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Ryu CJ. Automatic lesion detection and segmentation in 18F-flutemetamol positron emission tomography images using deep learning. Biomed Eng Online 2022; 21:88. [PMID: 36539779 PMCID: PMC9768895 DOI: 10.1186/s12938-022-01058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Beta amyloid in the brain, which was originally confirmed by post-mortem examinations, can now be confirmed in living patients using amyloid positron emission tomography (PET) tracers, and the accuracy of diagnosis can be improved by beta amyloid plaque confirmation in patients. Amyloid deposition in the brain is often associated with the expression of dementia. Hence, it is important to identify the anatomically and functionally meaningful areas of the human brain cortex surface using PET to diagnose the possibility of developing dementia. In this study, we demonstrated the validity of automated 18F-flutemetamol PET lesion detection and segmentation based on a complete 2D U-Net convolutional neural network via masking treatment strategies. METHODS PET data were first normalized by volume and divided into five amyloid accumulation zones through axial, coronary, and thalamic slices. A single U-Net was trained using a divided dataset for one of these zones. Ground truth segmentations were obtained by manual delineation and thresholding (1.5 × background). RESULTS The following intersection over union values were obtained for the various slices in the verification dataset: frontal lobe axial/sagittal: 0.733/0.804; posterior cingulate cortex and precuneus coronal/sagittal: 0.661/0.726; lateral temporal lobe axial/coronal: 0.864/0.892; parietal lobe axial/coronal: 0.542/0.759; and striatum axial/sagittal: 0.679/0.752. The U-Net convolutional neural network architecture allowed fully automated 2D division of the 18F-flutemetamol PET brain images of Alzheimer's patients. CONCLUSIONS As dementia should be tested and evaluated in various ways, there is a need for artificial intelligence programs. This study can serve as a reference for future studies using auxiliary roles and research in Alzheimer's diagnosis.
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Affiliation(s)
- Chan Ju Ryu
- grid.410886.30000 0004 0647 3511Department of Nuclear Medicine, Cha University Bundang Medical Center, 59, Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do 13496 Korea
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Zeydan B, Schwarz CG, Przybelski SA, Lesnick TG, Kremers WK, Senjem ML, Kantarci OH, Min PH, Kemp BJ, Jack CR, Kantarci K, Lowe VJ. Comparison of 11C-Pittsburgh Compound B and 18F-Flutemetamol White Matter Binding in PET. J Nucl Med 2022; 63:1239-1244. [PMID: 34916245 PMCID: PMC9364341 DOI: 10.2967/jnumed.121.263281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023] Open
Abstract
PET imaging with β-amyloid ligands is emerging as a molecular imaging technique targeting white matter integrity and demyelination. β-amyloid PET ligands such as 11C-Pittsburgh compound B (11C-PiB) have been considered for quantitative measurement of myelin content changes in multiple sclerosis, but 11C-PiB is not commercially available given its short half-life. A 18F PET ligand such as flutemetamol with a longer half-life may be an alternative, but its ability to differentiate white matter hyperintensities (WMH) from normal-appearing white matter (NAWM) and its relationship with age remains to be investigated. Methods: Cognitively unimpaired (CU) older and younger adults (n = 61) were recruited from the community responding to a study advertisement for β-amyloid PET. Participants prospectively underwent MRI, 11C-PiB, and 18F-flutemetamol PET scans. MRI fluid-attenuated inversion recovery images were segmented into WMH and NAWM and registered to the T1-weighted MRI. 11C-PiB and 18F-flutemetamol PET images were also registered to the T1-weighted MRI. 11C-PiB and 18F-flutemetamol SUV ratios (SUVrs) from the WMH and NAWM were calculated using cerebellar crus uptake as a reference for both 11C-PiB and 18F-flutemetamol. Results: The median age was 38 y (range, 30-48 y) in younger adults and 67 y (range, 61-83 y) in older adults. WMH and NAWM SUVrs were higher with 18F-flutemetamol than with 11C-PiB in both older (P < 0.001) and younger (P < 0.001) CU adults. 11C-PiB and 18F-flutemetamol SUVrs were higher in older than in younger CU adults in both WMH (P < 0.001) and NAWM (P < 0.001). 11C-PiB and 18F-flutemetamol SUVrs were higher in NAWM than WMH in both older (P < 0.001) and younger (P < 0.001) CU adults. There was no apparent difference between 11C-PiB and 18F-flutemetamol SUVrs in differentiating WMH from NAWM in older and in younger adults. Conclusion:11C-PiB and 18F-flutemetamol show a similar topographic pattern of uptake in white matter with a similar association with age in WMH and NAWM. 11C-PiB and 18F-flutemetamol can also effectively distinguish between WMH and NAWM. However, given its longer half-life, commercial availability, and higher binding potential, 18F-flutemetamol can be an alternative to 11C-PiB in molecular imaging studies specifically targeting multiple sclerosis to evaluate white matter integrity.
