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Analysis of Clinical Brain SPECT Data Based on Anatomic Standardization and Reference to Normal Data: An ROC-Based Comparison of Visual, Semiquantitative, and Voxel-Based Methods

Koenraad J. Van Laere, MD, PhD, DrSc;1, James Warwick, MD;2, Jan Versijpt, MD;1, Ingeborg Goethals, MD;1, Kurt Audenaert, MD, PhD;3, Ben Van Heerden, MD, MSc;2 and Rudi Dierckx, MD, PhD1

1 Division of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
2 Department of Nuclear Medicine, Tygerberg Hospital, University of Stellenbosch, Matieland, South Africa
3 Department of Psychiatry, Ghent University Hospital, Ghent, Belgium



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  		FIGURE 1. Schematic study design. Each of 2 groups of well-defined patients was mixed with 5 studies from age- and sex-matched healthy volunteers. These were compared with reference studies from, respectively, 20 and 15 healthy volunteers using visual scoring system and 3 automated methods based on anatomic standardization: predefined VOI analysis, voxelwise analysis based on region growing (BRASS), and SPM (SPM99).

 


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  		FIGURE 2. Example of BRASS and SPM analysis for TBI (A) and cognitive impairment from AD (B). Cutoff for BRASS was taken at 3 SDs (minimal detection volume, 0.5 mL); for SPM, uncorrected probability value of 0.0005 was used for height (extent threshold = 18). SPM{Tx} indicates SPM t maps with x degrees of freedom.

 


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  		FIGURE 3. ROC curves for TBI group (A), cognitive impairment group (B), and total population (C). Curves represent visual scoring, predefined VOI analysis, voxel-based region growing (BRASS), and SPM (SPM99), both uncorrected (SPM_UC) and corrected for multiple comparisons (SPM_C).

 


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  		FIGURE 4. Agreement between regional analysis at cutoffs corresponding to 70% specificity and at least 70% sensitivity for visual (Vis) analysis, VOI analysis, BRASS, and SPM (uncorrected) in TBI group (A) and cognitive impairment group (B). CI = confidence interval.

 


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  		FIGURE 5. Between-methods agreement as function of VOI, irrespective of analysis method. Only left-sided volumes are indicated on x-axis; tick mark to right corresponds to contralateral VOI. LCB = left cerebellum; LCN = left caudate head; LFR = left frontal; LLT = left lateral temporal; LMT = left mesial temporal; LOC = left occipital; LPA = left parietal; LST = left striatum; LTH = left thalamus; PON = pons (unpaired).

 




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