Value of semiquantitative analysis for clinical reporting of 123I-2-?-carbomethoxy-3?-(4-iodophenyl)-N-(3-fluoropropyl) nortropane SPECT studies

Clinical 123I-2-b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl)
nortropane (123I-FP-CIT) SPECT studies are commonly
performed and reported using visual evaluation of tracer binding,
an inherently subjective method. Increased objectivity
can potentially be obtained using semiquantitative analysis. In
this study, we assessed whether semiquantitative analysis of
123I-FP-CIT tracer binding created more reproducible clinical
reporting. A secondary aim was to determine in what form semiquantitative
data should be provided to the reporter. Methods:
Fifty-four patients referred for the assessment of nigrostriatal
dopaminergic degeneration were scanned using SPECT/CT,
followed by semiquantitative analysis calculating striatal binding
ratios (SBRs) and caudate-to-putamen ratios (CPRs). Normal
reference values were obtained using 131 healthy controls enrolled
on a multicenter initiative backed by the European Association
of Nuclear Medicine. A purely quantitative evaluation
was first performed, with each striatum scored as normal or
abnormal according to reference values. Three experienced nuclear
medicine physicians then scored each striatum as normal
or abnormal, also indicating cases perceived as difficult, using
visual evaluation, visual evaluation in combination with SBR
data, and visual evaluation in combination with SBR and CPR
data. Intra- and interobserver agreement and agreement between
observers and the purely quantitative evaluation were
assessed using k-statistics. The agreement between scan interpretation
and clinical diagnosis was assessed for patients
with a postscan clinical diagnosis available (n 5 35). Results:
The physicians showed consistent reporting, with a good intraobserver
agreement obtained for the visual interpretation (mean
k 6 SD, 0.95 6 0.029). Although visual interpretation of tracer
binding gave good interobserver agreement (0.80 6 0.045), this
was improved as SBRs (0.86 6 0.070) and CPRs (0.95 6 0.040)
were provided. The number of striata perceived as difficult to
interpret decreased as semiquantitative data were provided (30
for the visual interpretation; 0 as SBR and CPR values were
given). The agreement between physicians' interpretations
and the purely quantitative evaluation showed that readers
used the semiquantitative data to different extents, with a more
experienced reader relying less on the semiquantitative data.
Good agreement between scan interpretation and clinical diagnosis
was seen. Conclusion: A combined approach of visual
assessment and semiquantitative analysis of tracer binding created
more reproducible clinical reporting of 123I-FP-CIT SPECT
studies. Physicians should have access to both SBR and CPR
data to minimize interobserver variability.

Publication type: 
Author or Creator: 
Söderlund, Therese A.
Dickson, John Caddell
Prvulovich, Elizabeth M.
Ben-Haim, Simona A.
Kemp, Paul M.
Booij, Jan
Nobili, Flavio Mariano
Thomsen, Gerda
Sabri, Osama
Koulibaly, Pierre Malik
Akdemir, Özgür Ümit
Pagani, Marco
Van Laere, Koen Van R
Asenbaum-Nan, Susanne
George, Jean Claude
Séra, Teréz
Tatsch, Klaus
Bomanji, Jamshed B.
Society of Nuclear Medicine., [New York], Stati Uniti d'America
The Journal of nuclear medicine (1978) 54 (2013): 714–722. doi:10.2967/jnumed.112.110106
info:cnr-pdr/source/autori:Söderlund, Therese A.; Dickson, John Caddell; Prvulovich, Elizabeth M.; Ben-Haim, Simona A.; Kemp, Paul M.; Booij, Jan; Nobili, Flavio Mariano; Thomsen, Gerda; Sabri, Osama; Koulibaly, Pierre Malik; Akdemir, Özgür Ümit; Pagani,
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