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A comparison of 99mTc-exametazime and 123I-FP-CIT SPECT imaging in the differential diagnosis of Alzheimer's disease and dementia with Lewy bodies

Published online by Cambridge University Press:  27 August 2008

Sean J. Colloby ,
Michael J. Firbank ,
Sanjeet Pakrasi ,
Jim J. Lloyd ,
Ian Driver ,
Ian G. McKeith ,
E. David Williams  and
John T. O'Brien
Sean J. Colloby*
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, U.K.
Michael J. Firbank
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, U.K.
Sanjeet Pakrasi
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, U.K.
Jim J. Lloyd
Affiliation:
Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
Ian Driver
Affiliation:
Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne, U.K.
Ian G. McKeith
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, U.K.
E. David Williams
Affiliation:
Regional Medical Physics Department, Sunderland Royal Hospital, Sunderland, U.K
John T. O'Brien
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, U.K.
*
Correspondence should be addressed to: Dr. Sean J. Colloby, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, U.K. Phone: +44 191 248 1321; Fax: +44 191 248 1301; Email: s.j.colloby@ncl.ac.uk.
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Abstract

Background: The aim of this study is to investigate the diagnostic value of perfusion 99mTc-exametazime single photon emission computed tomography (SPECT) in the diagnosis of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) in comparison with dopaminergic 123I-2β-carbomethoxy-3β-(4-iodophenyl)-n-(3-fluoropropyl) nortropane (FP-CIT) SPECT imaging.

Methods: Subjects underwent 99mTc-exametazime scanning (39 controls, 36 AD, 30 DLB) and 123I-FP-CIT scanning (33 controls, 33 AD, 28 DLB). For each scan, five raters performed visual assessments blind to clinical diagnosis on selected transverse 99mTc-exametazime images in standard stereotactic space. Diagnostic accuracy of 99mTc-exametazime was compared to 123I-FP-CIT results for the clinically relevant subgroups AD and DLB using receiver operating characteristic (ROC) curve analysis.

Results: Inter-rater agreement for categorizing uptake was “moderate” (mean κ = 0.53) for 99mTc-exametazime and “excellent” (mean κ = 0.88) for 123I-FP-CIT. For AD and DLB, consensus rating matched clinical diagnosis in 56% of cases using 99mTc-exametazime and 84% using 123I-FP-CIT. In distinguishing AD from DLB, ROC analysis revealed superior diagnostic accuracy with 123I-FP-CIT (ROC curve area 0.83, sensitivity 78.6%, specificity 87.9%) compared to occipital 99mTc-exametazime (ROC curve area 0.64, sensitivity 64.3%, specificity 63.6%) p = 0.03.

Conclusion: Diagnostic accuracy was superior with 123I-FP-CIT compared to 99mTc-exametazime in the differentiation of DLB from AD.

