Kuo Phillip Hsin, Avery Ryan, Krupinski Elizabeth, Lei Hong, Bauer Adam, Sherman Scott, McMillan Natalie, Seibyl John, Zubal George
Medical Imaging/Radiology and Neurology, University of Arizona, Tucson, Arizona 85724-5067, USA.
J Nucl Med Technol. 2013 Mar;41(1):26-31. doi: 10.2967/jnmt.112.114827. Epub 2013 Feb 11.
A fully automated objective striatal analysis (OSA) program that quantitates dopamine transporter uptake in subjects with suspected Parkinson's disease was applied to images from clinical (123)I-ioflupane studies. The striatal binding ratios or alternatively the specific binding ratio (SBR) of the lowest putamen uptake was computed, and receiver-operating-characteristic (ROC) analysis was applied to 94 subjects to determine the best discriminator using this quantitative method.
Ninety-four (123)I-ioflupane SPECT scans were analyzed from patients referred to our clinical imaging department and were reconstructed using the manufacturer-supplied reconstruction and filtering parameters for the radiotracer. Three trained readers conducted independent visual interpretations and reported each case as either normal or showing dopaminergic deficit (abnormal). The same images were analyzed using the OSA software, which locates the striatal and occipital structures and places regions of interest on the caudate and putamen. Additionally, the OSA places a region of interest on the occipital region that is used to calculate the background-subtracted SBR. The lower SBR of the 2 putamen regions was taken as the quantitative report. The 33 normal (bilateral comma-shaped striata) and 61 abnormal (unilateral or bilateral dopaminergic deficit) studies were analyzed to generate ROC curves.
Twenty-nine of the scans were interpreted as normal and 59 as abnormal by all 3 readers. For 12 scans, the 3 readers did not unanimously agree in their interpretations (discordant). The ROC analysis, which used the visual-majority-consensus interpretation from the readers as the gold standard, yielded an area under the curve of 0.958 when using 1.08 as the threshold SBR for the lowest putamen. The sensitivity and specificity of the automated quantitative analysis were 95% and 89%, respectively.
The OSA program delivers SBR quantitative values that have a high sensitivity and specificity, compared with visual interpretations by trained nuclear medicine readers. Such a program could be a helpful aid for readers not yet experienced with (123)I-ioflupane SPECT images and if further adapted and validated may be useful to assess disease progression during pharmaceutical testing of therapies.
一个用于对疑似帕金森病患者的多巴胺转运体摄取进行定量分析的全自动客观纹状体分析（OSA）程序被应用于临床（123）I-碘氟潘研究的图像。计算纹状体结合率或最低壳核摄取的特异性结合率（SBR），并对94名受试者进行受试者操作特征（ROC）分析，以确定使用这种定量方法的最佳判别指标。
对转诊至我们临床影像科的患者的94次（123）I-碘氟潘单光子发射计算机断层扫描（SPECT）进行分析，并使用制造商提供的针对该放射性示踪剂的重建和滤波参数进行重建。三名经过培训的阅片者进行独立的视觉解读，并将每个病例报告为正常或显示多巴胺能缺陷（异常）。使用OSA软件对相同的图像进行分析，该软件可定位纹状体和枕叶结构，并在尾状核和壳核上放置感兴趣区域。此外，OSA在枕叶区域放置一个感兴趣区域，用于计算扣除背景后的SBR。取两个壳核区域中较低的SBR作为定量报告。对33例正常（双侧逗号形纹状体）和61例异常（单侧或双侧多巴胺能缺陷）研究进行分析以生成ROC曲线。
所有三名阅片者均将29次扫描解读为正常，59次解读为异常。对于12次扫描，三名阅片者在解读上未达成一致意见（不一致）。ROC分析以阅片者的视觉多数共识解读作为金标准，当将1.08作为最低壳核的阈值SBR时，曲线下面积为0.958。自动定量分析的敏感性和特异性分别为95%和89%。
与经过培训的核医学阅片者的视觉解读相比，OSA程序提供的SBR定量值具有高敏感性和特异性。这样的程序对于尚未熟悉（123）I-碘氟潘SPECT图像的阅片者可能是一个有用的辅助工具，并且如果进一步调整和验证，可能有助于在治疗药物测试期间评估疾病进展。
