Quantitative Research of 11C-CFT and 18F-FDG PET in Parkinson’s Disease: A Pilot Study With NeuroQ Software

Abstract

Dopamine transporter (DAT) and glucose metabolism imaging have been applied in the diagnosis of Parkinson’s disease (PD). We explored the possibility of evaluating for PD with NeuroQ software by analyzing 11 C-2β-carbomethoxy-3β-(4-fluorophenyl) tropane ( 11 C-CFT) and 18 F-FDG PET/CT. We retrospectively analyzed brain 11 C-CFT and 18 F-FDG PET/CT of 38 patients with parkinsonism, including 20 with PD, 10 with multiple system atrophy (MSA) and 8 with essential tremor (ET), and compared them with the PET/CT of 11 normal healthy controls (NC). PD patients were divided into mild and moderate-severe grade according to the Hoehn-Yahr (H&Y) scale. The 11 C-CFT uptake in the caudate nuclei (CN) and putamen (Pu) normalized with cerebellum (CN/Cb and Pu/Cb) were obtained with a manual method and NeuroQ software, and their diagnostic performance was compared. 18 F-FDG uptake of specific regions was also obtained with NeuroQ, and the enhancement effect for the differential diagnosis was evaluated. There was significant agreement between the manual method and the NeuroQ method for 11 C-CFT uptake by CN ( r 2 = 0.680) and Pu ( r 2 = 0.770). 11 C-CFT uptake by CN and Pu in PD and MSA patients was significantly lower compared to NC and ET patients. The cutoffs of CN/Cb and Pu/Cb for the distinction between PD and NC were 1.71 and 2.20, respectively. No difference in uptake ratios occurred between PD and MSA. 18 F-FDG uptake by the pons and cerebellum in the MSA group was markedly decreased. It was highly accurate in distinguishing between PD and MSA when combined with analysis of 11 C-CFT uptake. Pu/Cb decreased significantly in mild grade PD compared to NC group (1.92 ± 0.33 vs. 2.82 ± 0.43); however no statistically significant decrease in CN/Cb was observed until moderate-severe grade PD (1.43 ± 0.11 vs. 2.23 ± 0.36). In early asymmetric PD, a statistically significant difference could be seen with Pu/Cb between the symptomatic and asymptomatic side (2.17 ± 0.30 vs. 1.95 ± 0.22). 11 C-CFT and 18 F-FDG PET/CT can be analyzed quantitatively with NeuroQ software, which provides an accurate method for the diagnosis and severity evaluation of PD.

Clinical impact of digital and conventional PET control databases for semi-quantitative analysis of brain 18F-FDG digital PET scans

“…These distinct image qualities lead to problematic head-to-head comparisons between digital and conventional PET images as reflected in our study by the relatively poor diagnostic performance obtained for SQA using conventional controls for discriminating AD. However, all currently implemented control databases in dedicated software for automated SQA in clinical practice still rely on conventional PET control images [ 9 , 13 ]. Of course, it is now possible to implement local databases in the majority of these types of software, but establishing control databases acquired with digital PET technology remains an extensive undertaking, particularly because it involves a relative recently implemented technology.…”

“…Indeed, age and sex effects have been reported to influence metabolism distribution in brain 18 F-FDG PET images [7]. In addition, all currently implemented control databases in dedicated software for automated SQA are still based on acquisitions performed with conventional PET [8][9][10][11][12][13]. It is very likely that improvements in image quality provided by digital PET technology may also influence results of SQA, even though, to the best of our knowledge there is currently no data in the literature which evaluates the potential clinical impact of such an effect.…”

Clinical Impact of Digital and Conventional PET Control Databases for Semi-Quantitative Analysis of Brain 18F-FDG Digital PET Scans

“…These distinct image qualities lead to problematic head-to-head comparisons between digital and conventional PET images as re ected in our study by the relatively poor diagnostic performance obtained for SQA using conventional controls (accuracy at the individual level of only 63%). However, all currently implemented control databases in dedicated software for automated SQA in clinical practice still rely on conventional PET control images (9,13). Of course, it is now possible to implement local databases in the majority of these types of software, but establishing control databases acquired with digital PET technology remains an extensive undertaking, particularly because it involves a relative recently implemented technology.…”

“…Indeed, age and sex effects have been reported to in uence metabolism distribution in brain 18 F-FDG PET images (7). In addition, all currently implemented control databases in dedicated software for automated SQA are still based on acquisitions performed with conventional PET (8)(9)(10)(11)(12)(13). It is very likely that improvements in image quality provided by digital PET technology may also in uence results of SQA, even though, to the best of our knowledge there is currently no data in the literature which evaluates the potential clinical impact of such an effect.…”

Regional SUV quantification in hybrid PET/MR, a comparison of two atlas-based automatic brain segmentation methods

“…For PET quantitative analysis, previous studies usually extracted the regional cerebral standardized uptake values (SUVs) directly based on an atlas, e.g., the widely used 3D stereotactic surface projection (3D SSP), or acquired the PET/CT and MRI data sequentially, registered the PET and MRI by postprocessing [19][20][21], and performed quantitative SUV analysis. In hybrid PET/MR, the two modalities are acquired simultaneously, which avoids image misregistration.…”