Abstract
Purpose
To evaluate a fully automatic computer-assisted diagnostic system for mild dementia with Lewy bodies (DLB), permitting distinction from mild Alzheimer’s disease (AD).
Methods
Using 18F-fluorodeoxyglucose and positron emission tomography (FDG-PET), glucose metabolic images were obtained from mild DLB and mild AD patients. Two groups consisting of 16 mild DLB patients and 21 mild AD patients were recruited for diagnostic evaluation between mild DLB and mild AD. The mean age ± SD of the mild DLB group and the mild AD group was 74.3 ± 4.9 and 71.7 ± 2.1 years, respectively, and the mean scores of the MMSE for the mild DLB and the mild AD group were 21.7 ± 1.9 and 23.1 ± 2.1, respectively. A receiver operating characteristic (ROC) analysis was performed to compare the diagnostic performance, in terms of discrimination between DLB and AD, of conventional axial FDG-PET images inspected visually by experts and beginners with that of our fully automatic diagnosis system using the statistical brain mapping method and Z scores obtained with the DLB template.
Results
The diagnostic performance of the automatic system was comparable to that of visual inspection by experts. The area under the ROC curve for the automatic diagnosis system was 0.77. The mean area under the ROC curve for visual inspection by experts and beginners was 0.76 and 0.65, respectively.
Conclusion
The fully automatic differential diagnosis system for distinction between mild DLB and AD showed a similar diagnostic accuracy to visual inspection by experts. It would be a useful diagnostic tool to distinguish mild DLB from mild AD in clinical practice.
Similar content being viewed by others
References
Perry RH, Irving D, Blessed G, Perry EK, Fairbairn AF. Clinically and neuropathologically distinct form of dementia in the elderly. Lancet 1989;I:166.
Perry RH, Irving D, Tomlinson BE. Lewy body prevalence in the aging brain: relationship to neuropsychiatric disorders, Alzheimer-type pathology and catecholaminergic nuclei. J Neurol Sci 1990;100:223–33.
McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 1996;47:1113–24.
McKeith IG, Dickson DW, Lowe J, Emre M, O’Brien JT, Feldman H, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005;65:1863–72.
Ishii K, Kono AK, Sasaki H, Miyamoto N, Fukuda T, Sakamoto S, et al. Fully automatic diagnostic system for early- and late-onset mild Alzheimer’s disease using FDG PET and 3D-SSP. Eur J Nucl Med Mol Imaging 2006;33:575–83.
Minoshima S, Frey KA, Koeppe RA, Foster NL, Kuhl DE. A diagnostic approach in Alzheimer’s disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET. J Nucl Med 1995;36:1238–48.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–44.
Ishii K, Sasaki M, Kitagaki H, Yamaji S, Sakamoto S, Matsuda K, et al. Reduction of cerebellar glucose metabolism in advanced Alzheimer’s disease. J Nucl Med 1997;38:925–8.
Ishii K, Yamaji S, Mori E. Cerebellar metabolic reduction in Alzheimer’s disease and data normalization. J Nucl Med 1998;39:375–6.
Ishii K, Imamura T, Sasaki M, Yamaji S, Sakamoto S, Kitagaki H, et al. Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer’s disease. Neurology 1998;51:125–30.
Mega MS, Masterman DL, Benson DF, Vinters HV, Tomiyasu U, Craig AH, et al. Dementia with Lewy bodies: reliability and validity of clinical and pathologic criteria. Neurology 1996;47:1403–9.
Litvan I, MacIntyre A, Goetz CG, Wenning GK, Jellinger K, Verny M, et al. Accuracy of the clinical diagnoses of Lewy body disease, Parkinson disease, and dementia with Lewy bodies. A clinicopathologic study. Arch Neurol 1998;55:969–78.
Hohl U, Tiraboschi P, Hansen LA, Thal LJ, Corey-Bloom J. Diagnostic accuracy of dementia with Lewy bodies. Arch Neurol 2000;57:347–51.
Lopez OL, Becker JT, Kaufer DJ, Hamilton RL, Sweet RA, Klunk W, et al. Research evaluation and prospective diagnosis of dementia with Lewy bodies. Arch Neurol 2002;59:43–6.
McKeith IG, Ballard CG, Perry RH, Ince PG, O’Brien JT, Neill D, et al. Prospective validation of consensus criteria for the diagnosis of dementia with Lewy bodies. Neurology 2000;54:1050–8.
Middlekoop HA, van der Flier WM, Burton EJ, Lloyd AJ, Paling S, Barber R, et al. Dementia with Lewy bodies and AD are not associated with occipital lobe atrophy on MRI. Neurology 2001;57:2117–20.
Ishii K, Hosaka K, Mori T, Mori E. Comparison of FDG-PET and IMP-SPECT in patients with dementia with Lewy bodies. Ann Nucl Med 2004;18:447–51.
Albin RL, Minoshima S, Damato CJ, Fley KA, Kuhl DA, Sima AAF. Fluoro-deoxyglucose positron emission tomography in diffuse Lewy body disease. Neurology 1996;47:462–6.
Minoshima S, Foster NL, Sima AAF, Frey KA, Albin RL, Kuhl DE. Alzheimer’s disease versus dementia with Lewy bodies: cerebral metabolic distinction with autopsy confirmation. Ann Neurol 2001;50:358–65.
Lobotesis K, Fenwick JD, Phipps A, Ryman A, Swann A, Ballard C, et al. Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology 2001;56:643–9.
Hansen L, Salmon D, Galasko D, Masliah E, Katzman R, De Teresa R, et al. The Lewy body variant of Alzheimer’s disease: a pathological and clinical entity. Neurology 1990;40:1–8.
Gerlach M, Stadler K, Aichner F, Ransmayr G. Dementia with Lewy bodies and AD are not associated with occipital lobe atrophy on MRI. Neurology 2002;59:1476.
Ishii K, Willoch F, Minoshima S, Drzezga A, Ficaro EP, Cross DJ, et al. Statistical brain mapping of 18F-FDG PET in Alzheimer’s disease: validation of anatomic standardization for atrophied brains. J Nucl Med 2001;42:548–57.
Marshall V, Grosset D. Role of dopamine transporter imaging in routine clinical practice. Mov Disord 2003;18:1415–23.
Vaamonde-Gamo J, Flores-Barrangan JM, Ibanez R, Gudin M, Hernandez A. DaT-SCAN SPECT in the differential diagnosis of dementia with Lewy bodies and Alzheimer’s disease. Rev Neurol 2005;41:276–9.
Colloby SJ, O’Brien JT, Fenwick JD, Firbank ML, Burn DJ, McKeith IG, et al. The application of statistical parametric mapping to 123I-FP-CIT SPECT in dementia with Lewy bodies, Alzheimer’s disease and Parkinson’s disease. Neuroimage 2004;23:956–66.
Hu XS, Okamura N, Arai H, Higuchi M, Matsui T, Tashiro M, et al. 18F-fluorodopa PET study of striatal dopamine uptake in the diagnosis of dementia with Lewy bodies. Neurology 2000;55:1575–7.
Acknowledgements
The authors thank Mr. Shuya Miki (Nihon Medi-Physics, Nishinomiya, Hyogo, Japan) for providing and improving the iSSP program which uses the 3D-SSP program and was dedicated to this automatic method.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kono, A.K., Ishii, K., Sofue, K. et al. Fully automatic differential diagnosis system for dementia with Lewy bodies and Alzheimer’s disease using FDG-PET and 3D-SSP. Eur J Nucl Med Mol Imaging 34, 1490–1497 (2007). https://doi.org/10.1007/s00259-007-0380-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-007-0380-y