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Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; and
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; and
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; and
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Information Technology, Mayo Clinic, Rochester, Minnesota
| | | | - Paul H Min
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Kemp
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota;
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Otani T, Otsuka H, Matsushita K, Otomi Y, Kunikane Y, Azane S, Amano M, Harada M, Miyoshi H. Effect of different examination conditions on image quality and quantitative value of amyloid positron emission tomography using 18F-flutemetamol. Ann Nucl Med 2021; 35:1004-1014. [PMID: 34046870 DOI: 10.1007/s12149-021-01634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The recommended start time for 18F-flutemetamol amyloid positron emission tomography (PET) examination is 60-120 min after 18F-flutemetamol injection, while an acquisition time of 10-30 min is generally recommended. We aimed to elucidate the effects of different examination conditions on image quality, diagnostic ability, and quantitative value of amyloid PET using 18F-flutemetamol. METHODS We acquired data on a Discovery PET/computed tomography 710 scanner using Hoffman brain and pillar phantoms with 20 MBq of 18F for 30 min. The images were reconstructed into 10-, 20-, and 30-min periods. The ordered subset-expectation maximization algorithm was used for image reconstruction, which uses a 2- or 4-mm Gaussian filter and a combination of iteration and subset numbers. The percentage contrast and coefficient of variation (CV; as the image noise) were used as physical evaluation indices for reconstructed images, and images with superior contrast and low image noise were selected for clinical evaluation. The imaging data of 15 symptomatic patients (n = 7 and n = 8 for positive and negative diagnoses of Alzheimer's disease, respectively) were reconstructed under the phantom study conditions. Radiographers visually evaluated and ranked the clinical images based on the overall contrast and image noise, and nuclear medicine specialists diagnosed Alzheimer's disease. We compared the standardized uptake value ratio (SUVR) obtained with different acquisition conditions. RESULTS The basic study using the phantom revealed high convergence of contrast and image noise in five patterns of acquisition time and filter strengths. Regarding visual evaluation, the use of a 2-mm Gaussian filter caused difficulties in diagnosis because the brain parenchymal accumulation was mottled with high image noise. Differences in image quality and diagnostic ability due to different examination times were not significant. Differences in the SUVR were not significant in patients with a negative Alzheimer's disease diagnosis; in patients with a positive diagnosis, the SUVR showed significant fluctuation depending on the acquisition conditions. CONCLUSION The differences in image quality and diagnostic performance due to the differences in 10-min acquisition time were not significant; however, of note, SUVR showed significant fluctuation depending on the acquisition conditions in patients diagnosed with Alzheimer's disease.
