Benton Line Orientation (BLO) and the Rey-Osterrieth Complex Figure (RO). Cross-sectional analysis demonstrated that mean scores differed in accordance with disease status: control group (BLO 25.5, RO 33.3); mild AD (BLO 20.1, RO 25.5); moderate/severe AD (BLO 10.7, RO 16). Correlations were observed between BLO/RO and right parietal SPECT regions in the AD groups. Visuospatial performance, often undersampled in cognitive batteries for AD, is clearly impaired even in mild AD and correlates with functional deficits as indexed by cerebral perfusion ratios on SPECT implicating right hemisphere circuits. Furthermore, PLS reveals that usual spatial tasks probe a distributed brain network in both hemispheres including many areas targeted by early AD pathology.
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Effect of sample size for normal database on diagnostic performance of brain FDG PET for the detection of Alzheimer's disease using automated image analysis. Nucl Med Commun 2008; 29:270-6. [PMID: 18349798 DOI: 10.1097/mnm.0b013e3282f3fa76] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the relationship between the sample size for a normal database (NDB) and diagnostic performance of FDG PET using three-dimensional stereotactic surface projection for the detection of Alzheimer's disease. METHODS We generated nine NDB sets consisting of 4, 6, 8, 10, 20, 30, 40, 50 and 60 normal subjects. In order to assess the diagnostic performance using these NDBs to distinguish Alzheimer's disease patients from normal subjects, we recruited 52 patients with probable Alzheimer's disease (25 males, 27 females; mean age, 66.8+/-8.1 years) and 50 normal subjects (24 males, 26 females; mean age, 65.7+/-9.4 years). A receiver operating characteristic (ROC) analysis was performed for comparison of diagnostic accuracy among NDB sets. RESULTS Small NDBs (n< or =10) yielded poor quality of mean and SD images as compared with large NDBs (n> or =20). The ROC curves of the smaller group varied inconsistently, whereas those of the larger group were nearly superimposable. The area under the ROC curve (AUC) of the NDBs with sample size 6 (0.911) or 8 (0.929) was significantly smaller than that of the largest NDB (n=60, 0.956). The AUCs of the larger group did not fall below 0.950, whereas AUCs of the smaller subgroup never exceeded 0.950. CONCLUSIONS Our data indicate that the sample size for an NDB affects the diagnostic performance of FDG PET using automated statistical approach, and that inclusion of at least 10 subjects is recommended, and 20 seems to be preferable for generating NDBs, although even a small NDB may provide clinically relevant results.
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Nihashi T, Yatsuya H, Hayasaka K, Kato R, Kawatsu S, Arahata Y, Iwai K, Takeda A, Washimi Y, Yoshimura K, Mizuno K, Kato T, Naganawa S, Ito K. Direct comparison study between FDG-PET and IMP-SPECT for diagnosing Alzheimer's disease using 3D-SSP analysis in the same patients. ACTA ACUST UNITED AC 2007; 25:255-62. [PMID: 17634878 DOI: 10.1007/s11604-007-0132-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 02/23/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate and compare the diagnostic ability of 2-[(18)F]-fluoro-2-deoxy-D: -glucose (FDG) positron emission tomography (PET) and N-isopropyl-p-(123)I iodoamphetamine single photon emission computed tomography (IMP-SPECT) using three-dimensional stereotactic surface projections (3D-SSP) in patients with moderate Alzheimer's disease (AD). MATERIALS AND METHODS FDG-PET and IMP-SPECT were performed within 3 months in 14 patients with probable moderate AD. Z-score maps of FDG-PET and IMP-SPECT images of a patient were obtained by comparison with data obtained from control subjects. Four expert physicians evaluated and graded the glucose hypometabolism and regional cerebral blood flow (rCBF), focusing in particular on the posterior cingulate gyri/precunei and parietotemporal regions, and determined the reliability for AD. Receiver operating characteristic (ROC) curves were applied to the results for clarification. To evaluate the correlation between two modalities, the regions of interest (ROIs) were set in the posterior cingulate gyri/precunei and parietotemporal region on 3D-SSP images, and mean Z-values were calculated. CONCLUSION No significant difference was observed in the area under the ROC curve (AUC) between FDG-PET and IMP-SPECT images (FDG-PET 0.95, IMP-SPECT 0.94). However, a significant difference (P < 0.05) was observed in the AUC for the posterior cingulate gyri/precuneus (FDG-PET 0.94, IMP-SPECT 0.81). The sensitivity and specificity of each modality were 86%, and 97% for FDG-PET and 70% and 100% for IMP-SPECT. We could find no significant difference between FDG-PET and IMP-SPECT in terms of diagnosing moderate AD using 3D-SSP. There was a high correlation between the two modalities in the parietotemporal region (Spearman's r = 0.82, P < 0.001). The correlation in the posterior cingulate gyri/precunei region was lower than that in the parietotemporal region (Spearman's r = 0.63, P < 0.016).
