Prediction of outcomes in MCI with 123I-IMP-CBF SPECT: a multicenter prospective cohort study

Medientyp: E-Artikel
Titel: Prediction of outcomes in MCI with 123I-IMP-CBF SPECT: a multicenter prospective cohort study
Beteiligte: Ito, Kengo; Mori, Etsuro; Fukuyama, Hidenao; Ishii, Kazunari; Washimi, Yukihiko; Asada, Takashi; Mori, Satoru; Meguro, Kenichi; Kitamura, Shin; Hanyu, Haruo; Nakano, Seigo; Matsuda, Hiroshi; Kuwabara, Yasuo; Hashikawa, Kazuo; Momose, Toshimitsu; Uchida, Yoshitaka; Hatazawa, Jun; Minoshima, Satoshi; Kosaka, Kenji; Yamada, Tatsuo; Yonekura, Yoshiharu
Erschienen: Springer Science and Business Media LLC, 2013
Erschienen in: Annals of Nuclear Medicine
Sprache: Englisch
DOI: 10.1007/s12149-013-0768-7
ISSN: 0914-7187; 1864-6433
Schlagwörter: Radiology, Nuclear Medicine and imaging ; General Medicine
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Beschreibung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The multicenter prospective cohort study (Japan Cooperative SPECT Study on Assessment of Mild Impairment of Cognitive Function: J-COSMIC) aimed to examine the value of <jats:sup>123</jats:sup>I-<jats:italic>N</jats:italic>-isopropyl-4-iodoamphetamine cerebral blood flow (IMP-CBF) SPECT in regards to early diagnosis of Alzheimer’s disease (AD) in patients with mild cognitive impairment (MCI).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Three hundred and nineteen patients with amnestic MCI at 41 participating institutions each underwent clinical and neuropsychological examinations and <jats:sup>123</jats:sup>I-IMP-CBF SPECT at baseline. Subjects were followed up periodically for 3 years, and progression to dementia was evaluated. SPECT images were classified as AD/DLB (dementia with Lewy bodies) pattern and non-AD/DLB pattern by central image interpretation and automated region of interest (ROI) analysis, respectively. Logistic regression analyses were used to assess whether baseline <jats:sup>123</jats:sup>I-IMP-CBF SPECT was predictive of longitudinal clinical outcome.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Ninety-nine of 216 amnestic MCI patients (excluding 3 cases with epilepsy (<jats:italic>n</jats:italic> = 2) or hydrocephalus (<jats:italic>n</jats:italic> = 1) and 100 cases with incomplete follow-up) converted to AD within the observation period. Central image interpretation and automated ROI analysis predicted conversion to AD with 56 and 58 % overall diagnostic accuracy (sensitivity, 76 and 81 %; specificity, 39 and 37 %), respectively. Multivariate logistic regression analysis identified SPECT as a predictor, which distinguished AD converters from non-converters. The odds ratio for a positive SPECT to predict conversion to AD with automated ROI analysis was 2.5 and combining SPECT data with gender and mini-mental state examination (MMSE) further improved classification (joint odds ratio 20.08).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p> <jats:sup>123</jats:sup>I-IMP-CBF SPECT with both automated ROI analysis and central image interpretation was sensitive but relatively nonspecific for prediction of clinical outcome during the 3-year follow-up in individual amnestic MCI patients. A combination of statistically significant predictors, both SPECT with automated ROI analysis and neuropsychological evaluation, may increase predictive utility.</jats:p> </jats:sec>

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