Regional gray matter-dedicated SUVR with 3D-MRI detects positive amyloid deposits in equivocal amyloid PET images
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ORIGINAL ARTICLE
Regional gray matter‑dedicated SUVR with 3D‑MRI detects positive amyloid deposits in equivocal amyloid PET images Kazunari Ishii1,2,3 · Takahiro Yamada2 · Kohei Hanaoka2 · Hayato Kaida1,2 · Koichi Miyazaki1 · Masami Ueda3 · Kazushi Hanada3 · Kazumasa Saigoh3 · Julia Sauerbeck4 · Axel Rominger5 · Peter Bartenstein4 · Yuichi Kimura6 Received: 12 July 2020 / Accepted: 18 August 2020 © The Japanese Society of Nuclear Medicine 2020
Abstract Purpose It is usually easy to judge whether amyloid PET images should be interpreted as positive or negative for amyloid deposits by visual inspection or quantitative measurement standard uptake value ratio (SUVR), but the findings are equivocal in some cases. As conventional mean cortical SUVR (mcSUVR) measures accumulation in both gray matter (GM) and white matter, it may mis-estimate amyloid deposits. The purpose of the study was to develop a regional GM-dedicated SUVR measuring (GMSUVR) system for amyloid PET images with 3D-MRI, and evaluate its utility for detecting amyloid deposits in equivocal cases. Methods Of 126 subjects who underwent amyloid PET with 11C-PiB and 3D-MRI, the area of amyloid-positive regions and the critical regional GMSUVR thresholds were first determined in 15 amyloid-positive and 15 amyloid-negative patients, using the automatic volumetric measurement of segmented brain images system. We then tested 36 amyloid-negative, 60 amyloid-positive, and 13 equivocal subjects with this GMSUVR system and with conventional mcSUVR. Results Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 100%, 92%, 97%, 95%, and 100% for the GMSUVR system; and 97%, 86%, 93%, 92% and 94%, respectively, for mcSUVR. In 24 cases in which the findings were equivocal or discordant, the sensitivity, specificity, accuracy, PPV, and NPV were all 100% for the GMSUVR system; and were 90%, 33%, 83%, 90%, and 33%, respectively, for mcSUVR. Conclusion The regional GMSUVR measurement method was well able to discriminate between amyloid-positive and -negative subjects, even in cases where amyloid deposition was equivocal. Keywords Alzheimer’s disease · Amyloid · 11C-PiB PET · MRI · Equivocal accumulation
Introduction Amyloid PET is a powerful tool for the in vivo detection of amyloid β deposition in brains with Alzheimer’s disease (AD). In the clinical setting, amyloid PET images are * Kazunari Ishii [email protected] 1
Department of Radiology, Kindai University Faculty of Medicine, 377‑2 Ohnohigashi, Osaka‑Sayama, Osaka 589‑8511, Japan
2
Institute of Advanced Clinical Medicine, Kindai University Hospital, 377‑2 Ohnohigashi, Osaka‑Sayama, Osaka 589‑8511, Japan
3
Neurocognitive Disorders Center, Kindai University Hospital, 377‑2 Ohnohigashi, Osaka‑Sayama, Osaka 589‑8511, Japan
assessed visually and classified as positive or negative for amyloid deposition in the cerebral cortices, whereas quantitative measurement of amyloid PET images is performed only for research. Several methods have been repo
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