Pontecorvo Michael J, Arora Anupa K, Devine Marybeth, Lu Ming, Galante Nick, Siderowf Andrew, Devadanam Catherine, Joshi Abhinay D, Heun Stephen L, Teske Brian F, Truocchio Stephen P, Krautkramer Michael, Devous Michael D, Mintun Mark A
Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), 3711 Market St, Philadelphia, PA, 19104, USA.
Eur J Nucl Med Mol Imaging. 2017 May;44(5):825-837. doi: 10.1007/s00259-016-3601-4. Epub 2017 Jan 7.
This study examined the feasibility of using quantitation to augment interpretation of florbetapir PET amyloid imaging.
A total of 80 physician readers were trained on quantitation of florbetapir PET images and the principles for using quantitation to augment a visual read. On day 1, the readers completed a visual read of 96 scans (46 autopsy-verified and 50 from patients seeking a diagnosis). On day 2, 69 of the readers reinterpreted the 96 scans augmenting their interpretation with quantitation (VisQ method) using one of three commercial software packages. A subset of 11 readers reinterpreted all scans on day 2 based on a visual read only (VisVis control). For the autopsy-verified scans, the neuropathologist's modified CERAD plaque score was used as the truth standard for interpretation accuracy. Because an autopsy truth standard was not available for scans from patients seeking a diagnosis, the majority VisQ interpretation of the three readers with the best accuracy in interpreting autopsy-verified scans was used as the reference standard.
Day 1 visual read accuracy was high for both the autopsy-verified scans (90%) and the scans from patients seeking a diagnosis (87.3%). Accuracy improved from the visual read to the VisQ read (from 90.1% to 93.1%, p < 0.0001). Importantly, access to quantitative information did not decrease interpretation accuracy of the above-average readers (>90% on day 1). Accuracy in interpreting the autopsy-verified scans also increased from the first to the second visual read (VisVis group). However, agreement with the reference standard (best readers) for scans from patients seeking a diagnosis did not improve with a second visual read, and in this cohort the VisQ group was significantly improved relative to the VisVis group (change 5.4% vs. -1.1%, p < 0.0001).
These results indicate that augmentation of visual interpretation of florbetapir PET amyloid images with quantitative information obtained using commercially available software packages did not reduce the accuracy of readers who were already performing with above average accuracy on the visual read and may improve the accuracy and confidence of some readers in clinically relevant cases.
本研究探讨了使用定量分析来辅助氟代硼吡咯正电子发射断层扫描（PET）淀粉样蛋白成像解读的可行性。
共80名医生读者接受了氟代硼吡咯PET图像定量分析及使用定量分析辅助视觉解读原则的培训。在第1天，读者们对96次扫描进行了视觉解读（46次经尸检证实，50次来自寻求诊断的患者）。在第2天，69名读者使用三个商业软件包之一，通过定量分析（VisQ方法）对这96次扫描进行重新解读，以辅助他们的解读。11名读者组成的一个子集在第2天仅基于视觉解读对所有扫描进行了重新解读（VisVis对照组）。对于经尸检证实的扫描，神经病理学家修改后的CERAD斑块评分被用作解读准确性的真值标准。由于无法获得寻求诊断患者扫描的尸检真值标准，因此将在解读经尸检证实的扫描中准确性最高的三名读者的多数VisQ解读用作参考标准。
对于经尸检证实的扫描（90%）和寻求诊断患者的扫描（87.3%），第1天的视觉解读准确性都很高。从视觉解读到VisQ解读，准确性有所提高（从90.1%提高到93.1%，p < 0.0001）。重要的是，获取定量信息并没有降低高于平均水平的读者（第1天>90%）的解读准确性。在第1次和第2次视觉解读（VisVis组）之间，经尸检证实的扫描的解读准确性也有所提高。然而，对于寻求诊断患者的扫描，与参考标准（最佳读者）的一致性在第2次视觉解读时并未提高，并且在该队列中，VisQ组相对于VisVis组有显著改善（变化5.4%对-1.1%，p < 0.0001）。
这些结果表明，使用商业软件包获得的定量信息辅助氟代硼吡咯PET淀粉样蛋白图像的视觉解读，并不会降低在视觉解读中已经具有高于平均水平准确性的读者的准确性，并且可能会提高一些读者在临床相关病例中的准确性和信心。
