脑脊液-模板算法对I-碘氟烷单光子发射计算机断层扫描（SPECT）诊断性能的影响：帕金森综合征的一项研究
Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of I-Ioflupane SPECT: an investigation of parkinsonian syndromes.
作者信息
Iwabuchi Yu, Nakahara Tadaki, Kameyama Masashi, Matsusaka Yohji, Minami Yasuhiro, Ito Daisuke, Tabuchi Hajime, Yamada Yoshitake, Jinzaki Masahiro
机构信息
Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan.
出版信息
EJNMMI Res. 2019 Sep 3;9(1):85. doi: 10.1186/s13550-019-0558-x.
BACKGROUND
A cerebrospinal fluid (CSF)-mask algorithm has been developed to reduce the adverse influence of CSF-low-counts on the diagnostic utility of the specific binding ratio (SBR) index calculated with Southampton method. We assessed the effect of the CSF-mask algorithm on the diagnostic performance of the SBR index for parkinsonian syndromes (PS), including Parkinson's disease, and the influence of cerebral ventricle dilatation on the CSF-mask algorithm.
METHODS
We enrolled 163 and 158 patients with and without PS, respectively. Both the conventional SBR (non-CSF-mask) and SBR corrected with the CSF-mask algorithm (CSF-mask) were calculated from I-Ioflupane single-photon emission computed tomography (SPECT) images of these patients. We compared the diagnostic performance of the corresponding indices and evaluated whether the effect of the CSF-mask algorithm varied according to the extent of ventricle dilatation, as assessed with the Evans index (EI). A receiver-operating characteristics (ROC) analysis was used for statistical analyses.
RESULTS
ROC analyses demonstrated that the CSF-mask algorithm performed better than the non-CSF-mask (no correction, area under the curve [AUC] = 0.917 [95% confidence interval (CI) 0.887-0.947] vs. 0.895 [95% CI 0.861-0.929], p < 0.001; attenuation correction, AUC = 0.930 [95% CI 0.902-0.957] vs. 0.903 [95% CI 0.870-0.936], p < 0.001). When not corrected for attenuation, no significant difference in the AUC was observed in the low EI group between the non-CSF-mask and CSF-mask algorithms (0.927 [95% CI 0.877-0.978] vs. 0.942 [95% CI 0.898-0.986], p = 0.11); in the middle and high EI groups, the CSF-mask algorithm performed better than the non-CSF-mask algorithm (middle EI group, AUC = 0.894 [95% CI 0.825-0.963] vs. 0.872 [95% CI 0.798-0.947], p < 0.05; high EI group, AUC = 0.931 [95% CI 0.883-0.978] vs. 0.900 [95% CI 0.840-0.961], p < 0.01). When corrected for attenuation, significant differences in the AUC were observed in all three EI groups (low EI group, AUC = 0.961 [95% CI 0.924-0.998] vs. 0.942 [95% CI 0.895-0.988], p < 0.05; middle EI group, AUC = 0.905 [95% CI 0.843-0.968] vs. 0.872 [95% CI 0.800-0.944], p < 0.005; high EI group, AUC = 0.954 [95% CI 0.917-0.991] vs. 0.917 [95% CI 0.862-0.973], p < 0.005).
CONCLUSION
The CSF-mask algorithm improved the performance of the SBR index in informing the diagnosis of PS, especially in cases with ventricle dilatation.
背景
已开发出一种脑脊液（CSF）掩码算法，以减少脑脊液计数低对采用南安普敦方法计算的特异性结合率（SBR）指数诊断效用的不利影响。我们评估了CSF掩码算法对帕金森综合征（PS）（包括帕金森病）SBR指数诊断性能的影响，以及脑室扩张对CSF掩码算法的影响。
方法
我们分别纳入了163例和158例患有和未患有PS的患者。从这些患者的碘-123氟代苯单光子发射计算机断层扫描（SPECT）图像中计算常规SBR（非CSF掩码）和经CSF掩码算法校正的SBR（CSF掩码）。我们比较了相应指数的诊断性能，并评估了CSF掩码算法的效果是否根据脑室扩张程度（用埃文斯指数（EI）评估）而有所不同。采用受试者操作特征（ROC）分析进行统计分析。
结果
ROC分析表明，CSF掩码算法的表现优于非CSF掩码算法（未校正时，曲线下面积[AUC] = 0.917 [95%置信区间（CI）0.887 - 0.947] 对比 0.895 [95% CI 0.861 - 0.929]，p < 0.001；衰减校正后，AUC = 0.930 [95% CI 0.902 - 0.957] 对比 0.903 [95% CI 0.870 - 0.936]，p < 0.001）。在未进行衰减校正时，低EI组中，非CSF掩码算法和CSF掩码算法的AUC无显著差异（0.927 [95% CI 0.877 - 0.978] 对比 0.942 [95% CI 0.898 - 0.986]，p = 0.11）；在中EI组和高EI组中，CSF掩码算法的表现优于非CSF掩码算法（中EI组，AUC = 0.894 [95% CI 0.825 - 0.963] 对比 0.872 [95% CI 0.798 - 0.947]，p < 0.05；高EI组，AUC = 0.931 [95% CI 0.883 - 0.978] 对比 0.900 [95% CI 0.840 - 0.961]，p < 0.01）。在进行衰减校正后，所有三个EI组的AUC均存在显著差异（低EI组，AUC = 0.961 [95% CI 0.924 - 0.998] 对比 0.942 [95% CI 0.895 - 0.988]，p < 0.05；中EI组，AUC = 0.905 [95% CI 0.843 - 0.968] 对比 0.872 [95% CI 0.800 - 0.944]，p < 0.005；高EI组，AUC = 0.954 [95% CI 0.917 - 0.991] 对比 0.917 [95% CI 0.862 - 0.973]，p < 0.005）。
结论
CSF掩码算法提高了SBR指数在PS诊断中的性能，尤其是在脑室扩张的病例中。
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