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Regional HmPAO SPECT and CT Measurements in the Diagnosis of Alzheimer's Disease

Published online by Cambridge University Press:  18 September 2015

A. Mattman ,
H. Feldman ,
B. Forste ,
D. Li ,
I. Szasz ,
B.L. Beattie  and
M. Schulzer
A. Mattman
Affiliation:
Clinic for Alzheimer's Disease and Related Disorders, Vancouver Hospital and Health Sciences Center-UBC Site, Vancouver.
H. Feldman*
Affiliation:
Clinic for Alzheimer's Disease and Related Disorders, Division of Neurology, Department of Medicine, Vancouver Hospital and Health Sciences Center-UBC Site, Vancouver.
B. Forste
Affiliation:
Department of Radiology, Vancouver Hospital and Health Sciences Center-UBC Site, Vancouver.
D. Li
Affiliation:
Department of Radiology, Vancouver Hospital and Health Sciences Center-UBC Site, Vancouver.
I. Szasz
Affiliation:
Department of Nuclear Medicine, Vancouver Hospital and Health Sciences Center-UBC Site, Vancouver.
B.L. Beattie
Affiliation:
Clinic for Alzheimer's Disease and Related Disorders, Division of Geriatric Medicine, Department of Medicine, Vancouver Hospital and Health Sciences Center-UBC Site, Vancouver.
M. Schulzer
Affiliation:
Departments of Statistics and Medicine, Vancouver Hospital and Health Sciences Center, Vancouver.
*
Division of Neurology, Vancouver Hospital and HSC-UBC Site, S192-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5
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Abstract:

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Background:

This study investigated the hypothesis that the combination of regional CT brain atrophy measurements and semiquantitative SPECT regional blood flow ratios could produce a diagnostic test for Alzheimer's disease (AD) with an accuracy comparable to that achieved with the present clinical gold standard of the NINCDS-ADRDA criteria.

Methods:

Single proton emission computed tomography (SPECT) and CT head scans were performed on 122 subjects referred an UBC Alzheimer clinic and diagnosed as either ‘not demented’ (ND-37) or ‘possible/probable AD’ (AD-85) by the NINCDS-ADRDA criteria. Stepwise discriminant analysis (SDA) was performed on the bilateral SPECT regions of interest and compared to bilateral CT qualitative/quantitative assessment in the frontal, parietal and temporal lobes to determine which were most accurate at ND/AD distinction. Receiver operating curves (ROC) were then constructed for these variables individually and for their combined discriminant function.

Results:

The left temporal qualitative cortical atrophy score (CT) and left temporal perfusion ratio (SPECT) were selected in the SDA. The combined discriminant function was more specific at AD/ND distinction than either of CT or SPECT alone. The accuracy of AD/ND distinction with the combined discriminant function was below that achieved by clinical diagnosis according to the NINCDS-ADRDA criteria and was not significantly different from that achieved with SPECT or CT alone as defined by ROC curve analysis.

Conclusion:

The measurements of left temporal cortical atrophy and regional cerebral blood flow were most indicative of AD; however they lacked the sensitivity and specificity to recommend their use as a diagnostic test for AD.

Résumé:

RÉSUMÉ:Introduction et objectifs:

Dans cette étude nous évaluons l'hypothèse selon laquelle l'association de mesures de l'atrophie cérébrale régionale par CT scan et de rapports de débits sanguins régionaux obtenus par SPECT pourrait constituer un test diagnostique de la maladie d'Alzheimer (MA) d'une précision comparable à celle des critères de l'étalon or actuel, le NINCDS-ADRDA.

Méthodes:

122 patients référés à la clinique d'Alzheimer de l'Université de la Colombie-Britannique ont subi un scan cérébral par SPECT et par CT, et on les a classifiés comme non déments (ND-37) ou MA possible/probable (MA-85) selon les critères du NINCDS-ADRDA. Nous avons effectué une analyse factorielle discriminante pas à pas (ADP) sur les données des régions d'intérêt obtenues par SPECT bilatéral et nous l'avons comparée à l'évaluation qualitative/quantitative des lobes pariétaux et temporaux bilatéraux obtenue par CT afin de déterminer quelle méthode d'investigation était plus fiable pour distinguer les patients ND des MA. Des courbes ROC ont ensuite été générées individuellement pour ces variables et pour leur fonction discriminante combinée.

Résultats:

La cote d'atrophie corticale qualitative du lobe temporal gauche (CT) et le taux de perfusion du lobe temporal gauche (SPECT) ont été sélectionnés à l'ADP. La fonction discriminante combinée était plus spécifique pour distinguer la MA de la ND que le CT ou le SPECT seul. La précision de la distinction MA/ND au moyen de la fonction discriminante comtinée état inférieure à celle obtenue par le diagnostic clinique selon les critères du NINCDS-ADRDA et n'était pas signi-ficativement différente de celle obtenue par le SPECT ou le CT seul, selon l'analyse de courbe ROC.

Conclusions:

Les mesures de l'atrophie corticale du lobe temporal gauche et du débit sanguin cérébral régional étaient les meilleurs marqueurs de la MA; cependant, ils n'ont pas une sensibilité et une spécificité suffisante pour recommander leur utilisation comme épreuves diagnostiques de la MA.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 1 , February 1997 , pp. 22 - 28
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

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