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Added value of semiquantitative analysis of brain FDG-PET for the differentiation between MCI-Lewy bodies and MCI due to Alzheimer’s disease

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

FDG-PET is an established supportive biomarker in dementia with Lewy bodies (DLB), but its diagnostic accuracy is unknown at the mild cognitive impairment (MCI-LB) stage when the typical metabolic pattern may be difficultly recognized at the individual level. Semiquantitative analysis of scans could enhance accuracy especially in less skilled readers, but its added role with respect to visual assessment in MCI-LB is still unknown.

Methods

We assessed the diagnostic accuracy of visual assessment of FDG-PET by six expert readers, blind to diagnosis, in discriminating two matched groups of patients (40 with prodromal AD (MCI-AD) and 39 with MCI-LB), both confirmed by in vivo biomarkers. Readers were provided in a stepwise fashion with (i) maps obtained by the univariate single-subject voxel-based analysis (VBA) with respect to a control group of 40 age- and sex-matched healthy subjects, and (ii) individual odds ratio (OR) plots obtained by the volumetric regions of interest (VROI) semiquantitative analysis of the two main hypometabolic clusters deriving from the comparison of MCI-AD and MCI-LB groups in the two directions, respectively.

Results

Mean diagnostic accuracy of visual assessment was 76.8 ± 5.0% and did not significantly benefit from adding the univariate VBA map reading (77.4 ± 8.3%) whereas VROI-derived OR plot reading significantly increased both accuracy (89.7 ± 2.3%) and inter-rater reliability (ICC 0.97 [0.96–0.98]), regardless of the readers’ expertise.

Conclusion

Conventional visual reading of FDG-PET is moderately accurate in distinguishing between MCI-LB and MCI-AD, and is not significantly improved by univariate single-subject VBA but by a VROI analysis built on macro-regions, allowing for high accuracy independent of reader skills.

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Acknowledgements

This work was developed within the framework of the DINOGMI Department of Excellence of MIUR 2018-2022 (legge 232 del 2016).

Funding

This work received fund support by the Italian Ministry of Health (Fondi per la Ricerca Corrente, 2020).

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Authors and Affiliations

  1. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Largo Daneo 3, 16132, Genoa, Italy

    Federico Massa, Enrico Peira, Dario Arnaldi, Matteo Pardini, Beatrice Orso, Andrea Brugnolo, Erica Biassoni, Pietro Mattioli, Nicola Girtler & Flavio Nobili

  2. National Institute of Nuclear Physics (INFN), Genoa section, Genoa, Italy

    Andrea Chincarini & Enrico Peira

  3. IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Matteo Bauckneht, Dario Arnaldi, Matteo Pardini, Andrea Brugnolo, Nicola Girtler, Silvia Morbelli & Flavio Nobili

  4. Department of Health Science (DISSAL), University of Genoa, Genoa, Italy

    Stefano Raffa, Maria Isabella Donegani & Silvia Morbelli

  5. Institute of Cognitive Sciences and Technologies, Consiglio Nazionale Delle Ricerche (CNR), Rome, Italy

    Marco Pagani

  6. Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden

    Marco Pagani

  7. Formerly at Nuclear Medicine Unit, Fondazione Poliambulanza, Brescia, Italy

    Ugo Paolo Guerra

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  1. Federico Massa
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Contributions

All authors contributed to the conception and design of the study and to data acquisition and analysis. The first draft of the manuscript was written by FM and AC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Federico Massa.

Ethics declarations

Ethics approval

All procedures were performed in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. An institutional review board statement was not necessary because we merely used data collected during clinical routine and no other supplementary examinations were performed.

Informed consent and consent for publication

Informed consent was obtained from all individual participants included in the study. All subjects gave their consent to publish their anonymized data.

Conflict of interest

Silvia Morbelli has received speaker Honoraria from G.E. Healthcare; Dario Arnaldi received fees from Fidia for lectures and board participation; Matteo Pardini receives research support from Novartis and Nutricia; received fees from Novartis, Merck, and Biogen; and is partly supported by a University of Genoa “curiosity-driven” grant; Flavio Nobili has received fees for participating in boards from Roche, and speaker Honoraria from Bial e G.E. Healthcare. The other authors declare no competing interests.

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Massa, F., Chincarini, A., Bauckneht, M. et al. Added value of semiquantitative analysis of brain FDG-PET for the differentiation between MCI-Lewy bodies and MCI due to Alzheimer’s disease. Eur J Nucl Med Mol Imaging 49, 1263–1274 (2022). https://doi.org/10.1007/s00259-021-05568-w

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