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Affiliation(s)
- Takashi Nihashi
- Department of Radiology, National Center for Geriatrics and Gerontology, 36-3 Gengo, Morioka-Cho, Ohbu, 474-8522, Japan.
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Abstract
There are five potential major roles for neuroimaging with respect to dementia; (1) as a cognitive neuroscience research tool, (2) for prediction of which normal or slightly impaired individuals will develop dementia and over what time frame, (3) for early diagnosis of Alzheimer's disease (AD) in demented individuals, (sensitivity) and separation of AD from other forms of dementia (specificity), (4) for monitoring of disease progression, and (5) for monitoring response to therapies. Focusing on the last role, no single imaging approach is yet ideal, as all trade-off speed, cost, and accuracy. Functional imaging (SPECT and PET) is best suited to tracking symptomatic therapy response, and anatomic (MRI volumetric) imaging or amyloid PET are more suited to reflect dementia modulation studies. The potential for imaging with respect to pharmacological studies of dementia--to provide surrogate markers for drug studies, to improve diagnosis, to speed evaluation of outcomes, and to decrease sample sizes--is huge. At the present time, however, no single measure has sufficient proven reliability, replicability, or robustness, to replace clinical primary outcome measures.
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Affiliation(s)
- Howard Chertkow
- Department of Clinical Neuroscience, Sir Mortimer B. Davis-Jewish General Hospital, Toronto, ON, Canada
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Kono AK, Ishii K, Sofue K, Miyamoto N, Sakamoto S, Mori E. Fully automatic differential diagnosis system for dementia with Lewy bodies and Alzheimer’s disease using FDG-PET and 3D-SSP. Eur J Nucl Med Mol Imaging 2007; 34:1490-7. [PMID: 17318545 DOI: 10.1007/s00259-007-0380-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Accepted: 01/24/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate a fully automatic computer-assisted diagnostic system for mild dementia with Lewy bodies (DLB), permitting distinction from mild Alzheimer's disease (AD). METHODS Using 18F-fluorodeoxyglucose and positron emission tomography (FDG-PET), glucose metabolic images were obtained from mild DLB and mild AD patients. Two groups consisting of 16 mild DLB patients and 21 mild AD patients were recruited for diagnostic evaluation between mild DLB and mild AD. The mean age+/-SD of the mild DLB group and the mild AD group was 74.3+/-4.9 and 71.7+/-2.1 years, respectively, and the mean scores of the MMSE for the mild DLB and the mild AD group were 21.7+/-1.9 and 23.1+/-2.1, respectively. A receiver operating characteristic (ROC) analysis was performed to compare the diagnostic performance, in terms of discrimination between DLB and AD, of conventional axial FDG-PET images inspected visually by experts and beginners with that of our fully automatic diagnosis system using the statistical brain mapping method and Z scores obtained with the DLB template. RESULTS The diagnostic performance of the automatic system was comparable to that of visual inspection by experts. The area under the ROC curve for the automatic diagnosis system was 0.77. The mean area under the ROC curve for visual inspection by experts and beginners was 0.76 and 0.65, respectively. CONCLUSION The fully automatic differential diagnosis system for distinction between mild DLB and AD showed a similar diagnostic accuracy to visual inspection by experts. It would be a useful diagnostic tool to distinguish mild DLB from mild AD in clinical practice.
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Affiliation(s)
- Atsushi K Kono
- Department of Radiology and Nuclear Medicine, Hyogo Brain and Heart Center, 520 Saisho-Ko, Himeji, Hyogo, 670-0981, Japan
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