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Open Access 01-12-2019 | Parkinson's Disease | Original research

Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of ¹²³I-Ioflupane SPECT: an investigation of parkinsonian syndromes

Authors: Yu Iwabuchi, Tadaki Nakahara, Masashi Kameyama, Yohji Matsusaka, Yasuhiro Minami, Daisuke Ito, Hajime Tabuchi, Yoshitake Yamada, Masahiro Jinzaki

Published in: EJNMMI Research | Issue 1/2019

Abstract

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 ¹²³I-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.

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Title: Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of 123I-Ioflupane SPECT: an investigation of parkinsonian syndromes
Authors: Yu Iwabuchi
Tadaki Nakahara
Masashi Kameyama
Yohji Matsusaka
Yasuhiro Minami
Daisuke Ito
Hajime Tabuchi
Yoshitake Yamada
Masahiro Jinzaki
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keyword: Parkinson's Disease
Published in: EJNMMI Research / Issue 1/2019
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/s13550-019-0558-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of ¹²³I-Ioflupane SPECT: an investigation of parkinsonian syndromes

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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