title: Diagnosis of Alzheimer's disease using brain perfusion SPECT and MR imaging: which modality achieves better diagnostic accuracy?
abstract: OBJECTIVE
  The purpose of this study was to compare the accuracy of MR imaging and brain perfusion single-photon emission tomography (SPECT) in diagnosing Alzheimer's disease (AD).
  
  
  METHODS
  The transaxial section display of brain perfusion SPECT, three-dimensional stereotactic surface projection (3D-SSP) SPECT image sets, thin-section MR imaging of the hippocampus and perfusion MR imaging were evaluated in 66 subjects comprising 35 AD patients and 31 subjects without AD. SPECT and MR imaging were visually interpreted by two experts and two novices, and the diagnostic ability of each modality was evaluated by receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  In the experts' interpretations, there was no significant difference in the area under the ROC curve (Az) between 3D-SSP and thin-section MR imaging, whereas the Az of transaxial SPECT display was significantly lower than that of 3D-SSP (3D-SSP: 0.97, thin-section MR imaging: 0.96, transaxial SPECT: 0.91), and the Az of perfusion MR imaging was lowest (0.63). The sensitivity and specificity of each modality were, respectively, 80.0% and 96.8% for 3D-SSP, 77.1% and 96.8% for thin-section MR imaging, 60.0% and 93.5% for transaxial SPECT display and 34.3% and 100% for perfusion MR imaging. In the novices' interpretations, the Az, sensitivity and specificity of 3D-SSP were superior to those of thin-section MR imaging.
  
  
  CONCLUSIONS
  Thin-section hippocampal MR imaging and 3D-SSP image sets had potentially equivalent value for the diagnosis of AD, and they were superior to transaxial SPECT display and perfusion MR imaging. For avoidance of the effect of interpreters' experience on image evaluation, 3D-SSP appears to be optimal.
authors.affiliation: Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Radiology, Kyoto, Japan. tkubota@koto.kpu-m.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Kubota
authors.forename: Yo
authors.initials: Y
authors.lastname: Ushijima
authors.forename: Kei
authors.initials: K
authors.lastname: Yamada
authors.forename: Chio
authors.initials: C
authors.lastname: Okuyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Kizu
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D001931:Brain Mapping / Q000379:methods; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D020367:Iofetamine; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D020367:Iofetamine