Abstract
Although specific patterns of technetium-99m exametazime [99mTc-hexamethylpropylene amine oxime (HMPAO)] brain single-photon emission tomography (SPET) uptake have been described for patients with dementia, no multi-institutional study has evaluated interobserver agreement. Interobserver agreement for99mTc-HMPAO brain SPET uptake patterns in 50 clinically diagnosed demented subjects from four institutions were studied. Neurologists classified these subjects as presumed Alzheimer's disease (n=21), confirmed Alzheimers's disease (n=10), multi-infarct dementia (n=9), HIV-related dementia (n=7), or “mixed” (n=3). In addition 20 normal (five per institution)99mTc-HMPAO studies were included in a randomized blinded evaluation by three readers each from a different institution. Readers classified the general appearance of the images in one of four categories: normal, globally decreased uptake, focal areas of decreased uptake, and patchy changes in uptake. Consensus results show a sensitivity of 72% and specificity of 79% for identifying abnormalities in scans of demented subjects. Readers also rated99mTc-HMPAO uptake in eight designated regions in each hemisphere. Significant reader agreement (P < 0.01) for the classification by general appearance and the ratings of regional uptake was obtained. This study demonstrates that interpretation of regional cerebral blood flow/SPET images is concordant across multiple institutions and readers.
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References
Neary D, SnowdenJS, Shields RA, Burjan AWI, Northen B, MacDermott N, Prescott M, Testa HJ. Single photon emission tomography using 99mTc-HM PAO in the investigation of dementia.J Neurol Neurosurg Psychiatry 1987;1101–1109.
Costa DC, Ell PJ, Burns A, Philpot M, Levy R. CBF tomograms with [99mTc]-HM PAO in patients with dementia (Alzheimer type and HIV) and Parkinson's disease — initial results.J Cereb Blood Flow Metab 1988;8:S109-S115.
Testa HJ, Snowden JS, Neary D, Shields RA, Burjan AWI, Prescott MC, Northen B, Goulding P. The use of [99mTc]-HM PAO in the diagnosis of primary degenerative dementia.J Cereb Blood Flow Metab 1988;8:S123-S126.
Weinstein HC, Haan J, van Royen EO, et al. SPECT in the diagnosis of Alzheimer's disease and multi-infarct dementia.Clin Neural Neurosurg 1991;93:39–43.
Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A. The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium-99m-HMPAO SPECT.J Nucl Med 1992;33:181–185.
Masdeu JC, Yudd A, VanHeertum RL, Grundman M, Hriso E, O'Connell RA, Luck D, Camli U, King LN. Single-photon emission computed tomography in human immunodeficiency virus encephalopathy: a preliminary report.J Nucl Med 1991;21:1471–1475.
Tatsch K, Schielke E, Bauer WM, Markl A, Einh(a)upl KM, Kirsch C-M. Functional and morphological findings in early and advanced stages of HIV infection: a comparison of 99mTc-HMPAO SPECT with CT and MRI studies.Nuklearmedizin 1990;29:252–258.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ARDA WorkGroup under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.Neurology 1984;34:939–944.
Loeb C. Clinical criteria for the diagnosis of vascular dementia.Eur Neurol 1988;28:87–92.
Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome.MMWR 1987;36(Suppl):1–15.
Landis JR, Koch GG, The measurement of observer agreement for categorical data.Biometrics 1977;33:159–174.
Joachim CL, Morris J, Selkoe DJ. Autopsy neuropathology in 76 cases of clinically diagnosed Alzheimer's disease.Neuropathology 1986;36(Suppl 1):226.
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Subject studies performed at St. Vincent's Hospital, New York
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Heilman, R.S., Tikofsky, R.S., Van Heertumz, R. et al. A multi-institutional study of interobserver agreement in the evaluation of dementia with rCBF/SPET technetium-99m exametazime (HMPAO). Eur J Nucl Med 21, 306–313 (1994). https://doi.org/10.1007/BF00947965
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DOI: https://doi.org/10.1007/BF00947965