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European Journal of Nuclear Medicine and Molecular Imaging

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06.12.2022 | Original Article

Different z-score cut-offs for striatal binding ratio (SBR) of DaT SPECT are needed to support the diagnosis of Parkinson’s Disease (PD) and dementia with Lewy bodies (DLB)

verfasst von: Francesco Lanfranchi, Dario Arnaldi, Alberto Miceli, Pietro Mattioli, Francesca D’Amico, Stefano Raffa, Maria Isabella Donegani, Silvia Chiola, Federico Massa, Matteo Pardini, Tania Di Raimondo, Gianmario Sambuceti, Matteo Bauckneht, Flavio Nobili, Silvia Morbelli

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 4/2023

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Abstract

Purpose

A cut-off of -2 z-score for striatal or putaminal SBR has been to date arbitrarily used to define an abnormal DaT SPECT in patients with suspected neurodegenerative parkinsonism. We aimed to experimentally identify the most accurate z-score cut-offs for SBR of striatal and substriatal regions to independently discriminate PD and DLB, with respect to essential tremor (ET) and Alzheimer’s disease (AD) respectively.

Methods

Two-hundred twenty-five patients undergoing DaT SPECT were enrolled (seventy-five de novo PD, eighty ET, fifty DLB, and twenty AD). Semiquantification was computed by means of Datquant® software which returns measures of striatal SBR and z-scores with respect to 118 healthy volunteers belonging to the Parkinson’s Progression Markers Initiative (PPMI). ROC analysis was used to identify most accurate cut-offs for z-score for striatum and substriatal regions (clinical diagnosis at follow-up as gold standard).

Results

Posterior putamen of the most affected hemisphere (MAH) with a z-score cut-off of − 1.27 demonstrated the highest accuracy to differentiate between PD and ET (sensitivity 0.97, specificity 0.94). The whole putamen (z-score cut-off − 0.96) was the most accurate parameter to support the diagnosis of DLB (sensitivity 0.74, specificity 0.95). Putamen to caudate ratio was accurate to detect PD (especially in early stages) while not DLB patients.

Conclusion

We experimentally demonstrated that different substriatal regions and cut-offs for z-score of SBR should be considered to support the diagnosis of either PD or DLB. The identified less conservative cut-offs showed higher sensitivity without a measurable reduction in specificity with respect to the arbitrary − 2 z-score.

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Titel: Different z-score cut-offs for striatal binding ratio (SBR) of DaT SPECT are needed to support the diagnosis of Parkinson’s Disease (PD) and dementia with Lewy bodies (DLB)
verfasst von: Francesco Lanfranchi
Dario Arnaldi
Alberto Miceli
Pietro Mattioli
Francesca D’Amico
Stefano Raffa
Maria Isabella Donegani
Silvia Chiola
Federico Massa
Matteo Pardini
Tania Di Raimondo
Gianmario Sambuceti
Matteo Bauckneht
Flavio Nobili
Silvia Morbelli
Publikationsdatum: 06.12.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 4/2023
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-022-06069-0

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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