title: The utility of cerebral perfusion SPECT analysis using SPM8, eZIS and vbSEE for the diagnosis of multiple system atrophy-parkinsonism.
abstract: OBJECTIVE
  Although a correct diagnosis is important for appropriate management, accurately differentiating between multiple system atrophy with predominant parkinsonism (MSA-P) and Parkinson's disease (PD) is often difficult because of similarities in the early-stage symptoms. The aim of this study was to evaluate the diagnostic value of cerebral perfusion single photon emission computed tomography (SPECT) and voxel-based analysis for diagnosing MSA-P patients.
  
  
  METHODS
  Thirty-eight subjects (9 with early-stage MSA-P, 11 with PD, and 18 controls) were included in this study. Z-scores suggestive of hypoperfusion were calculated between patients and controls using statistical parametric mapping (SPM) 8 and easy Z-score imaging system (eZIS) programs. A voxel-based stereotactic extraction estimation (vbSEE) program was performed to determine the target volumes of interest (VOIs) in the putamen, pons, and cerebellum, and quantify Z-scores as "extent" (the rate of voxels with a Z-score >2.0 in these VOIs) and "severity" (average Z-scores in these VOIs). These parameters were used as the determinant in receiver operating characteristic (ROC) analyses.
  
  
  RESULTS
  The extent and severity of the cerebellar VOIs were higher in MSA-P patients than in PD patients. In ROC analyses, the extent and severity of the cerebellar VOI exhibited the highest areas under the curves of 0.86 and 0.84, and accuracies of 90 and 90 %, respectively.
  
  
  CONCLUSIONS
  The diagnostic value of significant cerebellar hypoperfusion was the highest for differentiating MSA-P from PD. This voxel-based analysis of cerebral perfusion SPECT using the SPM8, eZIS, and vbSEE programs is useful for clinically diagnosing MSA-P.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan, ksak666@yahoo.co.jp.
authors.forename: Keita
authors.initials: K
authors.lastname: Sakurai
authors.forename: Etsuko
authors.initials: E
authors.lastname: Imabayashi
authors.forename: Kimiteru
authors.initials: K
authors.lastname: Ito
authors.forename: Aya M
authors.initials: AM
authors.lastname: Tokumaru
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Muto
authors.forename: Motoo
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Okita
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Matsukawa
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002560:Cerebrovascular Circulation; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D010300:Parkinson Disease / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*