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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: [email protected].
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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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