title: Reference cluster normalization improves detection of frontotemporal lobar degeneration by means of FDG-PET.
abstract: Positron emission tomography with [18F] fluorodeoxyglucose (FDG-PET) plays a well-established role in assisting early detection of frontotemporal lobar degeneration (FTLD). Here, we examined the impact of intensity normalization to different reference areas on accuracy of FDG-PET to discriminate between patients with mild FTLD and healthy elderly subjects. FDG-PET was conducted at two centers using different acquisition protocols: 41 FTLD patients and 42 controls were studied at center 1, 11 FTLD patients and 13 controls were studied at center 2. All PET images were intensity normalized to the cerebellum, primary sensorimotor cortex (SMC), cerebral global mean (CGM), and a reference cluster with most preserved FDG uptake in the aforementioned patients group of center 1. Metabolic deficits in the patient group at center 1 appeared 1.5, 3.6, and 4.6 times greater in spatial extent, when tracer uptake was normalized to the reference cluster rather than to the cerebellum, SMC, and CGM, respectively. Logistic regression analyses based on normalized values from FTLD-typical regions showed that at center 1, cerebellar, SMC, CGM, and cluster normalizations differentiated patients from controls with accuracies of 86%, 76%, 75% and 90%, respectively. A similar order of effects was found at center 2. Cluster normalization leads to a significant increase of statistical power in detecting early FTLD-associated metabolic deficits. The established FTLD-specific cluster can be used to improve detection of FTLD on a single case basis at independent centers - a decisive step towards early diagnosis and prediction of FTLD syndromes enabling specific therapies in the future.
authors: LREN, Département des Neurosciences Cliniques, CHUV, Université de Lausanne, Lausanne, Switzerland. dukart@cbs.mpg.de
authors: Juergen
authors: J
authors: Dukart
authors: Robert
authors: R
authors: Perneczky
authors: Stefan
authors: S
authors: Förster
authors: Henryk
authors: H
authors: Barthel
authors: Janine
authors: J
authors: Diehl-Schmid
authors: Bogdan
authors: B
authors: Draganski
authors: Hellmuth
authors: H
authors: Obrig
authors: Emiliano
authors: E
authors: Santarnecchi
authors: Alexander
authors: A
authors: Drzezga
authors: Andreas
authors: A
authors: Fellgiebel
authors: Richard
authors: R
authors: Frackowiak
authors: Alexander
authors: A
authors: Kurz
authors: Karsten
authors: K
authors: Müller
authors: Osama
authors: O
authors: Sabri
authors: Matthias L
authors: ML
authors: Schroeter
authors: Igor
authors: I
authors: Yakushev
mesh_terms: D000328:Adult; D005260:Female; D019788:Fluorodeoxyglucose F18; D057174:Frontotemporal Lobar Degeneration / Q000175:diagnosis*; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18