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Validation of an optimized SPM procedure for FDG-PET in dementia diagnosis in a clinical setting.

Perani D, Della Rosa PA, Cerami C, Gallivanone F, Fallanca F, Vanoli EG, Panzacchi A, Nobili F, Pappatà S, Marcone A, Garibotto V, Castiglioni I, Magnani G, Cappa SF, Gianolli L, EADC-PET Consorti - Neuroimage Clin (2014)

Bottom Line: In 88 patients with neurodegenerative diseases (Alzheimer's Disease-AD, Frontotemporal Lobar Degeneration-FTLD, Dementia with Lewy bodies-DLB and Mild Cognitive Impairment-MCI), 9 neuroimaging experts made a forced diagnostic decision on the basis of the evaluation of the three types of information.The clinical diagnosis confirmed at a long-term follow-up was used as the gold standard.FTD; beta 1.414, p = 0.019).

View Article: PubMed Central - PubMed

Affiliation: Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy ; Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy ; Istituto di Bioimmagini e Fisiologia Molecolare, CNR, Segrate, Italy.

ABSTRACT
Diagnostic accuracy in FDG-PET imaging highly depends on the operating procedures. In this clinical study on dementia, we compared the diagnostic accuracy at a single-subject level of a) Clinical Scenarios, b) Standard FDG Images and c) Statistical Parametrical (SPM) Maps generated via a new optimized SPM procedure. We evaluated the added value of FDG-PET, either Standard FDG Images or SPM Maps, to Clinical Scenarios. In 88 patients with neurodegenerative diseases (Alzheimer's Disease-AD, Frontotemporal Lobar Degeneration-FTLD, Dementia with Lewy bodies-DLB and Mild Cognitive Impairment-MCI), 9 neuroimaging experts made a forced diagnostic decision on the basis of the evaluation of the three types of information. There was also the possibility of a decision of normality on the FDG-PET images. The clinical diagnosis confirmed at a long-term follow-up was used as the gold standard. SPM Maps showed higher sensitivity and specificity (96% and 84%), and better diagnostic positive (6.8) and negative (0.05) likelihood ratios compared to Clinical Scenarios and Standard FDG Images. SPM Maps increased diagnostic accuracy for differential diagnosis (AD vs. FTD; beta 1.414, p = 0.019). The AUC of the ROC curve was 0.67 for SPM Maps, 0.57 for Clinical Scenarios and 0.50 for Standard FDG Images. In the MCI group, SPM Maps showed the highest predictive prognostic value (mean LOC = 2.46), by identifying either normal brain metabolism (exclusionary role) or hypometabolic patterns typical of different neurodegenerative conditions.

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A) Sensitivity (blue) and specificity (red) values of Clinical Scenarios, Standard FDG Image and SPM Maps. B) Positive (LR+) (dark grey) and negative (LR−) likelihood (pale grey) ratio for correct classification of patients, broken down by type of information.
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f0020: A) Sensitivity (blue) and specificity (red) values of Clinical Scenarios, Standard FDG Image and SPM Maps. B) Positive (LR+) (dark grey) and negative (LR−) likelihood (pale grey) ratio for correct classification of patients, broken down by type of information.

Mentions: Raters' performance for diagnostic accuracy and confidence levels is illustrated in Figs. 2 and 3 (see also the figure on the supplementary materials). Analysis of raters' performances for diagnostic accuracy indicated higher sensitivity and specificity values for SPM Maps (96% and 84%), compared to Clinical Scenarios (91% and 40%) and Standard FDG Images (78% and 50%), considering the total sample of 88 subjects. Diagnostic LR+ was better for SPM Maps (6.08) than for Standard FDG Images (1.55) or Clinical Scenarios (1.52), exceeding the LR+ accuracy cut-off (≥5) only for SPM Maps. LR-values were best for SPM Maps (0.05) and very poor for Standard FDG Images (0.45) and Clinical Scenarios (0.22), with only SPM Maps fell below LR-cut off (≤0.2) (see Fig. 4A and 4B).


