Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of 123I-Ioflupane SPECT: an investigation of parkinsonian syndromes
Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of 123I-Ioflupane SPECT: an investigation of parkinsonian syndromes
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DOI：
10.1186/s13550-019-0558-x
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发表时间：
2019-09-03
期刊：
影响因子：
3.2
通讯作者：
Jinzaki, Masahiro
中科院分区：
文献类型：
--
作者：
Iwabuchi, Yu;Nakahara, Tadaki;Jinzaki, Masahiro
研究人员开发了一种脑脊液（CSF）屏蔽算法，以减少CSF低计数对使用南安普敦方法计算的特定结合比（SBR）指数的诊断效用的不利影响。我们评估了CSF-mask算法对包括帕金森病在内的帕金森综合征（PS）的SBR指数诊断性能的影响，以及脑室扩张对CSF-mask算法的影响。方法分别入组163例和158例非PS患者。从这些患者的i -123碘氟烷单光子发射计算机断层扫描（SPECT）图像中计算常规SBR（非CSF-mask）和用CSF-mask算法校正的SBR （CSF-mask）。我们比较了相应指标的诊断性能，并评估CSF-mask算法的效果是否根据心室扩张程度而变化，如Evans指数（EI）所评估的那样。采用受试者工作特征（ROC）分析进行统计分析。结果ROC分析显示，CSF-mask算法优于非CSF-mask算法(无校正，曲线下面积[AUC] = 0.917[95%置信区间（CI） 0.887-0.947] vs. 0.895 [95% CI 0.861-0.929], p < 0.001；衰减校正，AUC = 0.930 [95% CI 0.902-0.957] vs. 0.903 [95% CI 0.870-0.936], p < 0.001)。当未校正衰减时，低EI组非CSF-mask算法和CSF-mask算法的AUC无显著差异（0.927 [95% CI 0.877-0.978] vs 0.942 [95% CI 0.898-0.986], p = 0.11）；在中高EI组，CSF-mask算法优于非CSF-mask算法（中EI组，AUC = 0.894 [95% CI 0.825-0.963]比0.872 [95% CI 0.798-0.947], p < 0.05；高EI组，AUC = 0.931 [95% CI 0.883-0.978]比0.900 [95% CI 0.840-0.961], p < 0.01）。经衰减校正后，三个EI组的AUC均有显著差异（低EI组，AUC = 0.961 [95% CI 0.924-0.998] vs 0.942 [95% CI 0.895-0.988], p < 0.05；中等EI组，AUC = 0.905 [95% CI 0.843-0.968] vs 0.872 [95% CI 0.800-0.944], p < 0.005；高EI组，AUC = 0.954 [95% CI 0.917-0.991] vs 0.917 [95% CI 0.862-0.973], p < 0.005）。结论CSF-mask算法提高了SBR指数对脑室扩张患者的诊断价值。
Background A cerebrospinal fluid (CSF)-mask algorithm has been developed to reduce the adverse influence of CSF-low-counts on the diagnostic utility of the specific binding ratio (SBR) index calculated with Southampton method. We assessed the effect of the CSF-mask algorithm on the diagnostic performance of the SBR index for parkinsonian syndromes (PS), including Parkinson's disease, and the influence of cerebral ventricle dilatation on the CSF-mask algorithm. Methods We enrolled 163 and 158 patients with and without PS, respectively. Both the conventional SBR (non-CSF-mask) and SBR corrected with the CSF-mask algorithm (CSF-mask) were calculated from I-123-Ioflupane single-photon emission computed tomography (SPECT) images of these patients. We compared the diagnostic performance of the corresponding indices and evaluated whether the effect of the CSF-mask algorithm varied according to the extent of ventricle dilatation, as assessed with the Evans index (EI). A receiver-operating characteristics (ROC) analysis was used for statistical analyses. Results ROC analyses demonstrated that the CSF-mask algorithm performed better than the non-CSF-mask (no correction, area under the curve [AUC] = 0.917 [95% confidence interval (CI) 0.887-0.947] vs. 0.895 [95% CI 0.861-0.929], p < 0.001; attenuation correction, AUC = 0.930 [95% CI 0.902-0.957] vs. 0.903 [95% CI 0.870-0.936], p < 0.001). When not corrected for attenuation, no significant difference in the AUC was observed in the low EI group between the non-CSF-mask and CSF-mask algorithms (0.927 [95% CI 0.877-0.978] vs. 0.942 [95% CI 0.898-0.986], p = 0.11); in the middle and high EI groups, the CSF-mask algorithm performed better than the non-CSF-mask algorithm (middle EI group, AUC = 0.894 [95% CI 0.825-0.963] vs. 0.872 [95% CI 0.798-0.947], p < 0.05; high EI group, AUC = 0.931 [95% CI 0.883-0.978] vs. 0.900 [95% CI 0.840-0.961], p < 0.01). When corrected for attenuation, significant differences in the AUC were observed in all three EI groups (low EI group, AUC = 0.961 [95% CI 0.924-0.998] vs. 0.942 [95% CI 0.895-0.988], p < 0.05; middle EI group, AUC = 0.905 [95% CI 0.843-0.968] vs. 0.872 [95% CI 0.800-0.944], p < 0.005; high EI group, AUC = 0.954 [95% CI 0.917-0.991] vs. 0.917 [95% CI 0.862-0.973], p < 0.005). Conclusion The CSF-mask algorithm improved the performance of the SBR index in informing the diagnosis of PS, especially in cases with ventricle dilatation.