Assessing Amyloid Pathology in Cognitively Normal Subjects using [18F]Flutemetamol PET: Comparing Visual Reads and Quantitative Methods

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Abstract

Objective: Determine the optimal approach for assessing amyloid pathology in a cognitively normal elderly population. Methods: Dynamic [18F]flutemetamol PET scans acquired using a coffee-break protocol (0-30 and 90-110 min. scan) from 190 cognitively normal elderly (mean age 70.4 years, 60% female) were included. Parametric images were generated from standard uptake value ratio (SUVr) and non-displaceable binding potential (BPND) methods, with cerebellar grey matter as a reference region and were visually assessed by three trained readers. Inter-reader agreement was calculated using Kappa statistics and (semi-)quantitative values were obtained. Global cut-offs were calculated for both SUVr and BPND using a ROC analysis and the Youden Index. Visual assessment was related to (semi-)quantitative classifications. Results: Inter-reader agreement in visual assessment was moderate for SUVr (κ = 0.57) and good for BPND images (κ = 0.77). There was discordance between readers for 35 cases (18%) using SUVr and for 15 cases (8%) using BPND, with 9 overlapping cases. For the total cohort, the mean (±SD) SUVr and BPND values were 1.33 (± 0.21) and 0.16 (± 0.12), respectively. Most of the 35 cases (91%) where SUVr image assessment was discordant between readers, were classified as negative based on (semi-) quantitative measurements. Conclusion: The use of parametric BPND images for visual assessment of [18F]flutemetamol in a population with low amyloid burden improves inter-reader agreement. Implementing semi-quantification in addition to visual assessment of SUVr images can reduce false-positive classification in this population.

LanguageEnglish
Pages541-547
JournalJournal of nuclear medicine : official publication, Society of Nuclear Medicine
Volume60
Issue number4
DOIs
Publication statusPublished - 1 Apr 2019

Cite this

@article{170299d54e7e437e9b6e75fdce18a9a4,
title = "Assessing Amyloid Pathology in Cognitively Normal Subjects using [18F]Flutemetamol PET: Comparing Visual Reads and Quantitative Methods",
abstract = "Objective: Determine the optimal approach for assessing amyloid pathology in a cognitively normal elderly population. Methods: Dynamic [18F]flutemetamol PET scans acquired using a coffee-break protocol (0-30 and 90-110 min. scan) from 190 cognitively normal elderly (mean age 70.4 years, 60{\%} female) were included. Parametric images were generated from standard uptake value ratio (SUVr) and non-displaceable binding potential (BPND) methods, with cerebellar grey matter as a reference region and were visually assessed by three trained readers. Inter-reader agreement was calculated using Kappa statistics and (semi-)quantitative values were obtained. Global cut-offs were calculated for both SUVr and BPND using a ROC analysis and the Youden Index. Visual assessment was related to (semi-)quantitative classifications. Results: Inter-reader agreement in visual assessment was moderate for SUVr (κ = 0.57) and good for BPND images (κ = 0.77). There was discordance between readers for 35 cases (18{\%}) using SUVr and for 15 cases (8{\%}) using BPND, with 9 overlapping cases. For the total cohort, the mean (±SD) SUVr and BPND values were 1.33 (± 0.21) and 0.16 (± 0.12), respectively. Most of the 35 cases (91{\%}) where SUVr image assessment was discordant between readers, were classified as negative based on (semi-) quantitative measurements. Conclusion: The use of parametric BPND images for visual assessment of [18F]flutemetamol in a population with low amyloid burden improves inter-reader agreement. Implementing semi-quantification in addition to visual assessment of SUVr images can reduce false-positive classification in this population.",
author = "Lyduine Collij and Elles Konijnenberg and Juhan Reimand and {Ten Kate}, Mara and {Den Braber}, Anouk and {Lopes Alves}, Isadora and Marissa Zwan and Maqsood Yaqub and {Van Assema}, Dani{\"e}lle and Wink, {Alle Meije} and Adriaan Lammertsma and Philip Scheltens and Visser, {Pieter Jelle} and Frederik Barkhof and {Van Berckel}, Bart",
note = "Copyright {\circledC} 2018 by the Society of Nuclear Medicine and Molecular Imaging, Inc.",
year = "2019",
month = "4",
day = "1",
doi = "10.2967/jnumed.118.211532",
language = "English",
volume = "60",
pages = "541--547",
journal = "Journal of nuclear medicine : official publication, Society of Nuclear Medicine",
issn = "1535-5667",
number = "4",