Validation of an optimized SPM procedure for FDG-PET in dementia diagnosis in a clinical setting.

Perani D, Della Rosa PA, Cerami C, Gallivanone F, Fallanca F, Vanoli EG, Panzacchi A, Nobili F, Pappatà S, Marcone A, Garibotto V, Castiglioni I, Magnani G, Cappa SF, Gianolli L, EADC-PET Consorti - Neuroimage Clin (2014)

A) Sensitivity (blue) and specificity (red) values of Clinical Scenarios, Standard FDG Image and SPM Maps. B) Positive (LR+) (dark grey) and negative (LR−) likelihood (pale grey) ratio for correct classification of patients, broken down by type of information.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225527&req=5

f0020: A) Sensitivity (blue) and specificity (red) values of Clinical Scenarios, Standard FDG Image and SPM Maps. B) Positive (LR+) (dark grey) and negative (LR−) likelihood (pale grey) ratio for correct classification of patients, broken down by type of information.
Mentions: Raters' performance for diagnostic accuracy and confidence levels is illustrated in Figs. 2 and 3 (see also the figure on the supplementary materials). Analysis of raters' performances for diagnostic accuracy indicated higher sensitivity and specificity values for SPM Maps (96% and 84%), compared to Clinical Scenarios (91% and 40%) and Standard FDG Images (78% and 50%), considering the total sample of 88 subjects. Diagnostic LR+ was better for SPM Maps (6.08) than for Standard FDG Images (1.55) or Clinical Scenarios (1.52), exceeding the LR+ accuracy cut-off (≥5) only for SPM Maps. LR-values were best for SPM Maps (0.05) and very poor for Standard FDG Images (0.45) and Clinical Scenarios (0.22), with only SPM Maps fell below LR-cut off (≤0.2) (see Fig. 4A and 4B).

Bottom Line: In 88 patients with neurodegenerative diseases (Alzheimer's Disease-AD, Frontotemporal Lobar Degeneration-FTLD, Dementia with Lewy bodies-DLB and Mild Cognitive Impairment-MCI), 9 neuroimaging experts made a forced diagnostic decision on the basis of the evaluation of the three types of information.The clinical diagnosis confirmed at a long-term follow-up was used as the gold standard.FTD; beta 1.414, p = 0.019).

View Article: PubMed Central - PubMed

Affiliation: Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy ; Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy ; Istituto di Bioimmagini e Fisiologia Molecolare, CNR, Segrate, Italy.

ABSTRACT
Diagnostic accuracy in FDG-PET imaging highly depends on the operating procedures. In this clinical study on dementia, we compared the diagnostic accuracy at a single-subject level of a) Clinical Scenarios, b) Standard FDG Images and c) Statistical Parametrical (SPM) Maps generated via a new optimized SPM procedure. We evaluated the added value of FDG-PET, either Standard FDG Images or SPM Maps, to Clinical Scenarios. In 88 patients with neurodegenerative diseases (Alzheimer's Disease-AD, Frontotemporal Lobar Degeneration-FTLD, Dementia with Lewy bodies-DLB and Mild Cognitive Impairment-MCI), 9 neuroimaging experts made a forced diagnostic decision on the basis of the evaluation of the three types of information. There was also the possibility of a decision of normality on the FDG-PET images. The clinical diagnosis confirmed at a long-term follow-up was used as the gold standard. SPM Maps showed higher sensitivity and specificity (96% and 84%), and better diagnostic positive (6.8) and negative (0.05) likelihood ratios compared to Clinical Scenarios and Standard FDG Images. SPM Maps increased diagnostic accuracy for differential diagnosis (AD vs. FTD; beta 1.414, p = 0.019). The AUC of the ROC curve was 0.67 for SPM Maps, 0.57 for Clinical Scenarios and 0.50 for Standard FDG Images. In the MCI group, SPM Maps showed the highest predictive prognostic value (mean LOC = 2.46), by identifying either normal brain metabolism (exclusionary role) or hypometabolic patterns typical of different neurodegenerative conditions.

Show MeSH
Related in: MedlinePlus