Keywords

neuroimagingvisual ratingregion of interestROCperfusiondopamine
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 6 , December 2008 , pp. 1124 - 1140
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Aarsland, D., Mosimann, U. P. and McKeith, I. G. (2004). Role of cholinesterase inhibitors in Parkinson's disease and dementia with Lewy bodies. Journal of Geriatric Psychiatry and Neurology, 17, 164–171.CrossRefGoogle ScholarPubMed
Aarsland, D. et al. (2005). Neuroleptic sensitivity in Parkinson's disease and parkinsonian dementias. Journal of Clinical Psychiatry, 66, 633–637.Google ScholarPubMed
Benamer, T. S. et al. (2000). Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: the [123I]-FP-CIT study group. Movement Disorders, 15, 503–510.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Ceravolo, R. et al. (2003). Dopaminergic degeneration and perfusional impairment in Lewy body dementia and Alzheimer's disease. Neurological Sciences, 24, 162–163.CrossRefGoogle ScholarPubMed
Fahn, S. et al. (1987). Unified Parkinson's disease rating scale. In Fahn, S., Elton, R. L., Marsden, C. D. and Goldstein, M. (eds.), Recent Developments in Parkinson's Disease (pp. 153–163). New York: Macmillan.Google Scholar
Firbank, M., Colloby, S. J., Burn, D., McKeith, I. G. and O'Brien, J. T. (2003). Regional cerebral blood flow in Parkinson's disease with and without dementia. Neuroimage, 20, 1309–1319.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Gilman, S. et al. (2005). Differentiation of Alzheimer's disease from dementia with Lewy bodies utilizing positron emission tomography with [18 F]fluorodeoxyglucose and neuropsychological testing. Experimental Neurology, 191 (Suppl. 1), S95–S103.CrossRefGoogle ScholarPubMed
Hanyu, H., Nakano, S., Abe, S., Arai, H., Iwamoto, T. and Takasaki, M. (1995). Differential diagnosis of Alzheimer-type dementia and vascular dementia based on neuroimaging study. No To Shinkei, 47, 665–670.Google ScholarPubMed
Hanyu, H. et al. (2006a). Comparative value of brain perfusion SPECT and [(123)I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer's disease. European Journal of Nuclear Medicine and Molecular Imaging, 33, 248–253.CrossRefGoogle ScholarPubMed
Hanyu, H. et al. (2006b). Differentiation of dementia with lewy bodies from Alzheimer's disease using Mini-Mental State Examination and brain perfusion SPECT. Journal of the Neurological Sciences, 250, 97–102.Google Scholar
Imran, M. B. et al. (1999). Tc-99 m HMPAO SPECT in the evaluation of Alzheimer's disease: correlation between neuropsychiatric evaluation and CBF images. Journal of Neurology, Neurosurgery and Psychiatry, 66, 228–232.CrossRefGoogle Scholar
Ishii, K. et al. (1998). Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer's disease. Neurology, 51, 125–130.CrossRefGoogle ScholarPubMed
Ishii, K., Sasaki, M., Sakamoto, S., Yamaji, S., Kitagaki, H. and Mori, E. (1999a). Tc-99 m ethyl cysteinate dimer SPECT and 2-[F-18]fluoro-2-deoxy-D-glucose PET in Alzheimer's disease: comparison of perfusion and metabolic patterns. Clinical Nuclear Medicine, 24, 572–575.CrossRefGoogle Scholar
Ishii, K., Yamaji, S., Kitagaki, H., Imamura, T., Hirono, N. and Mori, E. (1999b). Regional cerebral blood flow difference between dementia with Lewy bodies and AD. Neurology, 53, 413–416.CrossRefGoogle ScholarPubMed
Kemp, P. M., Hoffmann, S. A., Tossici-Bolt, L., Fleming, J. S. and Holmes, C. (2007). Limitations of the HMPAO SPECT appearances of occipital lobe perfusion in the differential diagnosis of dementia with Lewy bodies. Nuclear Medicine Communications, 28, 451–456.CrossRefGoogle ScholarPubMed
Lee, Y. C. et al. (2003). Statistical parametric mapping of brain SPECT perfusion abnormalities in patients with Alzheimer's disease. European Neurology, 49, 142–145.CrossRefGoogle ScholarPubMed
Lobotesis, K. et al. (2001). Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology, 56, 643–649.CrossRefGoogle Scholar
McKeith, I. G., Fairbairn, A. F., Perry, R. H. and Thompson, P. (1994). The clinical diagnosis and misdiagnosis of senile dementia of Lewy body type (SDLT). British Journal of Psychiatry, 165, 324–332.CrossRefGoogle ScholarPubMed
McKeith, I. G. et al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 1113–1124.Google Scholar
McKeith, I. G. et al. (2005). Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology, 65, 1863–1872.Google Scholar
McKeith, I. et al. (2007). Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study. Lancet Neurology, 6, 305–313.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Minoshima, S., Foster, N. L., Sima, A. A. F., Frey, K. A., Albin, R. L. and Kuhl, D. E. (2001). Alzheimer's disease versus dementia with Lewy bodies: cerebral metabolic distinction with autopsy confirmation. Annals of Neurology, 50, 358–365.CrossRefGoogle ScholarPubMed
O'Brien, J. T. et al. (2004). Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy bodies. Archives of Neurology, 61, 919–925.CrossRefGoogle ScholarPubMed
Oide, T. et al. (2003). Usefulness of [123I]metaiodobenzylguanidine ([123I]MIBG) myocardial scintigraphy in differentiating between Alzheimer's disease and dementia with Lewy bodies. Internal Medicine, 42, 686–690.CrossRefGoogle ScholarPubMed
Pasquier, J., Michel, B. F., Brenot-Rossi, I., Hassan-Sebbag, N., Sauvan, R. and Gastaut, J. L. (2002). Value of (99 m)Tc-ECD SPET for the diagnosis of dementia with Lewy bodies. European Journal of Nuclear Medicine and Molecular Imaging, 29, 1342–1348.CrossRefGoogle Scholar
Roth, M. et al. (1986). CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698–709.Google Scholar
Shimizu, S., Hanyu, H., Kanetaka, H., Iwamoto, T., Koizumi, K. and Abe, K. (2005). Differentiation of dementia with Lewy bodies from Alzheimer's disease using brain SPECT. Dementia and Geriatric Cognitive Disorders, 20, 25–30.Google Scholar
Talairach, J. and Tournoux, P. (1988). Co-planar Stereotactic Atlas of the Human Brain. Stuttgart, New York: Thieme.Google Scholar
Walker, Z. et al. (2002). Differentiation of dementia with Lewy bodies from Alzheimer's disease using a dopaminergic presynaptic ligand. Journal of Neurology, Neurosurgery and Psychiatry, 73, 134–140.CrossRefGoogle ScholarPubMed
Walker, Z. et al. (2007). Dementia with Lewy bodies: a comparison of clinical diagnosis, FP-CIT single photon emission computed tomography imaging and autopsy. Journal of Neurology, Neurosurgery and Psychiatry, 78, 1176–1181.Google Scholar
Zweig, M. H. and Campbell, G. (1993). Receiver operating characteristic (ROC) plots – a fundamental evaluation tool in clinical medicine. Clinical Chemistry, 39, 1589–1589.Google Scholar