}

TY - JOUR

T1 - Assessing Amyloid Pathology in Cognitively Normal Subjects using [18F]Flutemetamol PET

T2 - Journal of nuclear medicine : official publication, Society of Nuclear Medicine

AU - Collij, Lyduine

AU - Konijnenberg, Elles

AU - Reimand, Juhan

AU - Ten Kate, Mara

AU - Den Braber, Anouk

AU - Lopes Alves, Isadora

AU - Zwan, Marissa

AU - Yaqub, Maqsood

AU - Van Assema, Daniëlle

AU - Wink, Alle Meije

AU - Lammertsma, Adriaan

AU - Scheltens, Philip

AU - Visser, Pieter Jelle

AU - Barkhof, Frederik

AU - Van Berckel, Bart

N1 - Copyright © 2018 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objective: Determine the optimal approach for assessing amyloid pathology in a cognitively normal elderly population. Methods: Dynamic [18F]flutemetamol PET scans acquired using a coffee-break protocol (0-30 and 90-110 min. scan) from 190 cognitively normal elderly (mean age 70.4 years, 60% female) were included. Parametric images were generated from standard uptake value ratio (SUVr) and non-displaceable binding potential (BPND) methods, with cerebellar grey matter as a reference region and were visually assessed by three trained readers. Inter-reader agreement was calculated using Kappa statistics and (semi-)quantitative values were obtained. Global cut-offs were calculated for both SUVr and BPND using a ROC analysis and the Youden Index. Visual assessment was related to (semi-)quantitative classifications. Results: Inter-reader agreement in visual assessment was moderate for SUVr (κ = 0.57) and good for BPND images (κ = 0.77). There was discordance between readers for 35 cases (18%) using SUVr and for 15 cases (8%) using BPND, with 9 overlapping cases. For the total cohort, the mean (±SD) SUVr and BPND values were 1.33 (± 0.21) and 0.16 (± 0.12), respectively. Most of the 35 cases (91%) where SUVr image assessment was discordant between readers, were classified as negative based on (semi-) quantitative measurements. Conclusion: The use of parametric BPND images for visual assessment of [18F]flutemetamol in a population with low amyloid burden improves inter-reader agreement. Implementing semi-quantification in addition to visual assessment of SUVr images can reduce false-positive classification in this population.

AB - Objective: Determine the optimal approach for assessing amyloid pathology in a cognitively normal elderly population. Methods: Dynamic [18F]flutemetamol PET scans acquired using a coffee-break protocol (0-30 and 90-110 min. scan) from 190 cognitively normal elderly (mean age 70.4 years, 60% female) were included. Parametric images were generated from standard uptake value ratio (SUVr) and non-displaceable binding potential (BPND) methods, with cerebellar grey matter as a reference region and were visually assessed by three trained readers. Inter-reader agreement was calculated using Kappa statistics and (semi-)quantitative values were obtained. Global cut-offs were calculated for both SUVr and BPND using a ROC analysis and the Youden Index. Visual assessment was related to (semi-)quantitative classifications. Results: Inter-reader agreement in visual assessment was moderate for SUVr (κ = 0.57) and good for BPND images (κ = 0.77). There was discordance between readers for 35 cases (18%) using SUVr and for 15 cases (8%) using BPND, with 9 overlapping cases. For the total cohort, the mean (±SD) SUVr and BPND values were 1.33 (± 0.21) and 0.16 (± 0.12), respectively. Most of the 35 cases (91%) where SUVr image assessment was discordant between readers, were classified as negative based on (semi-) quantitative measurements. Conclusion: The use of parametric BPND images for visual assessment of [18F]flutemetamol in a population with low amyloid burden improves inter-reader agreement. Implementing semi-quantification in addition to visual assessment of SUVr images can reduce false-positive classification in this population.

U2 - 10.2967/jnumed.118.211532

DO - 10.2967/jnumed.118.211532

M3 - Article

VL - 60

SP - 541

EP - 547

JO - Journal of nuclear medicine : official publication, Society of Nuclear Medicine

JF - Journal of nuclear medicine : official publication, Society of Nuclear Medicine

SN - 1535-5667

IS - 4

ER -