The utility of cerebral perfusion SPECT analysis using SPM8, eZIS and vbSEE for the diagnosis of multiple system atrophy
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ORIGINAL ARTICLE
The utility of cerebral perfusion SPECT analysis using SPM8, eZIS and vbSEE for the diagnosis of multiple system atrophy-parkinsonism Keita Sakurai • Etsuko Imabayashi • Kimiteru Ito • Aya M. Tokumaru Yoshiyuki Ozawa • Masahiro Muto • Motoo Nakagawa • Kenji Okita • Noriyuki Matsukawa • Yuta Shibamoto
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Received: 30 August 2014 / Accepted: 9 November 2014 / Published online: 21 November 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract Objective Although a correct diagnosis is important for appropriate management, accurately differentiating between multiple system atrophy with predominant parkinsonism (MSA-P) and Parkinson’s disease (PD) is often difficult because of similarities in the early-stage symptoms. The aim of this study was to evaluate the diagnostic value of cerebral perfusion single photon emission computed tomography (SPECT) and voxel-based analysis for diagnosing MSA-P patients. Methods Thirty-eight subjects (9 with early-stage MSAP, 11 with PD, and 18 controls) were included in this study. Z-scores suggestive of hypoperfusion were calculated between patients and controls using statistical parametric mapping (SPM) 8 and easy Z-score imaging system (eZIS) programs. A voxel-based stereotactic extraction estimation (vbSEE) program was performed to determine the target volumes of interest (VOIs) in the putamen, pons, and cerebellum, and quantify Z-scores as ‘‘extent’’ (the rate of K. Sakurai (&) Y. Ozawa M. Muto M. Nakagawa Y. Shibamoto Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan e-mail: [email protected] E. Imabayashi Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan K. Ito A. M. Tokumaru Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology, Tokyo, Japan K. Okita N. Matsukawa Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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voxels with a Z-score [2.0 in these VOIs) and ‘‘severity’’ (average Z-scores in these VOIs). These parameters were used as the determinant in receiver operating characteristic (ROC) analyses. Results The extent and severity of the cerebellar VOIs were higher in MSA-P patients than in PD patients. In ROC analyses, the extent and severity of the cerebellar VOI exhibited the highest areas under the curves of 0.86 and 0.84, and accuracies of 90 and 90 %, respectively. Conclusions The diagnostic value of significant cerebellar hypoperfusion was the highest for differentiating MSAP from PD. This voxel-based analysis of cerebral perfusion SPECT using the SPM8, eZIS, and vbSEE programs is useful for clinically diagnosing MSA-P. Keywords Multiple system atrophy (MSA) Single photon emission computed tomography (SPECT) Statistical parametric mapping (SPM) Easy Z-score imaging system (eZIS) Voxel-based stereotactic extraction estimation (vbSEE)
Introduction Multiple system atrophy (MSA) is a clinically
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