Diagnostic Performance of the Visual Reading of 123I-Ioflupane SPECT Images With or Without Quantification in Patients With Movement Disorders or Dementia
Diagnostic Performance of the Visual Reading of 123I-Ioflupane SPECT Images With or Without Quantification in Patients With Movement Disorders or Dementia
复制标题
DOI：
10.2967/jnumed.116.189266
复制
发表时间：
2017-11-01
影响因子：
9.3
通讯作者：
Kuo, Phillip H.
中科院分区：
文献类型：
--
作者：
Booij, Jan;Dubroff, Jacob;Kuo, Phillip H.
i -123-碘氟烷SPECT图像的视觉解释在区分帕金森综合征（PS）与特发性震颤和可能的痴呆与路易体（DLB）与阿尔茨海默病方面具有很高的诊断准确性。在这项研究中，我们调查了与单独的视觉解释相比，增加图像量化对准确性和读者信心的影响。方法：我们收集了来自3个试验的304张i -123碘氟烷图像，这些试验包括临床诊断为PS、非PS（主要是特发性震颤）、可能的DLB和非DLB（主要是阿尔茨海默病）的受试者。在纹状体结合率根据正常数据库量化之前，用标准化参数重建图像。5名核医学医生对图像进行了评估，他们之前对i -123-碘氟烷的解读经验有限。在至少相隔1个月的两次阅读中，读者要么单独进行视觉解读，要么进行组合解读（即视觉加定量数据）。读者被要求评估他们对图像解读的信心，并判断扫描的阅读难易程度。通过测量一致性的阳性百分比（相当于敏感性）和一致性的阴性百分比（相当于特异性），将图像结果与真实标准（即随访诊断）进行比较，评估诊断准确性。我们检验了组合阅读的结果不逊于视觉阅读分析的结果的假设。结果：联合阅读与目视阅读的比较显示，平均阴性一致百分比（89.9%对87.9%）和等效阳性一致百分比（80.2%对80.1%）的增加很小，但不显著。最初进行联合分析的读者具有更高的准确性（85.8% vs. 79.2%; P = 0.018），其准确性接近原始研究中的专家读者（范围，83.3%-87.2%）。当使用联合分析时，平均读者对图像解释的信心显着提高（P < 0.0001）。结论：定量的增加使得在123i -碘氟烷SPECT扫描解释方面经验有限的读者具有与初始研究中经验丰富的读者相当的诊断准确性。此外，组合阅读的结果并不逊于视觉阅读分析的结果，并增加了读者的信心。
Visual interpretation of I-123-ioflupane SPECT images has high diagnostic accuracy for differentiating parkinsonian syndromes (PS), from essential tremor and probable dementia with Lewy bodies (DLB) from Alzheimer disease. In this study, we investigated the impact on accuracy and reader confidence offered by the addition of image quantification in comparison with visual interpretation alone. Methods: We collected 304 I-123-ioflupane images from 3 trials that included subjects with a clinical diagnosis of PS, non-PS (mainly essential tremor), probable DLB, and non-DLB (mainly Alzheimer disease). Images were reconstructed with standardized parameters before striatal binding ratios were quantified against a normal database. Images were assessed by 5 nuclear medicine physicians who had limited prior experience with I-123-ioflupane interpretation. In 2 readings at least 1 mo apart, readers performed either a visual interpretation alone or a combined reading (i.e., visual plus quantitative data were available). Readers were asked to rate their confidence of image interpretation and judge scans as easy or difficult to read. Diagnostic accuracy was assessed by comparing image results with the standard of truth (i.e., diagnosis at follow-up) by measuring the positive percentage of agreement (equivalent to sensitivity) and the negative percentage of agreement (equivalent to specificity). The hypothesis that the results of the combined reading were not inferior to the results of the visual reading analysis was tested. Results: A comparison of the combined reading and the visual reading revealed a small, insignificant increase in the mean negative percentage of agreement (89.9% vs. 87.9%) and equivalent positive percentages of agreement (80.2% vs. 80.1%). Readers who initially performed a combined analysis had significantly greater accuracy (85.8% vs. 79.2%; P = 0.018), and their accuracy was close to that of the expert readers in the original studies (range, 83.3%-87.2%). Mean reader confidence in the interpretation of images showed a significant improvement when combined analysis was used (P < 0.0001). Conclusion: The addition of quantification allowed readers with limited experience in the interpretation of 123I-ioflupane SPECT scans to have diagnostic accuracy equivalent to that of the experienced readers in the initial studies. Also, the results of the combined reading were not inferior to the results of the visual reading analysis and offered an increase in reader confidence.