A comparison of Tc-99m-exametazime and I-123-FP-CIT SPECT imaging in the differential diagnosis of Alzheimer's disease and dementia with Lewy bodies

  1. Lookup NU author(s)
  2. Dr Sean Colloby
  3. Dr Michael Firbank
  4. Dr Sanjeet Pakrasi
  5. Dr James Lloyd
  6. Dr Ian Driver
  7. Professor Ian McKeith
  8. Professor David Williams
  9. Professor John O'Brien
Author(s)Colloby SJ, Firbank MJ, Pakrasi SE, Lloyd JJ, Driver I, McKeith IG, Williams ED, O'Brien JT
Publication type Article
JournalInternational Psychogeriatrics
ISSN (print)1041-6102
ISSN (electronic)1741-203X
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Background: The aim of this study is to investigate the diagnostic value of perfusion Tc-99m-exametazime single photon emission computed tomography (SPECT) in the diagnosis of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) in comparison with dopaminergic I-123-2 beta-carbomethoxy-3 beta-(4-iodophenyl)-n-(3-fluoropropyl) nortropane (FP-CIT) SPECT imaging. Methods: Subjects underwent Tc-99m-exametazime scanning (39 controls, 36 AD, 30 DLB) and I-123-FP-CIT scanning (33 controls, 33 AD, 28 DLB). For each scan, five raters performed visual assessments blind to clinical diagnosis on selected transverse (99)mTc-exametazime images in standard stereotactic space. Diagnostic accuracy of Tc-99m-exametazime was compared to I-123-FP-CIT results for the clinically relevant subgroups AD and DLB using receiver operating characteristic (ROC) curve analysis. Results: Inter-rater agreement for categorizing uptake was "moderate" (mean kappa = 0.53) for Tc-99m-exametazime and "excellent" (mean kappa = 0.88) for I-123-FP-CIT For AD and DLB, consensus rating matched clinical diagnosis in 56% of cases using Tc-99m-exametazime and 84% using I-123-FP-CIT In distinguishing AD from DLB, ROC analysis revealed superior diagnostic accuracy with I-123- FP-CIT (ROC curve area 0.83, sensitivity 78.6%, specificity 87.9%) compared to occipital Tc-99m-exametazime (ROC curve area 0.64, sensitivity 64.3%, specificity 63.6%) p = 0.03. Conclusion: Diagnostic accuracy was superior with I-123-FP-CIT compared to Tc-99m-exametazime in the differentiation of DLB from AD.
PublisherCambridge University Press
NotesTimes Cited: 0
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