title: A multi-institutional study of interobserver agreement in the evaluation of dementia with rCBF/SPET technetium-99m exametazime (HMPAO).
abstract: Although specific patterns of technetium-99m exametazime [99mTc-hexamethylpropylene amine oxime (HMPAO)] brain single-photon emission tomography (SPET) uptake have been described for patients with dementia, no multi-institutional study has evaluated interobserver agreement. Interobserver agreement for 99mTc-HMPAO brain SPET uptake patterns in 50 clinically diagnosed demented subjects from four institutions were studied. Neurologists classified these subjects as presumed Alzheimer's disease (n = 21), confirmed Alzheimer's disease (n = 10), multi-infarct dementia (n = 9), HIV-related dementia (n = 7), or "mixed" (n = 3). In addition 20 normal (five per institution) 99mTc-HMPAO studies were included in a randomized blinded evaluation by three readers each from a different institution. Readers classified the general appearance of the images in one of four categories: normal, globally decreased uptake, focal areas of decreased uptake, and patchy changes in uptake. Consensus results show a sensitivity of 72% and specificity of 79% for identifying abnormalities in scans of demented subjects. Readers also rated 99mTc-HMPAO uptake in eight designated regions in each hemisphere. Significant reader agreement (P < 0.01) for the classification by general appearance and the ratings of regional uptake was obtained. This study demonstrates that interpretation of regional cerebral blood flow/SPET images is concordant across multiple institutions and readers.
authors.affiliation: Department of Radiology, Medical College of Wisconsin, Milwaukee.
authors.forename: R S
authors.initials: RS
authors.lastname: Hellman
authors.forename: R S
authors.initials: RS
authors.lastname: Tikofsky
authors.forename: R
authors.initials: R
authors.lastname: Van Heertum
authors.forename: G
authors.initials: G
authors.lastname: Coade
authors.forename: R
authors.initials: R
authors.lastname: Carretta
authors.forename: R G
authors.initials: RG
authors.lastname: Hoffmann
mesh_terms: D015526:AIDS Dementia Complex / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001921:Brain / Q000000981:diagnostic imaging*; D015161:Dementia, Multi-Infarct / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D015588:Observer Variation; D015609:Organotechnetium Compounds; D010091:Oximes; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime