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Superiority of 3-Dimensional Stereotactic Surface Projection Analysis over Visual Inspection in Discrimination of Patients with Very Early Alzheimer’s Disease from Controls Using Brain Perfusion SPECT

¹ Department of Radiology, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan
² Department of Radiology, Yokohama City University School of Medicine, Yokohama, Japan
³ Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
⁴ Department of Geriatric Medicine, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan

View larger version (24K): [in a new window]   FIGURE 1. Decrease of rCBF adjusted to global mean cerebral blood flow, shown by group analysis of 3D-SSP in patients with early AD at baseline study (top row) and follow-up study (bottom row) compared with healthy volunteers (P < 0.05, with multiple comparisons). Rt. = right; Lt. = left.

View larger version (14K): [in a new window]   FIGURE 2. ROIs drawn over areas with significant decrease of rCBF in early AD. ROIs were classified into 5 specific areas as follows (numbers with open parentheses denote numbers of pixels included in ROIs): (1) posterior cingulate gyri and precunei: PCG&PC (r = 321 pixels, l = 280 pixels); (2) lower and medial temporal areas: MT (medial temporal areas) (r = 82 pixels, l = 79 pixels), BMT (basal medial temporal area) (r = 60 pixels, l = 112 pixels), and BTl (lateral basal temporal area) (r = 54 pixels, l = 74 pixels); (3) parietal association cortex: PAl (lateral parietal association cortex) (r = 279 pixels, l = 174 pixels), PAp (posterior parietal association cortex) (r = 320 pixels, l = 439 pixels), and Pas (superior parietal association cortex) (r = 543 pixels, l = 496 pixels); (4) temporal association cortex: TAl (lateral temporal association cortex) (r = 172 pixels, l = 367 pixels), TAp (posterior temporal association cortex) (r = 223 pixels, l = 241 pixels); (5) anterior cingulate gyri: ACG (r = 188 pixels, l = 256 pixels).

View larger version (12K): [in a new window]   FIGURE 3. Intraobserver reliability between 1st and 2nd trials. , Spearman for individual observer. PCG&PC = posterior cingulate gyri and precunei; PA = parietal association cortex; MT = lower and medial temporal areas; TA = temporal association cortex; ACG = anterior cingulate gyri.

View larger version (14K): [in a new window]   FIGURE 4. ROC curves obtained from 3D-SSP with global mean normalization when thresholding at highest value among averaged positive Z scores for ROIs belonging to posterior cingulate gyri and precunei and ROC curves for discrimination of AD patients and control subjects obtained from most excellent and poorest observers for either first or second reading. (A) Baseline study. (B) Follow-up study.

View larger version (15K): [in a new window]   FIGURE 5. Comparison of Az between observers’ first visual inspection and 3D-SSP with global mean normalization. , Az for individual observer; , Az for 3D-SSP. (A) Baseline study. (B) Follow-up study. PCG&PC = posterior cingulate gyri and precunei; PA = parietal association cortex; MT = lower and medial temporal areas; TA = temporal association cortex; ACG = anterior cingulate gyri. *Az of visual inspection is lower than Az by 3D-SSP analysis (P < 0.05). Statistical significance between Az values was calculated using ROCKIT program (18).