Combined brain and spinal FDG PET allows differentiation between ALS and ALS mimics
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ORIGINAL ARTICLE
Combined brain and spinal FDG PET allows differentiation between ALS and ALS mimics Donatienne Van Weehaeghe 1,2 & Martijn Devrome 1 & Georg Schramm 1 & Joke De Vocht 3 & Wies Deckers 2 & Kristof Baete 1,2 & Philip Van Damme 3,4 & Michel Koole 1 & Koen Van Laere 1,2 Received: 31 December 2019 / Accepted: 20 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with on average a 1-year delay between symptom onset and diagnosis. Studies have demonstrated the value of [18F]-FDG PET as a sensitive diagnostic biomarker, but the discriminatory potential to differentiate ALS from patients with symptoms mimicking ALS has not been investigated. We investigated the combination of brain and spine [18F]-FDG PET-CT for differential diagnosis between ALS and ALS mimics in a real-life clinical diagnostic setting. Methods Patients with a suspected diagnosis of ALS (n = 98; 64.8 ± 11 years; 61 M) underwent brain and spine [18F]-FDG PETCT scans. In 62 patients, ALS diagnosis was confirmed (67.8 ± 10 years; 35 M) after longitudinal follow-up (average 18.1 ± 8.4 months). In 23 patients, another disease was diagnosed (ALS mimics, 60.9 ± 12.9 years; 17 M) and 13 had a variant motor neuron disease, primary lateral sclerosis (PLS; n = 4; 53.6 ± 2.5 years; 2 M) and progressive muscular atrophy (PMA; n = 9; 58.4 ± 7.3 years; 7 M). Spine metabolism was determined after manual and automated segmentation. VOI- and voxel-based comparisons were performed. Moreover, a support vector machine (SVM) approach was applied to investigate the discriminative power of regional brain metabolism, spine metabolism and the combination of both. Results Brain metabolism was very similar between ALS mimics and ALS, whereas cervical and thoracic spine metabolism was significantly different (in standardised uptake values; cervical: ALS 2.1 ± 0.5, ALS mimics 1.9 ± 0.4; thoracic: ALS 1.8 ± 0.3, ALS mimics 1.5 ± 0.3). As both brain and spine metabolisms were very similar between ALS mimics and PLS/PMA, groups were pooled for accuracy analyses. Mean discrimination accuracy was 65.4%, 80.0% and 81.5%, using only brain metabolism, using spine metabolism and using both, respectively. Conclusion The combination of brain and spine FDG PET-CT with SVM classification is useful as discriminative biomarker between ALS and ALS mimics in a real-life clinical setting. Keywords Amyotrophic lateral sclerosis . ALS mimics . Brain and spinal [18F]-FDG PET-CT . Support vector machine . Automated spinal cord segmentation . Convolutional neural network
Donatienne Van Weehaeghe, Martijn Devrome, Michel Koole and Koen Van Laere contributed equally to this work. This article is part of the Topical Collection on Neurology * Donatienne Van Weehaeghe [email protected] 1
Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
2
Division of Nuclear Medicine, UZ Leuven, Herestraat 49, 3000 Leuve
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