Confirmation of 123I-FP-CIT SPECT Quantification Methods in Dementia with Lewy Bodies and Other Neurodegenerative Disorders

Daniela D. Maltais; Lennon G. Jordan; Hoon-Ki Min; Toji Miyagawa; Scott A. Przybelski; Timothy G. Lesnick; Robert R. Reichard; Dennis W. Dickson; Melissa E. Murray; Kejal Kantarci; Bradley F. Boeve; Val J. Lowe

doi:10.2967/jnumed.119.239418

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FIGURE 1.
Diagnostic accuracy using AUC of SBR and z scores for various ROIs as calculated by MIM, by DaTQUANT, and manually to differentiate between no LBD and LBD.
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FIGURE 2.
Correlations between programs using minimum caudate, minimum putamen, and minimum striatum SBRs (A) and z scores (B). ICC = intraclass correlation coefficient.
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FIGURE 3.
Box-and-whisker plots showing distribution of z scores and SBRs for minimum striatum, minimum caudate, and minimum putamen among LBD, mixed LBD and AD, and no-LBD neuropathologic diagnoses. *0.001 < P < 0.05. **P < 0.001.
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FIGURE 4.
Six patients who underwent ¹²³I-FP-CIT SPECT and then neuropathologic examination. Clinical diagnoses before death and pathologic diagnosis are presented alongside each set of MRI coregistered images.

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TABLE 1

Clinical Data, Minimum SBRs, Minimum z Scores, and Antemortem and Postmortem Diagnoses for the 6 Patients Who Underwent ¹²³I-FP-CIT SPECT and Then Neuropathologic Examination

			SBR
			DQ		MIM		Manual
Patient no.	Age at scan (y)	Time between last scan and death (y)	Striatum	Caudate	Striatum	Caudate	Striatum	Caudate	DAT visual interpretation	Clinical diagnosis before death	UPDRS	MMSE	CDR sum of boxes
1	75	2.23	0.09 (−4.72)	0.08 (−4.47)	0.27 (−3.70)	0.3 (−4.00)	.17	1.17	Abnormal	ADem	7	N/A	13
2	55	2.06	2.56 (1.46)	2.74 (1.18)	2.77 (0.70)	2.7 (0.10)	2.07	3.08	Normal	ADem + pDLB	5	15	3.5
3	63	2.85	2.09 (0.47)	2.10 (−0.10)	1.98 (−0.70)	2.05 (−1.00)	1.79	2.83	Normal	ADem	0	6	9
4	59	2.93	1.87 (−0.37)	2.21 (−0.05)	2.14 (−0.40)	2.37 (−0.30)	2.21	3.32	Normal	ADem	0	14	6
5	74	4.65	1.80 (0.09)	2.07 (0.20)	1.9 (−0.70)	1.89 (−1.00)	1.92	3.02	Normal	ADem (lpvPPA)	0	20	2
6	77	1.05	1.17 (−1.86)	1.64 (−0.71)	1.99 (−0.50)	2.19 (−0.50)	1.18	2.45	Abnormal	pDLB	11	21	6

DQ = DaTQUANT; DAT = ¹²³I-FP-CIT SPECT; UPDRS = Unified Parkinson Disease Rating Scale; MMSE = Mini-Mental State Examination; CDR = Clinical Dementia Rating Staging Instrument; lpvPPA = logopenic variant primary progressive aphasia.
Data in parentheses are z scores.

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TABLE 2

Clinical and Neuropathologic Data for the 6 Patients Who Underwent ¹²³I-FP-CIT SPECT and Then Neuropathologic Examination

Patient no.	Pathologic diagnosis	Age at death	Sex	Braak stage	NIA-AA	cDLB-4	Midbrain Lewy body involvement
1	Diffuse LBD/AD	78	F	Vl	High	Intermediate	Severe to very severe
2	AD	57	M	Vl	High	None	None
3	Diffuse LBD	66	F	Vl	Intermediate	Intermediate	Mild
4	AD	62	M	V	Intermediate	None	None
5	AD with ALB	78	M	Vl	High	Low	None
6	Diffuse LBD/PA/VD	81	M	ll	Low	High	Severe to very severe

NIA-AA = National Institute on Aging and Alzheimer Disease guidelines; cDLB-4 = Fourth Consortium on Dementia with Lewy Bodies; ALB = amygdala-restricted Lewy bodies; PA = pathologic aging; VD = vascular dementia.