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European Radiology
Published in: European Radiology 10/2017

Open Access 01-10-2017 | Neuro

Arterial spin labeling-based Z-maps have high specificity and positive predictive value for neurodegenerative dementia compared to FDG-PET

Authors: David Fällmar, Sven Haller, Johan Lilja, Torsten Danfors, Lena Kilander, Nelleke Tolboom, Karl Egger, Elias Kellner, Philip M. Croon, Sander C. J. Verfaillie, Bart N. M. van Berckel, Rik Ossenkoppele, Frederik Barkhof, Elna-Marie Larsson

Published in: European Radiology | Issue 10/2017

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Abstract

Objective

Cerebral perfusion analysis based on arterial spin labeling (ASL) MRI has been proposed as an alternative to FDG-PET in patients with neurodegenerative disease. Z-maps show normal distribution values relating an image to a database of controls. They are routinely used for FDG-PET to demonstrate disease-specific patterns of hypometabolism at the individual level. This study aimed to compare the performance of Z-maps based on ASL to FDG-PET.

Methods

Data were combined from two separate sites, each cohort consisting of patients with Alzheimer’s disease (n = 18 + 7), frontotemporal dementia (n = 12 + 8) and controls (n = 9 + 29). Subjects underwent pseudocontinuous ASL and FDG-PET. Z-maps were created for each subject and modality. Four experienced physicians visually assessed the 166 Z-maps in random order, blinded to modality and diagnosis.

Results

Discrimination of patients versus controls using ASL-based Z-maps yielded high specificity (84%) and positive predictive value (80%), but significantly lower sensitivity compared to FDG-PET-based Z-maps (53% vs. 96%, p < 0.001). Among true-positive cases, correct diagnoses were made in 76% (ASL) and 84% (FDG-PET) (p = 0.168).

Conclusion

ASL-based Z-maps can be used for visual assessment of neurodegenerative dementia with high specificity and positive predictive value, but with inferior sensitivity compared to FDG-PET.

Key points

• ASL-based Z-maps yielded high specificity and positive predictive value in neurodegenerative dementia.
• ASL-based Z-maps had significantly lower sensitivity compared to FDG-PET-based Z-maps.
• FDG-PET might be reserved for ASL-negative cases where clinical suspicion persists.
• Findings were similar at two study sites.
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Metadata
Title
Arterial spin labeling-based Z-maps have high specificity and positive predictive value for neurodegenerative dementia compared to FDG-PET
Authors
David Fällmar
Sven Haller
Johan Lilja
Torsten Danfors
Lena Kilander
Nelleke Tolboom
Karl Egger
Elias Kellner
Philip M. Croon
Sander C. J. Verfaillie
Bart N. M. van Berckel
Rik Ossenkoppele
Frederik Barkhof
Elna-Marie Larsson
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-4784-1

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