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Affiliation(s)
- Tamaki Otani
- Advance Radiation Research, Education, and Management Center, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Hideki Otsuka
- Department of Medical Imaging/Nuclear Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kou Matsushita
- Faculty of Health Science, Tokushima University Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yoichi Otomi
- Department of Radiology and Radiation Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yamato Kunikane
- Department of Radiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Shota Azane
- Department of Radiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masafumi Amano
- Department of Radiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masafumi Harada
- Department of Radiology and Radiation Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hirokazu Miyoshi
- Advance Radiation Research, Education, and Management Center, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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Cho SH, Choe YS, Kim YJ, Kim HJ, Jang H, Kim Y, Kim SE, Kim SJ, Kim JP, Jung YH, Kim BC, Lockhart SN, Farrar G, Na DL, Moon SH, Seo SW. Head-to-Head Comparison of 18F-Florbetaben and 18F-Flutemetamol in the Cortical and Striatal Regions. J Alzheimers Dis 2021; 76:281-290. [PMID: 32474468 DOI: 10.3233/jad-200079] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND 18F-florbetaben (FBB) and 18F-flutemetamol (FMM) amyloid PET have been developed and approved for clinical use. It is important to understand the distinct features of these ligands to compare and correctly interpret the results of different amyloid PET studies. OBJECTIVE We performed a head-to-head comparison of FBB and FMM to compare with regard to imaging characteristics, including dynamic range of retention, and differences in quantitative measurements between the two ligands in cortical, striatal, and white matter (WM) regions. METHODS Paired FBB and FMM PET images were acquired in 107 participants. Correlations of FBB and FMM amyloid deposition in the cortex, striatum, and WM were investigated and compared in different reference regions (cerebellar gray matter (CG), whole cerebellum (WC), WC with brainstem (WC + B), and pons). RESULTS The cortical SUVR (R2 = 0.97) and striatal SUVR (R2 = 0.95) demonstrated an excellent linear correlation between FBB and FMM using a WC as reference region. There was no difference in the cortical SUVR ratio between the two ligands (p = 0.90), but the striatal SUVR ratio was higher in FMM than in FBB (p < 0.001). Also, the effect size of differences in striatal SUVR seemed to be higher with FMM (2.61) than with FBB (2.34). These trends were similarly observed according to four different reference regions (CG, WC, WC + B, and pons). CONCLUSION Our findings suggest that FMM might be better than FBB to detect amyloid burden in the striatum, although both ligands are comparable for imaging AD pathology in vivo.
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Affiliation(s)
- Soo Hyun Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yeong Sim Choe
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Young Ju Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Si Eun Kim
- Departments of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Seung Joo Kim
- Department of Neurology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Young Hee Jung
- Department of Neurology, Myoungji Hospital, Hanyang University, Goyangsi, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Samuel N Lockhart
- Internal Medicine - Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gill Farrar
- Pharmaceutical Diagnostics, GE Healthcare, Chalfont St Giles, UK
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
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Matsuda H, Ito K, Ishii K, Shimosegawa E, Okazawa H, Mishina M, Mizumura S, Ishii K, Okita K, Shigemoto Y, Kato T, Takenaka A, Kaida H, Hanaoka K, Matsunaga K, Hatazawa J, Ikawa M, Tsujikawa T, Morooka M, Ishibashi K, Kameyama M, Yamao T, Miwa K, Ogawa M, Sato N. Quantitative Evaluation of 18F-Flutemetamol PET in Patients With Cognitive Impairment and Suspected Alzheimer's Disease: A Multicenter Study. Front Neurol 2021; 11:578753. [PMID: 33519667 PMCID: PMC7838486 DOI: 10.3389/fneur.2020.578753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background: In clinical practice, equivocal findings are inevitable in visual interpretation of whether amyloid positron emission tomography (PET) is positive or negative. It is therefore necessary to establish a more objective quantitative evaluation method for determining the indication for disease-modifying drugs currently under development. Aims: We aimed to determine cutoffs for positivity in quantitative analysis of 18F-flutemetamol PET in patients with cognitive impairment and suspected Alzheimer's disease (AD). We also evaluated the clinical efficacy of amyloid PET in the diagnosis of AD. This study was registered in the Japan Registry of Clinical Trials (jRCTs, 031180321). Methods: Ninety-three patients suspected of having AD underwent 18F-flutemetamol PET in seven institutions. A PET image for each patient was visually assessed and dichotomously rated as either amyloid-positive or amyloid-negative by two board-certified nuclear medicine physicians. If the two readers obtained different interpretations, the visual rating was rerun until they reached consensus. The PET images were quantitatively analyzed using the standardized uptake value ratio (SUVR) and standardized Centiloid (CL) scale with the whole cerebellum as a reference area. Results: Visual interpretation obtained 61 positive and 32 negative PET scans. Receiver operating characteristic analysis determined the best agreement of quantitative assessments and visual interpretation of PET scans to have an area under curve of 0.982 at an SUVR of 1.13 and a CL of 16. Using these cutoff values, there was high agreement between the two approaches (kappa = 0.88). Five discordant cases had SUVR and CL values ranging from 1.00 to 1.22 and from 1 to 26, respectively. In these discordant cases, either diffuse or mildly focal elevation of cortical activity confused visual interpretation. The amyloid PET outcome significantly altered the diagnosis of AD (χ2 = 51.3, p < 0.0001). PET imaging elevated the proportions of the very high likelihood category from 20.4 to 46.2% and the very low likelihood category from 0 to 22.6%. Conclusion: Quantitative analysis of amyloid PET using 18F-flutemetamol can objectively evaluate amyloid positivity using the determined cutoffs for SUVR and CL. Moreover, amyloid PET may have added value over the standard diagnostic workup in dementia patients with cognitive impairment and suspected AD.
