Evaluation of semi-quantitative measures of 18F-flutemetamol PET for the clinical diagnosis of Alzheimer’s disease

Müller, Ebba Gløersen; Stokke, Caroline; Stokmo, Henning Langen; Edwin, Trine Holt; Knapskog, Anne Brita; Revheim, Mona-Elisabeth

doi:10.21037/qims-21-188

Cited by 9 publications

(6 citation statements)

References 47 publications

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“…Therefore, for this purpose, the SUVr — a widely used, well-documented approach — appears to be a suitable solution. Moreover, both this study and that of Müller and colleagues [ 30 ] show that the SUVr performs equally well in discriminating visually positive and negative scans, regardless of implementation and normalization procedure (see the Supplementary Table 5 ).…”

Section: Discussionsupporting

confidence: 68%

A comparison of advanced semi-quantitative amyloid PET analysis methods

Peira

Poggiali

Pardini

et al. 2022

Eur J Nucl Med Mol Imaging

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Purpose To date, there is no consensus on how to semi-quantitatively assess brain amyloid PET. Some approaches use late acquisition alone (e.g., ELBA, based on radiomic features), others integrate the early scan (e.g., TDr, which targets the area of maximum perfusion) and structural imaging (e.g., WMR, that compares kinetic behaviour of white and grey matter, or SI based on the kinetic characteristics of the grey matter alone). In this study SUVr, ELBA, TDr, WMR, and SI were compared. The latter — the most complete one — provided the reference measure for amyloid burden allowing to assess the efficacy and feasibility in clinical setting of the other approaches. Methods We used data from 85 patients (aged 44–87) who underwent dual time-point PET/MRI acquisitions. The correlations with SI were computed and the methods compared with the visual assessment. Assuming SUVr, ELBA, TDr, and WMR to be independent measures, we linearly combined them to obtain more robust indices. Finally, we investigated possible associations between each quantifier and age in amyloid-negative patients. Results Each quantifier exhibited excellent agreement with visual assessment and strong correlation with SI (average AUC = 0.99, ρ = 0.91). Exceptions to this were observed for subcortical regions with ELBA and WMR (ρELBA = 0.44, ρWMR = 0.70). The linear combinations showed better performances than the individual methods. Significant associations were observed between TDr, WMR, SI, and age in amyloid-negative patients (p < 0.05). Conclusion Among the other methods, TDr came closest to the reference with less implementation complexity. Moreover, this study suggests that combining independent approaches gives better results than the individual procedure, so efforts should focus on multi-classifier systems for amyloid PET. Finally, the ability of techniques integrating blood perfusion to depict age-related variations in amyloid load in amyloid-negative subjects demonstrates the goodness of the estimate.

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Section: Discussionsupporting

confidence: 68%

A comparison of advanced semi-quantitative amyloid PET analysis methods

Peira

Poggiali

Pardini

et al. 2022

Eur J Nucl Med Mol Imaging

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“…Images for quantitative analysis and visual evaluation were anatomically standardised without using magnetic resonance imaging (MRI). The SUVRs calculated by normalization with and without MRI normalization could discriminate Aβ deposition equally well [ 30 ]. We prioritised the replicability of our study using commercially available CortexID Suite and VIZCalc software.…”

Section: Discussionmentioning

confidence: 99%

Phantom and clinical evaluation of the Bayesian penalised likelihood reconstruction algorithm Q.Clear without PSF correction in amyloid PET images

