Head-to-Head Visual Comparison between Brain Perfusion SPECT and Arterial Spin-Labeling MRI with Different Postlabeling Delays in Alzheimer Disease

T. Kaneta; O. Katsuse; T. Hirano; M. Ogawa; K. Yoshida; T. Odawara; Y. Hirayasu; T. Inoue

doi:10.3174/ajnr.A5238

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Fig 1.
The regions used for scoring brain images. We evaluated 22 regions located at the levels of the vertex, lateral ventricle, basal ganglia, and cerebellum. The raters scored each region with a 4-point scale, where 0 is a normal CBF, 1 is a mild decrease, 2 is a moderate decease, and 3 is a severe decrease.
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Fig 2.
The comparisons of the total scores of the 2 raters for PLD_1.5, PLD_2.5, and SPECT images. The Friedman analysis of variance showed a significant difference among all 3 groups (P < .01), and the Wilcoxon test showed a significant difference between the 2 raters for the PLD_1.5, PLD_2.5, and SPECT total scores (P < .01).
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Fig 3.
An 86-year-old woman with AD. The patient had an MMSE score of 14. Axial images of T2-weighted MR imaging (A), ASL-MR imaging with PLD_1.5 in a color-scale fused with T1-weighted MR imaging (B), ASL-MR imaging with PLD_2.5 in a color-scale fused with T1-weighted MR imaging (C), and brain perfusion SPECT at the level of the parietal lobe, corona radiata, basal ganglia, and cerebellum (D). Both raters indicated a score of 4 (definitely AD) for PLD_1.5 and SPECT and 1 (probably not AD) for PLD_2.5.
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Fig 4.
An 83-year-old woman with AD. The patient had an MMSE score of 19. Axial images of T2-weighted MR imaging (A), fused T1-weighted and PLD_1.5 ASL-MR imaging (B), fused T1-weighted and PLD_2.5 ASL-MR imaging (C), and brain perfusion SPECT (D). Both raters indicated a score of 4 for PLD_1.5 and 2 (undetermined) for PLD_2.5. One rater indicated a score of 3 (probably AD) and another rater indicated a score of 4 for SPECT.
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Fig 5.
A 73-year-old woman with MCI. The patient had an MMSE score of 23. Axial images of T2-weighted MR imaging (A), fused T1-weighted and PLD_1.5 ASL-MR imaging (B), fused T1-weighted and PLD_2.5 ASL-MR imaging (C), and brain perfusion SPECT (D). Both raters scored 4 for PLD_1.5. However, 1 rater indicated a score of 1 (probably not AD) for PLD_2.5 and 2 for SPECT, while another rater indicated a score of 0 (definitely not AD) for PLD_2.5, and 1 for SPECT.

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Table 1:
Demographic and neuropsychological summary of the participants^{^a}
AD MCI due to AD
Age (yr) 77.1 (7.7) 78.2 (5.6)
No. of patients 14 19
Sex (M/F) 3:11 8:11
MMSE score 16.9 (3.0)^{^b} 25.2 (2.6)^{^b}
↵a Data are presented as mean (±SD).
↵b There was a significant difference in the MMSE score (P < .01) between AD and patients with AD-induced MCI.

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Table 2:

The results of visual assessments for the diagnosis of AD

	Overall Positive Rate (%)			Positive Rate in AD (%)			Positive Rate in MCI (%)
	PLD_1.5	PLD_2.5	SPECT	PLD_1.5	PLD_2.5	SPECT	PLD_1.5	PLD_2.5	SPECT
Rater 1	87.9	9.1	69.7	92.9	14.3	92.9	84.2	28.6	52.6
Rater 2	97.0	12.1	90.1	100	28.6	92.9	94.7	0	89.5
Agreement	84.8	3.0	66.7	92.9	7.1	85.7	84.2	0	52.6

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Table 3:
Interrater agreement
κ Statistic
5-Point Scoring Positive or Negative for AD Diagnosis
PLD_1.5 0.033 0.3694
PLD_2.5 0.141 0.203
SPECT 0.010 0.195