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Affiliation(s)
- Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Radiology, National Center of Neurology and Psychiatry, Kodaira, Japan.,Cyclotron and Drug Discovery Research Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Kengo Ito
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Japan.,Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, Osakasayama, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Masahiro Mishina
- Department of Neuro-Pathophysiological Imaging, Graduate School of Medicine, Nippon Medical School, Kawasaki, Japan
| | - Sunao Mizumura
- Department of Radiology, Medical Centre Omori, Toho University, Tokyo, Japan
| | - Kenji Ishii
- Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kyoji Okita
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yoko Shigemoto
- Department of Radiology, National Center of Neurology and Psychiatry, Kodaira, Japan.,Cyclotron and Drug Discovery Research Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Takashi Kato
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Akinori Takenaka
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Japan.,Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, Osakasayama, Japan
| | - Kohei Hanaoka
- Joint Research Division for the Quantum Cancer Therapy, Research Center for Nuclear Physics, Osaka University, Osaka, Japan
| | - Keiko Matsunaga
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Hatazawa
- Joint Research Division for the Quantum Cancer Therapy, Research Center for Nuclear Physics, Osaka University, Osaka, Japan
| | - Masamichi Ikawa
- Department of Neurology, Faculty of Medical Sciences, Fukui, Japan
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Miyako Morooka
- Department of Radiology, Medical Centre Omori, Toho University, Tokyo, Japan
| | - Kenji Ishibashi
- Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Masashi Kameyama
- Department of Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Tensho Yamao
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan.,Cyclotron and Drug Discovery Research Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan.,Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan
| | - Kenta Miwa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan.,Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan
| | - Masayo Ogawa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Kodaira, Japan
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Yun T, Lee W, Kang JH, Yang MP, Kang BT. Temporal and anatomical distribution of 18F-flutemetamol uptake in canine brain using positron emission tomography. BMC Vet Res 2020; 16:17. [PMID: 31952531 PMCID: PMC6969467 DOI: 10.1186/s12917-020-2240-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 01/10/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) is increasingly being used as an imaging modality for clinical and research applications in veterinary medicine. Amyloid PET has become a useful tool for diagnosing Alzheimer's disease (AD) in humans, by accurately identifying amyloid-beta (Aβ) plaques. Cognitive dysfunction syndrome in dogs shows cognitive and pathophysiologic characteristics similar to AD. Therefore, we assessed the physiologic characteristics of uptake of 18F-flutemetamol, an Aβ protein-binding PET tracer in clinical development, in normal dog brains, for distinguishing an abnormal state. Static and dynamic PET images of six adult healthy dogs were acquired after 18F-flutemetamol was administered intravenously at approximately 3.083 MBq/kg. For static images, PET data were acquired at 30, 60, and 90 min after injection. One week later, dynamic images were acquired for 120 min, from the time of tracer injection. PET data were reconstructed using an iterative technique, and corrections for attenuation and scatter were applied. Regions of interest were manually drawn over the frontal, parietal, temporal, occipital, anterior cingulate, posterior cingulate, and cerebellar cortices, cerebral white matter, midbrain, pons, and medulla oblongata. After calculating standardized uptake values with an established formula, standardized uptake value ratios (SUVRs) were obtained, using the cerebellar cortex as a reference region. RESULTS Among the six cerebral cortical regions, the cingulate cortices and frontal lobe showed the highest SUVRs. The lowest SUVR was observed in the occipital lobe. The average values of the cortical SUVRs were 1.25, 1.26, and 1.27 at 30, 60, and 90 min post-injection, respectively. Tracer uptake on dynamic scans was rapid, peaking within 4 min post-injection. After reaching this early maximum, cerebral cortical regions showed a curve with a steep descent, whereas cerebral white matter demonstrated a curve with a slow decline, resulting in a large gap between cerebral cortical regions and white matter. CONCLUSION This study provides normal baseline data of 18F-flutemetamol PET that can facilitate an objective diagnosis of cognitive dysfunction syndrome in dogs in future.
