title: Comparison of Alzheimer's disease with vascular dementia and non-dementia using specific voxel-based Z score maps.
abstract: OBJECTIVE
  We investigated the ability to discriminate between Alzheimer's disease (AD) and vascular dementia (VaD), and between AD and non-dementia using the program "easy Z score imaging system" (eZIS) developed by Matsuda et al., for the diagnosis of very early AD.
  
  
  METHODS
  Of 201 patients, we investigated 12 patients with AD, 10 with VaD, and 9 with non-dementia, who underwent brain perfusion single-photon emission computed tomography by technetium-99m ethyl cysteinate dimer (99mTc-ECD) between February 2005 and September 2006. The sensitivity and specificity of the indicators of specific volume of interest (VOI) analysis, namely, severity, extent, and ratio were evaluated for the distinction of AD from VaD and non-dementia.
  
  
  RESULTS
  There was a significant difference in all the criteria for severity, extent, and ratio between AD and non-dementia cases and in the ratio between AD and VaD. Between AD and non-dementia, the sensitivity and specificity of severity were 100% and 45%, respectively, using the cutoff value of 1.19. When using the cutoff value of 14.2 for extent, the sensitivity and specificity were both 100%. Using the cutoff value of 2.22 for ratio, the sensitivity of 42% and specificity of 100% were demonstrated. When comparing AD with VaD, using the cutoff value of 2.22 for ratio, the sensitivity and specificity were 42% and 100%, respectively. Using the cutoff value of 1.5 for ratio, the sensitivity and specificity between AD and VaD were 92% and 80%, respectively, thereby showing the best results.
  
  
  CONCLUSIONS
  The specific VOI analysis program of AD using specific voxel-based Z score maps is not influenced by interobserver differences among radiologists and is useful to discriminate AD from VaD and non-dementia. However, the setting of the cutoff value at each institution and comparison with original and eZIS images are suggested to distinguish better AD from VaD.
authors.affiliation: Department of Radiology, Fukusuhima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. shirou@fmu.ac.jp
authors.forename: Shirou
authors.initials: S
authors.lastname: Ishii
authors.forename: Fumio
authors.initials: F
authors.lastname: Shishido
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyajima
authors.forename: Koutarou
authors.initials: K
authors.lastname: Sakuma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shigihara
authors.forename: Tadanobu
authors.initials: T
authors.lastname: Tameta
authors.forename: Makoto
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kuroda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000544:Alzheimer Disease / Q000000981:diagnostic imaging*; D015140:Dementia, Vascular / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*