Clinical impact of digital and conventional PET control databases for semi-quantitative analysis of brain 18F-FDG digital PET scans

A ROI-based quantitative pipeline for 18F-FDG PET metabolism and pCASL perfusion joint analysis: Validation of the 18F-FDG PET line

In Mild Cognitive Impairment (MCI), the study of brain metabolism, provided by 18F-FluoroDeoxyGlucose Positron Emission Tomography (18F-FDG PET) can be integrated with brain perfusion through pseudo-Continuous Arterial Spin Labeling Magnetic Resonance sequences (MR pCASL). Cortical hypometabolism identification generally relies on wide control group datasets; pCASL control groups are instead not publicly available yet, due to lack of standardization in the acquisition parameters. This study presents a quantitative pipeline to be applied to PET and pCASL data to coherently analyze metabolism and perfusion inside 16 matching cortical regions of interest (ROIs) derived from the AAL3 atlas. The PET line is tuned on 36 MCI patients and 107 healthy control subjects, to agree in identifying hypometabolic regions with clinical reference methods (visual analysis supported by a vendor tool and Statistical Parametric Mapping, SPM, with two parametrizations here identified as SPM-A and SPM-B). The analysis was conducted for each ROI separately. The proposed PET analysis pipeline obtained accuracy 78 % and Cohen's к 60 % vs visual analysis, accuracy 79 % and Cohen's к 58 % vs SPM-A, accuracy 77 % and Cohen's к 54 % vs SPM-B. Cohen's к resulted not significantly different from SPM-A and SPM-B Cohen's к when assuming visual analysis as reference method (p-value 0.61 and 0.31 respectively). Considering SPM-A as reference method, Cohen's к is not significantly different from SPM-B Cohen's к as well (p-value = 1.00). The complete PET-pCASL pipeline was then preliminarily applied on 5 MCI patients and metabolism-perfusion regional correlations were assessed. The proposed approach can be considered as a promising tool for PET-pCASL joint analyses in MCI, even in the absence of a pCASL control group, to perform metabolism-perfusion regional correlation studies, and to assess and compare perfusion in hypometabolic or normo-metabolic areas.

Effect of Point Spread Function Deconvolution in Reconstruction of Brain 18F-FDG PET Images on the Diagnostic Thinking Efficacy in Alzheimer's Disease

Purpose: This study aims to determine the effect of applying Point Spread Function (PSF) deconvolution, which is known to improve contrast and spatial resolution in brain ¹⁸F-FDG PET images, to the diagnostic thinking efficacy in Alzheimer's disease (AD).

Methods: We compared Hoffman 3-D brain phantom images reconstructed with or without PSF. The effect of PSF deconvolution on AD diagnostic clinical performance was determined from digital brain ¹⁸F-FDG PET images of AD (n = 38) and healthy (n = 35) subjects compared to controls (n = 36). Performances were assessed with SPM at the group level (p < 0.001 for the voxel) and at the individual level by visual interpretation of SPM T-maps (p < 0.005 for the voxel) by the consensual analysis of three experienced raters.

Results: A mix of large hypometabolic (1,483cm³, mean value of −867 ± 492 Bq/ml) and intense hypermetabolic (902 cm³, mean value of 1,623 ± 1,242 Bq/ml) areas was observed in the PSF compared to the no PSF phantom images. Significant hypometabolic areas were observed in the AD group compared to the controls, for reconstructions with and without PSF (respectively 23.7 and 26.2 cm³), whereas no significant hypometabolic areas were observed when comparing the group of healthy subjects to the control group. At the individual level, no significant differences in diagnostic performances for discriminating AD were observed visually (sensitivity of 89 and 92% for reconstructions with and without PSF respectively, similar specificity of 74%).

Conclusion: Diagnostic thinking efficacy performances for diagnosing AD are similar for ¹⁸F-FDG PET images reconstructed with or without PSF.