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Affiliation(s)
- Taesik Yun
- Veterinary Teaching Hospital, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644 South Korea
| | - Wonguk Lee
- Department of Nuclear Medicine, Chungbuk National University Hospital, Cheongju, Chungbuk 28644 South Korea
| | - Ji-Houn Kang
- Veterinary Teaching Hospital, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644 South Korea
| | - Mhan-Pyo Yang
- Veterinary Teaching Hospital, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644 South Korea
| | - Byeong-Teck Kang
- Veterinary Teaching Hospital, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644 South Korea
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Dietemann S, Nkoulou R. Amyloid PET imaging in cardiac amyloidosis: a pilot study using 18F-flutemetamol positron emission tomography. Ann Nucl Med 2019; 33:624-8. [PMID: 31140154 DOI: 10.1007/s12149-019-01372-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Cardiac amyloidosis is a rare disease characterized by amyloid heart deposits and is usually a part of systemic amyloidosis, in relation to systemic light chain (AL) and transthyretin (ATTR wild-type or genetic) amyloidosis. Several recent studies suggest a promising role of amyloid PET imaging to image cardiac amyloidosis, and several PET tracers are now available for in vivo detection of amyloid deposits. The aim of this study was to evaluate 18F-flutemetamol in diagnosing cardiac amyloidosis. METHODS We performed a pilot study using 18F-flutemetamol (Vizamyl™) in 12 patients, 3 control subjects without cardiac amyloidosis, and 9 subjects with documented cardiac amyloidosis. Mean standardized uptake value (SUV) in the left ventricular myocardium and blood pool was determined and semi-quantitative parameter as target to background ratio (TBR, myocardial/blood pool mean SUV ratio) between 10th and 30th minutes was calculated. RESULTS Uptake of 18F-flutemetamol in the left ventricular myocardium was noted in all patients with cardiac amyloidosis except one and none in control patient. The TBR was significantly higher in amyloidosis patients than in control subjects: 1.46, interquartile range (IQR) 1.32-2.06 versus 1.06, IQR 0.72-1.1 (p = 0.033). Only one patient in our study had light chain amyloidosis and showed higher TBR than patients with transthyretin amyloid: TBR 3.0 versus TBR median 1.44, IQR 1.33-1.69. CONCLUSION Amyloid PET tracers such as 18F-flutemetamol could be a promising tool in diagnosing and in therapy response assessment for patients with cardiac amyloidosis.
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8
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Son HJ, Jeong YJ, Yoon HJ, Lee SY, Choi GE, Park JA, Kim MH, Lee KC, Lee YJ, Kim MK, Cho K, Kang DY. Assessment of brain beta-amyloid deposition in transgenic mouse models of Alzheimer's disease with PET imaging agents 18F-flutemetamol and 18F-florbetaben. BMC Neurosci 2018; 19:45. [PMID: 30053803 PMCID: PMC6063010 DOI: 10.1186/s12868-018-0447-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although amyloid beta (Aβ) imaging is widely used for diagnosing and monitoring Alzheimer's disease in clinical fields, paralleling comparison between 18F-flutemetamol and 18F-florbetaben was rarely attempted in AD mouse model. We performed a comparison of Aβ PET images between 18F-flutemetamol and 18F-florbetaben in a recently developed APPswe mouse model, C57BL/6-Tg (NSE-hAPPsw) Korl. RESULTS After an injection (0.23 mCi) of 18F-flutemetamol and 18F-florbetaben at a time interval of 2-3 days, we compared group difference of SUVR and kinetic parameters between the AD (n = 7) and control (n = 7) mice, as well as between 18F-flutemetamol and 18F-florbetaben image. In addition, bio-distribution and histopathology were conducted. With visual image and VOI-based SUVR analysis, the AD group presented more prominent uptake than did the control group in both the 18F-florbetaben and 18F-flutemetamol images. With kinetic analysis, the 18F-florbetaben images showed differences in K1 and k4 between the AD and control groups, although 18F-flutemetamol images did not show significant difference. 18F-florbetaben images showed more prominent cortical uptake and matched well to the thioflavin S staining images than did the 18F-flutemetamol image. In contrast, 18F-flutemetamol images presented higher K1, k4, K1/k2 values than those of 18F-florbetaben images. Also, 18F-flutemetamol images presented prominent uptake in the bowel and bladder, consistent with higher bio-distribution in kidney, lung, blood and heart. CONCLUSIONS Compared with 18F-flutemetamol images, 18F-florbetaben images showed prominent visual uptake intensity, SUVR, and higher correlations with the pathology. In contrast, 18F-flutemetamol was more actively metabolized than was 18F-florbetaben (Son et al. in J Nucl Med 58(Suppl 1):S278, 2017].