Wagatsuma,

Sakata,

Miwa

et al. 2024

EJNMMI Phys

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Purpose Bayesian penalised likelihood (BPL) reconstruction, which incorporates point-spread-function (PSF) correction, provides higher signal-to-noise ratios and more accurate quantitation than conventional ordered subset expectation maximization (OSEM) reconstruction. However, applying PSF correction to brain PET imaging is controversial due to Gibbs artefacts that manifest as unpredicted cortical uptake enhancement. The present study aimed to validate whether BPL without PSF would be useful for amyloid PET imaging. Methods Images were acquired from Hoffman 3D brain and cylindrical phantoms for phantom study and 71 patients administered with [18F]flutemetamol in clinical study using a Discovery MI. All images were reconstructed using OSEM, BPL with PSF correction, and BPL without PSF correction. Count profile, %contrast, recovery coefficients (RCs), and image noise were calculated from the images acquired from the phantoms. Amyloid β deposition in patients was visually assessed by two physicians and quantified based on the standardised uptake value ratio (SUVR). Results The overestimated radioactivity in profile curves was eliminated using BPL without PSF correction. The %contrast and image noise decreased with increasing β values in phantom images. Image quality and RCs were better using BPL with, than without PSF correction or OSEM. An optimal β value of 600 was determined for BPL without PSF correction. Visual evaluation almost agreed perfectly (κ = 0.91–0.97), without depending on reconstruction methods. Composite SUVRs did not significantly differ between reconstruction methods. Conclusion Gibbs artefacts disappeared from phantom images using the BPL without PSF correction. Visual and quantitative evaluation of [18F]flutemetamol imaging was independent of the reconstruction method. The BPL without PSF correction could be the standard reconstruction method for amyloid PET imaging, despite being qualitatively inferior to BPL with PSF correction for [18F]flutemetamol amyloid PET imaging.

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“…Although syngo.MI Neurology is provided by PET/CT vendors, several studies have shown that there is no significant difference in results when using the program compared with other analysis programs. Since the measured values using syngo.MI Neurology in various studies have been reported as research results, the same method was applied in our study [ 26 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Quantitative comparative analysis of amyloid PET images using three radiopharmaceuticals

et al. 2023

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Objective Amyloid positron emission tomography (PET) with F-18 florbetaben (FBB), F-18 flutemetamol (FMM), and F-18 florapronol (FPN) is being used clinically for the evaluation of dementia. These radiopharmaceuticals are commonly used to evaluate the accumulation of beta-amyloid plaques in the brain, but there are structural differences between them. We investigated whether there are any differences in the imaging characteristics. Methods A total of 605 subjects were enrolled retrospectively in this study, including healthy subjects (HS) and patients with mild cognitive impairment or Alzheimer’s disease. Participants underwent amyloid PET imaging using one of the three radiopharmaceuticals. The PET images were analyzed visually and semi-quantitatively using a standardized uptake value ratio (SUVR). In addition, we calculated and compared the cut-off SUVR of the representative regions for each radiopharmaceutical that can distinguish between positive and negative scans. Results In the negative images of the HS group, the contrast between the white matter and the gray matter was high in the FMM PET images, while striatal uptake was relatively higher in the FPN PET images. The SUVR showed significant differences across the radiopharmaceuticals in all areas except the temporal lobe, but the range of differences was relatively small. Accuracy levels for the global cut-off SUVR to discriminate between positive and negative images were highest in FMM PET, with a value of 0.989. FBB PET also showed a high value of 0.978, while FPN PET showed a relatively low value of 0.901. Conclusions Negative amyloid PET images using the three radiopharmaceuticals showed visually and quantitatively similar imaging characteristics except in the striatum. Binary classification using the cut-off of the global cortex showed high accuracy overall, although there were some differences between the three PET images.

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Evaluation of semi-quantitative measures of 18F-flutemetamol PET for the clinical diagnosis of Alzheimer’s disease

Cited by 9 publications

References 47 publications

A comparison of advanced semi-quantitative amyloid PET analysis methods

A comparison of advanced semi-quantitative amyloid PET analysis methods

Phantom and clinical evaluation of the Bayesian penalised likelihood reconstruction algorithm Q.Clear without PSF correction in amyloid PET images

Quantitative comparative analysis of amyloid PET images using three radiopharmaceuticals

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