RT Journal Article
SR Electronic
T1 The 18F-FDG PET Cingulate Island Sign and Comparison to 123I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1638
OP 1645
DO 10.2967/jnumed.109.065870
VO 50
IS 10
A1 Seok Ming Lim
A1 Andrew Katsifis
A1 Victor L. Villemagne
A1 Rene Best
A1 Gareth Jones
A1 Michael Saling
A1 Jennifer Bradshaw
A1 John Merory
A1 Michael Woodward
A1 Malcolm Hopwood
A1 Christopher C. Rowe
YR 2009
UL http://jnm.snmjournals.org/content/50/10/1638.abstract
AB Neuroimaging is increasingly used to supplement the clinical diagnosis of dementia with Lewy bodies (DLB) by showing reduced occipital metabolism and perfusion and reduced striatal dopaminergic innervation. We aimed to optimize the interpretation of 18F-FDG PET images for differentiating DLB from Alzheimer disease (AD) and to compare the results with dopamine transporter imaging using 123I-β-carbomethoxy-3ß-(4-iodophenyl)tropane (123I-β-CIT) SPECT. Methods: Fourteen subjects with a clinical diagnosis of DLB and 10 with AD underwent both 18F-FDG PET and 123I-β-CIT SPECT. Four DLB and 1 AD diagnoses were subsequently confirmed at autopsy. Diagnostic accuracy was calculated for visual interpretation by 3 readers of standard 3-plane and stereotactic surface projection 18F-FDG PET images, receiver-operating-characteristic analysis of regional 18F-FDG uptake, and a cutoff value for the striatal-to-occipital binding ratio of β-CIT defined by receiver-operating-characteristic analysis. Results: Visual interpretation of 3-plane 18F-FDG PET images had a sensitivity of 83% and specificity of 93% for DLB, slightly higher than the results with the stereotactic surface projection images. Regionally, hypometabolism in the lateral occipital cortex had the highest sensitivity (88%), but relative preservation of the mid or posterior cingulate gyrus (cingulate island sign) had the highest specificity (100%). Region-of-interest analysis revealed that occipital hypometabolism and relative preservation of the posterior cingulate both had a sensitivity of 77% and specificity of 80%. β-CIT achieved 100% accuracy and greater effect size than did 18F-FDG PET (Cohen d = 4.1 vs. 1.9). Conclusion: Both 18F-FDG PET and 123I-β-CIT SPECT appear useful for the diagnosis of DLB, although the latter provides more robust results. The cingulate island sign may enhance the specificity of 18F-FDG PET.