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Quantitative evaluation of the tracer distribution in dopamine transporter SPECT for objective interpretation

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Abstract

Purpose

Quantification of the tracer distribution would add objectivity to the visual assessments of dopamine transporter (DAT) single photon emission computed tomography (SPECT) data. Our study aimed to evaluate the diagnostic utility of fractal dimension (FD) as a quantitative indicator of tracer distribution and compared with the conventional quantitative value: specific binding ratio (SBR). We also evaluated the utility of the combined index SBR/FD (SBR divided by FD).

Materials and methods

We conducted both clinical and phantom studies. In the clinical study, 150 patients including 110 patients with Parkinsonian syndrome (PS) and 40 without PS were enrolled. In the phantom study, we used a striatal phantom with the striatum chamber divided into two spaces, representing the caudate nucleus and putamen. The SBR, FD, and SBR/FD were calculated and compared between datasets for evaluating the diagnostic utility. Mann–Whitney test and receiver-operating characteristics (ROC) analysis were used for analysis.

Results

ROC analysis revealed that the FD value had high diagnostic performance [the areas under the curve (AUC) = 0.943] and the combined use of SBR and FD (SBR/FD) delivered better results than the SBR alone (AUC, 0.964 vs 0.899; p < 0.001). The sensitivity, specificity, and accuracy, respectively, were 79.1, 85.0, and 80.7% with SBR, 84.5, 97.5, and 88.0% with FD, and 92.7, 87.5, and 91.3% with SBR/FD.

Conclusion

Our results confirmed that the FD value is a useful diagnostic index, which reflects the tracer distribution in DAT SPECT images. The combined use of SBR and FD was more useful than either used alone.

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Abbreviations

PD:

Parkinson’s disease

PET:

Positron emission tomography

SPECT:

Single photon emission computed tomography

DAT:

Dopamine transporter

PS:

Parkinsonian syndrome

DLB:

Dementia with Lewy body

SBR:

Specific binding ratio

VOI:

Volume of interest

FD:

Fractal dimension

3D-FA:

Three-dimensional-fractal analysis

NPS:

Non Parkinsonian syndrome

RI:

Radioisotope

OSEM:

Ordered-subset expectation maximization

ICC:

Intra-class correlation coefficient

ROC:

Receiver-operating characteristics

AUC:

Area under the ROC curve

LOA:

Limit of agreement

SSRI:

Selective serotonin reuptake inhibitor

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Acknowledgements

The authors thank the staff of the Division of Nuclear Medicine at the Department of Diagnostic Radiology, for their valuable support. We also thank Editage for English language editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan

    Yu Iwabuchi, Tadaki Nakahara, Masashi Kameyama, Yoshitake Yamada, Masahiro Hashimoto, Yuji Ogata, Yohji Matsusaka, Mari Katagiri, Kazunari Itoh & Masahiro Jinzaki

  2. Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan

    Masashi Kameyama

  3. Department of Neurology, Keio University School of Medicine, Tokyo, Japan

    Takashi Osada & Daisuke Ito

  4. Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan

    Hajime Tabuchi

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  1. Yu Iwabuchi
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Correspondence to Tadaki Nakahara.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Iwabuchi, Y., Nakahara, T., Kameyama, M. et al. Quantitative evaluation of the tracer distribution in dopamine transporter SPECT for objective interpretation. Ann Nucl Med 32, 363–371 (2018). https://doi.org/10.1007/s12149-018-1256-x

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