通过对参数分布体积比图像进行视觉评分来改进视觉[（123）I]FP-CIT单光子发射计算机断层扫描（SPECT）解释，以评估帕金森综合征。

Improved visual [(123)I]FP-CIT SPECT interpretation for evaluation of parkinsonism by visual rating of parametric distribution volume ratio images.

作者信息

Meyer P T, Winz O H, Dafotakis M, Werner C J, Krohn T, Schäfer W M

机构信息

Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany.

出版信息

Q J Nucl Med Mol Imaging. 2011 Jun;55(3):301-9.

PMID:21532542

Abstract

AIM

Imaging of presynaptic dopamine transporters (DAT) by single-photon emission computed tomography (SPECT) and [(123)I]FP-CIT is an established method for differentiating between neurodegenerative and non-neurodegenerative parkinsonism. Whereas a region-of-interest (ROI) analysis is the method of choice for analyzing [(123)I]FP-CIT SPECT studies, visual image interpretations can also provide highly accurate results. The present study was undertaken to validate a visual reading system for parametric volume of distribution (DVR) [(123)I]FP-CIT SPECT images that combines the quantitative nature of ROI analyses and the simplicity of visual readings.

METHODS

A 9-step linear visual rating template for semi-quantitative DVR ratings of caudate nucleus and putamen was developed (VRDVR). The conventional 4-step visual reading system that is mainly based on the [(123)I]FP-CIT uptake pattern was used for comparison (VRP method). Six independent observers retrospectively rated the [(123)I]FP-CIT scans of 30 consecutive parkinsonism and tremor patients (N.=16 neurodegenerative, N.=14 non-neurodegenerative) using VRDVR and VRP. In addition, a highly trained investigator performed manual ROI analyses.

RESULTS

The ROI analysis provided complete separation of both patient groups by comparing the lower DAT binding of both putamina (i.e., putamen contralateral to clinically most affected side in neurodegenerative parkinsonism). Using VRP, the two most experienced observers correctly classified all patients while 20 false-positive ratings occurred in the less experienced observers (mean area under the receiver operating characteristic curve [AUCROC] of all observers 0.93±0.07). The VRDVR ratings of the two most experienced observers did not overlap between patient groups, although at different VRDVR score cut-offs. Using the same VRDVR score cut-off for all observers, only six false-negative and one false-positive ratings occurred in total (AUCROC 0.99±0.01). Inter-observer agreement was good for VRP and VRDVR. Moreover, semi-quantitative VRDVR and quantitative ROI analyses showed a strong correlation in all observers (Spearman's rho, 0.85-0.91).

CONCLUSIONS

The proposed VRDVR method offers a very promising visual analysis method for [(123)I]FP-CIT SPECT studies in parkinsonism. The accuracy of VRDVR readings was found to be superior to conventional VRP, while it provided a diagnostic accuracy in less experienced observers that is comparable to manual ROI analyses by a highly trained investigator.

摘要

目的

通过单光子发射计算机断层扫描（SPECT）和[（123）I]FP-CIT对突触前多巴胺转运体（DAT）进行成像，是区分神经退行性帕金森综合征和非神经退行性帕金森综合征的既定方法。虽然感兴趣区（ROI）分析是分析[（123）I]FP-CIT SPECT研究的首选方法，但视觉图像解读也能提供高度准确的结果。本研究旨在验证一种用于分布容积参数（DVR）[（123）I]FP-CIT SPECT图像的视觉解读系统，该系统结合了ROI分析的定量特性和视觉解读的简易性。

方法

开发了一种用于尾状核和壳核DVR半定量评级的9步线性视觉评级模板（VRDVR）。将主要基于[（123）I]FP-CIT摄取模式的传统4步视觉解读系统用于比较（VRP方法）。6名独立观察者使用VRDVR和VRP对30例连续的帕金森综合征和震颤患者（n = 16例神经退行性疾病，n = 14例非神经退行性疾病）的[（123）I]FP-CIT扫描进行回顾性评级。此外，一名训练有素的研究人员进行了手动ROI分析。

结果

通过比较两侧壳核较低的DAT结合情况（即神经退行性帕金森综合征中临床受累最严重一侧对侧的壳核），ROI分析实现了两组患者的完全区分。使用VRP时，两名经验最丰富的观察者正确分类了所有患者，而经验较少者出现了20例假阳性评级（所有观察者的平均受试者工作特征曲线下面积[AUCROC]为0.93±0.07）。两名经验最丰富的观察者的VRDVR评级在患者组之间没有重叠，尽管VRDVR评分临界值不同。对所有观察者使用相同的VRDVR评分临界值时，总共仅出现6例假阴性和1例假阳性评级（AUCROC为0.99±0.01）。VRP和VRDVR的观察者间一致性良好。此外，半定量VRDVR和定量ROI分析在所有观察者中均显示出强相关性（Spearman秩相关系数，0.85 - 0.91）。