Confirmation of ¹²³I-FP-CIT SPECT Quantification Methods in Dementia with Lewy Bodies and Other Neurodegenerative Disorders

Abstract

Our rationale was to conduct a retrospective study comparing 3 123 I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane ( 123 I-FP-CIT) SPECT quantitative methods in patients with neurodegenerative syndromes as referenced to neuropathologic findings. Methods: 123 I-FP-CIT-SPECT and neuropathologic findings among patients with neurodegenerative syndromes from the Mayo Alzheimer Disease Research Center and Mayo Clinic Study of Aging were examined. Three 123 I-FP-CIT SPECT quantitative assessment methods -MIMneuro, DaTQUANT, and manual region-of-interest creation on a workstation-were compared with neuropathologic findings describing the presence or absence of Lewy body disease (LBD). Striatum-to-background ratios (SBRs) generated by DaTQUANT were compared with the calculated SBRs of the manual method and MIMneuro. The left and right SBRs for caudate, putamen, and striatum were evaluated with the manual method. For DaTQUANT and MIMneuro, the left, right, total, and average SBRs and z scores for whole striatum, caudate, putamen, anterior putamen, and posterior putamen were calculated. Results: The cohort included 24 patients (20 [83%] male, mean age for all patients at death, 75.4 ± 10.0 y). The antemortem clinical diagnoses were Alzheimer disease dementia (n 5 6), probable dementia with Lewy bodies (n 5 12), mixed Alzheimer disease dementia and probable dementia with Lewy bodies (n 5 1), Parkinson disease with mild cognitive impairment (n 5 2), corticobasal syndrome (n 5 1), idiopathic rapid-eye-movement sleep behavior disorder (n 5 1), and behavioral-variant frontotemporal dementia (n 5 1). Seventeen (71%) had LBD. All 3 123 I-FP-CIT SPECT quantitative methods had an area under the receiveroperating-characteristics curve ranging from more than 0.93 to up to 1.000 (P , 0.001) and showed excellent discrimination between LBD and non-LBD patients in each region assessed (P , 0.001). There was no significant difference between the accuracy of the regions in discriminating the 2 groups, with good discrimination for both caudate and putamen. Conclusion: All 3 123 I-FP-CIT SPECT quantitative methods showed excellent discrimination between LBD and non-LBD patients in each region assessed, using both SBRs and z scores.

β-Amyloid PET and 123 I-FP-CIT SPECT in Mild Cognitive Impairment at Risk for Lewy Body Dementia

“…Elevated amyloid-β burden on Pittsburgh compound-B (PiB) PET 6 , was reported in more than half of patients with DLB 7 and has been associated with greater cognitive impairment in DLB 8 . The quantitative analysis of antemortem 123 I-FP-CIT SPECT demonstrated excellent discrimination between patients with and without autopsy-confirmed LB disease, supporting the utility of 123 I-FP-CIT SPECT as a biomarker for the underlying Lewy-related pathology in MCI-LB 12 .…”

“…A 123 I-FP-CIT SPECT (DaTscan, GE Healthcare, Chicago, IL) was performed according to previously published protocol for each participant. 12 In brief, at least 1 hour before the injection of 123 I-ioflupane, a 100 mg Lugol solution was given, and then the recommended 123 I-ioflupane dose of 111 to 185 MBq (3–5 mCi) was slowly administered intravenously. SPECT imaging occurred 3 to 6 hours after injection.…”

“…Data were reconstructed with ordered subset expectation maximization method; the planar images were prefiltered with a Butterworth filter (power 10, cutoff 0.6 cycles/cm); and no attenuation correction was used. 12 Projection images were used for the quantitative analysis.…”

“… 20 Abnormal minimum DaTQUANT z score in putamen was defined as <−0.82, which was validated in autopsy-confirmed LB disease. 12 Participants were assigned to an A and D biomarker group, with A−D− denoting low PiB SUVR and high putamen 123 I-FP-CIT SPECT uptake, A+D− denoting high PiB SUVR and high putamen 123 I-FP-CIT SPECT uptake, A−D+ denoting low PiB SUVR and low putamen 123 I-FP-CIT SPECT uptake, and A+D+ denoting high PiB SUVR and low putamen 123 I-FP-CIT SPECT uptake.…”

“…GE D670/D630 SPECT systems with ultra-high-resolution fan Chen et al 8 beam collimators and an energy setting of 159 keV 20% window was used on all patients. Data were reconstructed using ordered subset expectation maximization method, and the planar images were pre-filtered using a Butterworth filter (power=10, cut-off = 0.6 cycles/cm), and no attenuation correction was used 12 . Projection images were used for the quantitative analysis.…”