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Affiliation(s)
- Hye Joo Son
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Young Jin Jeong
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Hyun Jin Yoon
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Sang Yoon Lee
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Go-Eun Choi
- Institute of Convergence Bio-Health, Dong-A University, Busan, Korea
| | - Ji-Ae Park
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Min Hwan Kim
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Kyo Chul Lee
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Yong Jin Lee
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Mun Ki Kim
- Pohang Center of Evolution of Biomaterials, Pohang Technopark, Pohang, Korea
| | - Kook Cho
- Institute of Convergence Bio-Health, Dong-A University, Busan, Korea
| | - Do-Young Kang
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Korea
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Hanseeuw B, Dricot L, Lhommel R, Quenon L, Ivanoiu A. Patients with Amyloid-Negative Mild Cognitive Impairment have Cortical Hypometabolism but the Hippocampus is Preserved. J Alzheimers Dis 2018; 53:651-60. [PMID: 27232217 DOI: 10.3233/jad-160204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with mild cognitive impairment (MCI) are at risk for Alzheimer's dementia but the presence of amyloid (Aβ) strongly increases this risk. In clinical settings, when Aβ status is not available, different neurodegenerative markers are used to characterize MCI. The accuracy of these markers to discriminate between Aβ-and Aβ+ MCI is not yet determined. OBJECTIVE To compare different markers of neurodegeneration in Aβ-and Aβ+ MCI, with an Aβ-elderly control (EC) group. METHODS Patients with MCI (n = 39) and EC (n = 28) underwent MRI, 18F-FDG PET, and Aβ PET (18F-flutemetamol). We compared FDG and MRI biomarker values in cortical and hippocampal regions of interest, and using voxel-wise surface maps. We computed ROC curves discriminating between the three groups for each biomarker. RESULTS All biomarker values were reduced in Aβ+ MCI compared to EC (p < 0.001). Aβ-MCI had low cortical metabolism (p = 0.002), but hippocampal volume, cortical thickness, and hippocampal metabolism were not significantly different between Aβ-MCI and EC (p > 0.40). Cortical metabolism best discriminated between MCI and EC (AUC = 0.92/0.86, Aβ+/Aβ-) while hippocampal volume best discriminated between Aβ-MCI and Aβ+ MCI (AUC = 0.79). CONCLUSIONS Cortical hypometabolism was observed in both Aβ-MCI and Aβ+ MCI whereas hippocampal atrophy was mostly found in Aβ+ MCI. For MCI patients without available Aβ information, hippocampal atrophy is thus more informative about Aβ status than cortical hypometabolism.
