Sato Tomohiro, Sawai Setsu, Shimada Naokazu
Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Radiology, Chiba Aoba Municipal Hospital, 1273-2 Aoba-cho, Chuo-ku, Chiba City, Chiba, 260-0852, Japan.
Jpn J Radiol. 2025 Jan;43(1):78-90. doi: 10.1007/s11604-024-01648-7. Epub 2024 Sep 5.
By imaging dopamine transporter (DAT) uptake in the striatum, I-FP-CIT SPECT can differentiate dopaminergic neurodegenerative disease (dNDD) and non-dNDD, which differ in pathophysiology and clinical management. Our aim was to compare and validate the diagnostic abilities of various I-FP-CIT SPECT quantitative indices for dNDD.
Distribution volume ratio (DVR) and binding ratio (BR), measures of DAT uptake capacity, were measured by analyzing clinical I-FP-CIT SPECT images of 29 patients with dNDD, including dementia with Lewy bodies and Parkinson's disease, and 18 patients with non-dNDD, using Montreal Neurological Institute space-based anatomical standardization and an atlas template, which utilizes statistical parametric mapping. Additionally, we computed the specific binding ratio (SBR) based on Bolt's method and the maximum and mean standardized uptake values (SUVmax and SUVmean, respectively).
The caudate-to-occipital lobe, putamen-to-occipital lobe, and striatum-to-occipital lobe ratios (COR, POR, and SOR, respectively) on DVR and POR and SOR on BR were significantly lower in dNDD than in non-dNDD, with areas under the ROC curve (AUCs) of 0.941-0.960, showing high diagnostic accuracy for dNDD. However, the AUC of COR on BR was 0.839, indicating lower diagnostic performance. SBR had an AUC of 0.921, while SUVmax and SUVmean had AUCs of 0.906 and 0.900, respectively. Although striatal asymmetry on both DVR and BR exhibited AUCs of 0.728 and 0.734 and asymmetry on SBR showed an AUC of 0.757, the ratio-based DAT quantitative indices were superior. There were strong positive correlations of DVR with BR, DVR with SBR or SUVmax, BR with SBR or SUVmax, and SBR with SUVmax.
COR, POR, and SOR on DVR and POR and SOR on BR were the most useful DAT quantitative indices. These indices can be compared with SBR and SUV, suggesting that comprehensive evaluation improves the diagnostic accuracy of dNDD.
通过对纹状体中多巴胺转运体（DAT）摄取进行成像，123I-氟代-N-异丙基-2β-碳-甲氧基-3β-(4-碘苯基)托烷单光子发射计算机断层扫描（I-FP-CIT SPECT）能够区分多巴胺能神经退行性疾病（dNDD）和非dNDD，这两类疾病在病理生理学和临床管理方面存在差异。我们的目的是比较并验证各种I-FP-CIT SPECT定量指标对dNDD的诊断能力。
使用蒙特利尔神经病学研究所基于空间的解剖标准化和一个利用统计参数映射的图谱模板，通过分析29例dNDD患者（包括路易体痴呆和帕金森病）以及18例非dNDD患者的临床I-FP-CIT SPECT图像，测量分布容积比（DVR）和结合比（BR），这两个指标用于衡量DAT摄取能力。此外，我们基于博尔特方法计算了特异性结合比（SBR）以及最大和平均标准化摄取值（分别为SUVmax和SUVmean）。
dNDD患者的DVR上的尾状核与枕叶、壳核与枕叶以及纹状体与枕叶的比值（分别为COR、POR和SOR）以及BR上的POR和SOR显著低于非dNDD患者，其受试者工作特征曲线（ROC）下面积（AUC）为0.941 - 0.960，对dNDD显示出较高的诊断准确性。然而，BR上COR的AUC为0.839，表明诊断性能较低。SBR的AUC为0.921，而SUVmax和SUVmean的AUC分别为0.906和0.900。尽管DVR和BR上的纹状体不对称性的AUC分别为0.728和0.734，SBR上的不对称性的AUC为0.757，但基于比值的DAT定量指标更具优势。DVR与BR、DVR与SBR或SUVmax、BR与SBR或SUVmax以及SBR与SUVmax之间存在强正相关。
DVR上的COR、POR和SOR以及BR上的POR和SOR是最有用的DAT定量指标。这些指标可与SBR和SUV进行比较，表明综合评估可提高dNDD的诊断准确性。
