Skip to main content

Advertisement

SpringerLink
Log in

Computer-assisted system for diagnosing degenerative dementia using cerebral blood flow SPECT and 3D-SSP: a multicenter study

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

Due to increasing numbers of patients with dementia, more physicians who do not specialize in brain nuclear medicine are being asked to interpret SPECT images of cerebral blood flow. We conducted a multicenter study to determine whether a computer-assisted diagnostic system Z-score summation analysis method (ZSAM) using three-dimensional stereotactic surface projections (3D-SSP) can differentiate Alzheimer’s disease (AD)/dementia with Lewy bodies (DLB) and non-AD/DLB in institutions using various types of gamma cameras.

Method

We determined the normal thresholds of Z-sum (summed Z-score) within a template region of interest for each single photon emission computed tomography (SPECT) device and then compared them with the Z-sums of patients and calculated the accuracy of the differential diagnosis by ZSAM. We compared the diagnostic accuracy between ZSAM and visual assessment.

Patients

We enrolled 202 patients with AD (mean age, 76.8 years), 40 with DLB (mean age 76.3 years) and 36 with non-AD/DLB (progressive supranuclear palsy, n = 10; frontotemporal dementia, n = 20; slowly progressive aphasia, n = 2 and one each with idiopathic normal pressure hydrocephalus, corticobasal degeneration, multiple system atrophy and Parkinson’s disease) who underwent N-isopropyl-p-[123I] iodoamphetamine cerebral blood flow SPECT imaging at each participating institution.

Results

The ZSAM sensitivity to differentiate between AD/DLB and non-AD/DLB in all patients, as well as those with mini-mental state examination scores of ≥24 and 20–23 points were 88.0, 78.0 and 88.4 %, respectively, with specificity of 50.0, 44.4 and 60.0 %, respectively. The diagnostic accuracy rates were 83.1, 72.9 and 84.2 %, respectively. The areas under receiver operating characteristics curves for visual inspection by four expert raters were 0.74–0.84, 0.66–0.85 and 0.81–0.93, respectively, in the same patient groups. The diagnostic accuracy rates were 70.9–89.2 %, 50.9–84.8 % and 76.2–93.1 %, respectively.

Conclusion

The diagnostic accuracy of ZSAM to differentiate AD/DLB from other types of dementia or degenerative diseases regardless of severity was equal to that of visual assessment by expert raters even across several institutions. These findings suggested that ZSAM could serve as a supplementary tool to help expert evaluators who differentially diagnose dementia from SPECT images by visual assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Reiman EM, Jagust WJ. Brain imaging in the study of Alzheimer’s disease. Neuroimage. 2012;61:505–16.

    PubMed Central  PubMed  Google Scholar 

  2. Herholz K. Perfusion SPECT and FDG-PET. Int Psychogeriatr. 2011;23(Suppl 2):S25–31.

    PubMed  Google Scholar 

  3. Ishii K, Kanda T, Uemura T, Miyamoto N, Yoshikawa T, Shimada K, et al. Computer-assisted diagnostic system for neurodegenerative dementia using brain SPECT and 3D-SSP. Eur J Nucl Med Mol Imaging. 2009;36:831–40.

    CAS  PubMed  Google Scholar 

  4. Minoshima S, Frey KA, Koeppe RA, Foster NL, Kuhl DE. A diagnostic approach in Alzheimer’s disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET. J Nucl Med. 1995;36:1238–48.

    CAS  PubMed  Google Scholar 

  5. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34:939–44.

    CAS  PubMed  Google Scholar 

  6. McKeith IG, Dickson DW, Lowe J, Emre M, O’Brien JT, Feldman H, et al. Consortium on DLB. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65:1863–72.

    CAS  PubMed  Google Scholar 

  7. Onishi H, Matsutomo N, Kai Y, Kangai Y, Amijima H, Yamaguchi T. Evaluation of a novel normal database with matched SPECT systems and optimal pre-filter parameters for 3D-SSP. Ann Nucl Med. 2012;26:16–25.

    CAS  PubMed  Google Scholar 

  8. Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998;51(1):546–54.

    Google Scholar 

  9. Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, et al. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome): report of the NINDSSPSP international workshop. Neurology. 1996;47:1–9.

    CAS  PubMed  Google Scholar 

  10. Ishikawa M, Hashimoto M, Kuwana N, Mori E, Miyake H, Wachi A, et al. Guidelines for management of idiopathic normal pressure hydrocephalus. Neurol Med Chir (Tokyo). 2008;48(Suppl):S1–23.

    PubMed  Google Scholar 

  11. Lang AE, Riley DE, Bergeron C. Cortical-basal ganglionic degeneration. In: Calne DB, editor. Neurodegenerative disease. Philadelphia: Saunders; 1994. p. 877–94.

    Google Scholar 

  12. Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71:670–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Calne DB, Snow BJ, Lee C. Criteria for diagnosing Parkinson’s disease. Ann Neurol. 1992;32 (Suppl):S125–7.

    Google Scholar 

  14. Ishii K, Yamaji S, Kitagaki H, Imamura T, Hirono N, Mori E. Regional cerebral blood flow difference between dementia with Lewy bodies and AD. Neurology. 1999;53:413–6.

    CAS  PubMed  Google Scholar 

  15. Minoshima S, Giordani B, Berent S, Frey KA, Foster NL, Kuhl DE. Metabolic reduction in the posterior cingulate cortex in very early Alzheimer’s disease. Ann Neurol. 1997;42:85–94.

    CAS  PubMed  Google Scholar 

  16. Sakamoto S, Ishii K, Sasaki M, Hosaka K, Mori T, Matsui M, et al. Differences in cerebral metabolic impairment between early and late onset types of Alzheimer’s disease. J Neurol Sci. 2002;200:27–32.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Mr. Kiyotaka Watanabe and Mr. Shuya Miki (Nihon Medi-Physics, Tokyo, Japan) for providing and improving the iNEUROSTAT++ program, which uses the 3D-SSP program and was dedicated to this Z-score summation analysis method.

Conflict of interest

Kazunari Ishii received lecture fees from Nihon Medi-Physics. Kengo Ito, Atsushi Nakanishi, Shin Kitamura, and Akira Terashima declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Kinki University, 377-2 Osakasayama, Osaka, 589-8511, Japan

    Kazunari Ishii

  2. Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan

    Kengo Ito

  3. Department of Radiology, School of Medicine, Juntendo University, Tokyo, Japan

    Atsushi Nakanishi

  4. Department of Internal Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan

    Shin Kitamura

  5. Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan

    Akira Terashima

Authors
  1. Kazunari Ishii
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kengo Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsushi Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shin Kitamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akira Terashima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazunari Ishii.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ishii, K., Ito, K., Nakanishi, A. et al. Computer-assisted system for diagnosing degenerative dementia using cerebral blood flow SPECT and 3D-SSP: a multicenter study. Jpn J Radiol 32, 383–390 (2014). https://doi.org/10.1007/s11604-014-0329-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-014-0329-6

Keywords

Search

Navigation