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Assessment of anti-GAD65-associated cerebellar ataxia with 18F-FDG cerebellar uptake: ROC analysis

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Abstract

Objective

Anti-glutamic acid decarboxylase 65 (anti-GAD65)-associated neurological disorders include two major phenotypes, namely Stiff person syndrome (SPS) and cerebellar ataxia (CA). Considering the potential for better outcomes with prompt immunotherapy, early detection of CA is crucial. Hence, a non-invasive imaging biomarker to detect CA with high specificity is desired. Herein, we evaluated brain 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) PET in detecting CA based on cerebellar uptake using receiver operating characteristic (ROC) analysis and five-fold cross-validation.

Methods

This study was based on STARD 2015 guidelines: thirty patients with anti-GAD65-associated neurological disorders, 11 of whom with CA were studied. Five test sets were created after patients were randomly sorted and divided into 5 equal folds. Each iteration included 24 patients for ROC analysis and 6 patients reserved for testing. The Z scores of left cerebellum, vermis, right cerebellum, and the average of the three regions were used in ROC analysis to determine areas with significant area under the curve (AUC). The cut-off values with high specificity were determined among the 24 patients in each iteration and tested against the reserved 6 patients.

Results

Left cerebellum and average of the three regions showed significant AUC above 0.5 in all iterations with left cerebellum being the highest AUC in 4 iterations. Testing the cut-off values of the left cerebellum against the reserved 6 patients in each iteration showed 100% specificity with sensitivities ranging from 0 to 75%.

Conclusions

Cerebellar 18F-FDG PET uptake can differentiate CA phenotypes from patients with SPS with high specificity.

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Data availability

The data is provided as a supplementary file.

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Funding

This publication was supported by the National Institute of Biomedical imaging and Bioengineering of the National Institutes of Health under award number T32EB006351.

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Authors and Affiliations

  1. Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD, 21287, USA

    Mohammad S. Sadaghiani, Steven P. Rowe, Jeffery P. Leal & Lilja B. Solnes

  2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA

    Samantha Roman, Yujie Wang & Scott D. Newsome

Authors
  1. Mohammad S. Sadaghiani
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  2. Samantha Roman
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  3. Yujie Wang
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  7. Lilja B. Solnes
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Correspondence to Lilja B. Solnes.

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Sadaghiani, M.S., Roman, S., Wang, Y. et al. Assessment of anti-GAD65-associated cerebellar ataxia with 18F-FDG cerebellar uptake: ROC analysis. Ann Nucl Med 37, 528–534 (2023). https://doi.org/10.1007/s12149-023-01853-w

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  • DOI: https://doi.org/10.1007/s12149-023-01853-w

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