title: Computer-assisted diagnostic system for neurodegenerative dementia using brain SPECT and 3D-SSP.
abstract: OBJECTIVE
  To develop a computer-assisted automated diagnostic system to distinguish among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and other degenerative disorders in patients with mild dementia.
  
  
  METHODS
  Single photon emission computed tomography (SPECT) images with injection of N-Isopropyl-p-[(123)I]iodoamphetamine (IMP) were obtained from patients with mild degenerative dementia. First, datasets from 20 patients mild AD, 15 patients with dementia with DLB, and 17 healthy controls were used to develop an automated diagnosing system based on three-dimensional stereotactic surface projections (3D-SSP). AD- and DLB-specific regional templates were created using 3D-SSP, and critical Z scores in the templates were established. Datasets from 50 AD patients, 8 DLB patients, and 10 patients with non-AD/DLB type degenerative dementia (5 with frontotemporal dementia and 5 with progressive supranuclear palsy) were then used to test the diagnostic accuracy of the optimized automated system in comparison to the diagnostic interpretation of conventional IMP-SPECT images. These comparisons were performed to differentiate AD and DLB from non-AD/DLB and to distinguish AD from DLB. A receiver operating characteristic (ROC) analysis was performed.
  
  
  RESULTS
  The area under the ROC curve (Az) and the accuracy of the automated diagnosis system were 0.89 and 82%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 65%, respectively, for AD vs. DLB patients. The mean Az and the accuracy of the visual inspection were 0.84 and 77%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 65%, respectively, for AD vs. DLB patients. The mean Az and the accuracy of the combination of visual inspection and this system were 0.96 and 91%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 66%, respectively, for AD vs. DLB patients.
  
  
  CONCLUSIONS
  The system developed in the present study achieved as good discrimination of AD, DLB, and other degenerative disorders in patients with mild dementia as the commonly performed visual inspection of conventional SPECT images. A combination of visual inspection and this system is helpful in the differential diagnosis of patients with mild dementia.
authors.affiliation: Department of Radiology and Nuclear Medicine, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan. kishii@hbhc.jp
authors.forename: Kazunari
authors.initials: K
authors.lastname: Ishii
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kanda
authors.forename: Takafumi
authors.initials: T
authors.lastname: Uemura
authors.forename: Naokazu
authors.initials: N
authors.lastname: Miyamoto
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Shimada
authors.forename: Shingo
authors.initials: S
authors.lastname: Ohkawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Minoshima
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D001331:Automation; D002560:Cerebrovascular Circulation; D003704:Dementia / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D021621:Imaging, Three-Dimensional; D020367:Iofetamine / Q000494:pharmacology; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000494:pharmacology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D020367:Iofetamine