A novel computer-assisted image analysis of [123I]β-CIT SPECT images improves the diagnostic accuracy of parkinsonian disorders.

Abstract

PURPOSE:

The purpose of this study was to develop an observer-independent algorithm for the correct classification of dopamine transporter SPECT images as Parkinson's disease (PD), multiple system atrophy parkinson variant (MSA-P), progressive supranuclear palsy (PSP) or normal.

METHODS:

A total of 60 subjects with clinically probable PD (n = 15), MSA-P (n = 15) and PSP (n = 15), and 15 age-matched healthy volunteers, were studied with the dopamine transporter ligand [(123)I]β-CIT. Parametric images of the specific-to-nondisplaceable equilibrium partition coefficient (BP(ND)) were generated. Following a voxel-wise ANOVA, cut-off values were calculated from the voxel values of the resulting six post-hoc t-test maps. The percentages of the volume of an individual BP(ND) image remaining below and above the cut-off values were determined. The higher percentage of image volume from all six cut-off matrices was used to classify an individual's image. For validation, the algorithm was compared to a conventional region of interest analysis.

RESULTS:

The predictive diagnostic accuracy of the algorithm in the correct assignment of a [(123)I]β-CIT SPECT image was 83.3% and increased to 93.3% on merging the MSA-P and PSP groups. In contrast the multinomial logistic regression of mean region of interest values of the caudate, putamen and midbrain revealed a diagnostic accuracy of 71.7%.

CONCLUSION:

In contrast to a rater-driven approach, this novel method was superior in classifying [(123)I]β-CIT-SPECT images as one of four diagnostic entities. In combination with the investigator-driven visual assessment of SPECT images, this clinical decision support tool would help to improve the diagnostic yield of [(123)I]β-CIT SPECT in patients presenting with parkinsonism at their initial visit.

• Authors: Georg Goebel, Klaus Seppi, Eveline Donnemiller, Boris Warwitz, Gregor K Wenning, Irene Virgolini, Werner Poewe, Christoph Scherfler
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 38 Issue 4 Pg. 702-10 (Apr 2011) ISSN: 1619-7089 [Electronic] Germany
• PMID: 21174092 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dopamine Plasma Membrane Transport Proteins
• 2beta-carbomethoxy-3beta-(4-iodophenyl)tropane
• Cocaine

Topics

• Aged
• Algorithms
• Analysis of Variance
• Brain (diagnostic imaging, metabolism)
• Case-Control Studies
• Cocaine (analogs & derivatives)
• Dopamine Plasma Membrane Transport Proteins (metabolism)
• Female
• Humans
• Image Processing, Computer-Assisted (methods)
• Male
• Middle Aged
• Multiple System Atrophy (diagnostic imaging, metabolism)
• Parkinson Disease (diagnostic imaging, metabolism)
• Parkinsonian Disorders (diagnostic imaging, metabolism)
• Regression Analysis
• Reproducibility of Results
• Sensitivity and Specificity
• Supranuclear Palsy, Progressive (diagnostic imaging, metabolism)
• Tomography, Emission-Computed, Single-Photon (methods)