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Affiliation(s)
- Bernard Hanseeuw
- Neurology Department, Saint-Luc University Hospital, Brussels, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.,Neurology Department, Massachusetts General Hospital and the Martinos Center for Biomedical Imaging, Boston, MA, USA
| | - Laurence Dricot
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Renaud Lhommel
- Nuclear Medicine Department, Saint-Luc University Hospital, Brussels, Belgium
| | - Lisa Quenon
- Neurology Department, Saint-Luc University Hospital, Brussels, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Adrian Ivanoiu
- Neurology Department, Saint-Luc University Hospital, Brussels, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
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Adamczuk K, De Weer AS, Nelissen N, Dupont P, Sunaert S, Bettens K, Sleegers K, Van Broeckhoven C, Van Laere K, Vandenberghe R. Functional Changes in the Language Network in Response to Increased Amyloid β Deposition in Cognitively Intact Older Adults. Cereb Cortex 2014; 26:358-73. [PMID: 25452579 DOI: 10.1093/cercor/bhu286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Word finding symptoms are frequent early in the course of Alzheimer's disease and relate principally to functional changes in left posterior temporal cortex. In cognitively intact older adults, we examined whether amyloid load affects the network for language and associative-semantic processing. Fifty-six community-recruited subjects (52-74 years), stratified for apolipoprotein E and brain-derived neurotrophic factor genotype, received a neurolinguistic assessment, (18)F-flutemetamol positron emission tomography, and a functional MRI of the associative-semantic system. The primary measure of amyloid load was the cerebral-to-cerebellar gray matter standardized uptake value ratio in a composite cortical volume of interest (SUVR(comp)). The primary outcome analysis consisted of a whole-brain voxelwise linear regression between SUVR(comp) and fMRI response during associative-semantic versus visuoperceptual processing. Higher activity in one region, the posterior left middle temporal gyrus, correlated positively with increased amyloid load. The correlation remained significant when only the word conditions were contrasted but not for pictures. According to a stepwise linear regression analysis, offline naming reaction times correlated positively with SUVR(comp). A binary classification into amyloid-positive and amyloid-negative cases confirmed our findings. The left posterior temporal activity increase may reflect higher demands for semantic control in the presence of a higher amyloid burden.
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Affiliation(s)
- Katarzyna Adamczuk
- Laboratory for Cognitive Neurology, KU Leuven, Belgium Alzheimer Research Centre KU Leuven, Leuven Institute of Neurodegenerative Disorders, KU Leuven, Belgium
| | | | - Natalie Nelissen
- Laboratory for Cognitive Neurology, KU Leuven, Belgium Department of Experimental Psychology, Oxford University, UK
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, KU Leuven, Belgium Alzheimer Research Centre KU Leuven, Leuven Institute of Neurodegenerative Disorders, KU Leuven, Belgium
| | - Stefan Sunaert
- Alzheimer Research Centre KU Leuven, Leuven Institute of Neurodegenerative Disorders, KU Leuven, Belgium Radiology Department, UZ Leuven, Belgium
| | - Karolien Bettens
- Neurodegenerative Brain Diseases Group, VIB Department of Molecular Genetics, Antwerp, Belgium Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Belgium
| | - Kristel Sleegers
- Neurodegenerative Brain Diseases Group, VIB Department of Molecular Genetics, Antwerp, Belgium Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Belgium
| | - Christine Van Broeckhoven
- Neurodegenerative Brain Diseases Group, VIB Department of Molecular Genetics, Antwerp, Belgium Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Belgium
| | - Koen Van Laere
- Alzheimer Research Centre KU Leuven, Leuven Institute of Neurodegenerative Disorders, KU Leuven, Belgium Nuclear Medicine and Molecular Imaging Department, KU Leuven and UZ Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, KU Leuven, Belgium Alzheimer Research Centre KU Leuven, Leuven Institute of Neurodegenerative Disorders, KU Leuven, Belgium Neurology Department, UZ Leuven, Belgium
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Thurfjell L, Lilja J, Lundqvist R, Buckley C, Smith A, Vandenberghe R, Sherwin P. Automated quantification of 18F-flutemetamol PET activity for categorizing scans as negative or positive for brain amyloid: concordance with visual image reads. J Nucl Med 2014; 55:1623-8. [PMID: 25146124 DOI: 10.2967/jnumed.114.142109] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Clinical trials of the PET amyloid imaging agent (18)F-flutemetamol have used visual assessment to classify PET scans as negative or positive for brain amyloid. However, quantification provides additional information about regional and global tracer uptake and may have utility for image assessment over time and across different centers. Using postmortem brain neuritic plaque density data as a truth standard to derive a standardized uptake value ratio (SUVR) threshold, we assessed a fully automated quantification method comparing visual and quantitative scan categorizations. We also compared the histopathology-derived SUVR threshold with one derived from healthy controls. METHODS Data from 345 consenting subjects enrolled in 8 prior clinical trials of (18)F-flutemetamol injection were used. We grouped subjects into 3 cohorts: an autopsy cohort (n = 68) comprising terminally ill patients with postmortem confirmation of brain amyloid status; a test cohort (n = 172) comprising 33 patients with clinically probable Alzheimer disease, 80 patients with mild cognitive impairment, and 59 healthy volunteers; and a healthy cohort of 105 volunteers, used to define a reference range for SUVR. Visual image categorizations for comparison were from a previous study. A fully automated PET-only quantification method was used to compute regional neocortical SUVRs that were combined into a single composite SUVR. An SUVR threshold for classifying scans as positive or negative was derived by ranking the PET scans from the autopsy cohort based on their composite SUVR and comparing data with the standard of truth based on postmortem brain amyloid status for subjects in the autopsy cohort. The derived threshold was used to categorize the 172 scans in the test cohort as negative or positive, and results were compared with categorization using visual assessment. Different reference and composite region definitions were assessed. Threshold levels were also compared with corresponding thresholds derived from the healthy group. RESULTS Automated quantification (using pons as the reference region) demonstrated 91% sensitivity and 88% specificity and gave 3 false-positive and 4 false-negative scans. All 3 false-positive cases were either borderline-normal by standard of truth or had moderate to heavy cortical diffuse plaque burden. In the test cohort, the concordance between quantitative and visual read categorization ranged from 97.1% to 99.4% depending on the selection of reference and composite regions. The threshold derived from the healthy group was close to the histopathology-derived threshold. CONCLUSION Categorization of (18)F-flutemetamol amyloid imaging data using an automated PET-only quantification method showed good agreement with histopathologic classification of neuritic plaque density and a strong concordance with visual read results.
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Affiliation(s)
- Lennart Thurfjell
- GE Healthcare, Uppsala, Sweden Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Catholic University Leuven, Leuven, Belgium Neurology Department, University Hospitals Leuven, Leuven, Belgium; and
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Lundqvist R, Lilja J, Thomas BA, Lötjönen J, Villemagne VL, Rowe CC, Thurfjell L. Implementation and validation of an adaptive template registration method for 18F-flutemetamol imaging data. J Nucl Med 2013; 54:1472-8. [PMID: 23740104 DOI: 10.2967/jnumed.112.115006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The spatial normalization of PET amyloid imaging data is challenging because different white and gray matter patterns of negative (Aβ-) and positive (Aβ+) uptake could lead to systematic bias if a standard method is used. In this study, we propose the use of an adaptive template registration method to overcome this problem. METHODS Data from a phase II study (n = 72) were used to model amyloid deposition with the investigational PET imaging agent (18)F-flutemetamol. Linear regression of voxel intensities on the standardized uptake value ratio (SUVR) in a neocortical composite region for all scans gave an intercept image and a slope image. We devised a method where an adaptive template image spanning the uptake range (the most Aβ- to the most Aβ+ image) can be generated through a linear combination of these 2 images and where the optimal template is selected as part of the registration process. We applied the method to the (18)F-flutemetamol phase II data using a fixed volume of interest atlas to compute SUVRs. Validation was performed in several steps. The PET-only adaptive template registration method and the MR imaging-based method used in statistical parametric mapping were applied to spatially normalize PET and MR scans, respectively. Resulting transformations were applied to coregistered gray matter probability maps, and the quality of the registrations was assessed visually and quantitatively. For comparison of quantification results with an independent patient-space method, FreeSurfer was used to segment each subject's MR scan and the parcellations were applied to the coregistered PET scans. We then correlated SUVRs for a composite neocortical region obtained with both methods. Furthermore, to investigate whether the (18)F-flutemetamol model could be generalized to (11)C-Pittsburgh compound B ((11)C-PIB), we applied the method to Australian Imaging, Biomarkers and Lifestyle (AIBL) (11)C-PIB scans (n = 285) and compared the PET-only neocortical composite score with the corresponding score obtained with a semimanual method that made use of the subject's MR images for the positioning of regions. RESULTS Spatial normalization was successful on all scans. Visual and quantitative comparison of the new PET-only method with the MR imaging-based method of statistical parametric mapping indicated that performance was similar in the cortical regions although the new PET-only method showed better registration in the cerebellum and pons reference region area. For the (18)F-flutemetamol quantification, there was a strong correlation between the PET-only and FreeSurfer SUVRs (Pearson r = 0.96). We obtained a similar correlation for the AIBL (11)C-PIB data (Pearson r = 0.94). CONCLUSION The derived adaptive template registration method allows for robust, accurate, and fully automated quantification of uptake for (18)F-flutemetamol and (11)C-PIB scans without the use of MR imaging data.
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