利用新研發之電腦軟體回溯性分析多巴胺轉運體影像

Semi-quantitative evaluation of brain DAT-SPECT with 99mTc-TRODAT-1 using a newly developed automated volumetric software.

蔡雅茹(Ya-Ju Tsai)

指導教授 ： 李友專

共同指導教授 ： 張祐誠

臺北醫學大學/醫學科技學院/醫學資訊研究所/碩士(2015年)

摘要

無資料

關鍵字

多巴胺轉運蛋白造影劑 ； 多巴胺轉運體 ； 半定量分析

並列摘要

Dopamine transporter imaging (DAT) has been proven to be useful in evaluating loss of nigrostriatal dopaminergic neurons. There are two major purposes in this study. First, we developed automated software that can derive volumetric regions of interest (ROIs), the VOIs, for semi-quantitative evaluation of 99mTc-TRODAT-1 SPECT without the need for coregistration with magnetic resonance imaging (MRI) or template. The performance of the automated software was analyzed in terms of inter-operator reproducibility, and how well its calculated global neuron loss correlated with that estimated from visual analysis. Second, the clinical diagnostic accuracy of brain 99mTc-TRODAT-1 imaging for differential diagnoses of clinically indeterminate movement disorders was retrospectively analyzed in combination of visual analysis and semi-quantitative evaluation using the automated software.
Methods
99mTc-TRODAT-1 imaging in 57 patients with clinically indeterminate movement disorders was retrospectively analyzed. Mean follow-up duration was 24.1 ± 7.1 months. In this study, the specific uptake of each striatum was obtained using the conventional method with manually drawn 2-dimensional (2-D) ROIs, and the developed automated software with computationally derived VOIs. Inter-operator reproducibility using the two semi-quantitative methods was assessed among three operators. In addition, correlation between semi-quantitative evaluation and visual interpreration was analyzed. Finally, the diagnostic performance of 99mTc-TRODAT-1 scan for neurodegenerative Parkinsonian disorders was calculated in patients with clinically indeterminate movement disorders.
Results
The automated software had high reproducibility (R2 = 0.97~0.99) among the three operators. Correlation between semi-quantitative values and visual four-level scoring was better using automated software than the manual method. Diagnostic performance of 99mTc-TRODAT-1 scan using the automated semi-quantitative method resulted in good accuracy of 86% for differential diagnoses between neurodegenerative Parkinsonian diseases and non-neurodegenerative movement disorders.
Conclusion
This study suggests that 99mTc-TRODAT-1 imaging using our automated software has high inter-operator reproducibility, correlates well to visually assessed severity of dopaminergic neuron loss, and has a good accuracy in diagnosing neurodegenerative Parkinsonian disorders. Combining visual analysis with the reliable semi-quantitative method can valuably increase confidence and reduce uncertainty associated with imaging interpretation to facilitate differential diagnoses and assist in better management in patients with clinically indeterminate movement disorders.

並列關鍵字

[99mTc]TRODAT-1 ； Dopamine transporter ； Semiquantitative evaluation

參考文獻

1. Shih MC, Hoexter MQ, Andrade LA, Bressan RA. Parkinson’s disease and dopamine transporter neuroimaging: a critical review. Sao Paulo Med J. 2006;124:168-175.

2. Ravina B, Eidelberg D, Ahlskog JE, et al. The role of radiotracer imaging in Parkinson disease. Neurology. 2005;64:208-215.

3. Felicio AC, Godeiro-Junior C, Shih MC, et al. Evaluation of patients with clinically

unclear Parkinsonian syndromes submitted to brain SPECT imaging using the technetium-99m labeled tracer TRODAT-1. J Neurol Sci. 2010;29:64-68.

4. Scherfler C, Schwarz J, Antonini A, et al. Role of DAT-SPECT in the diagnostic work up of parkinsonism. Mov Disord. 2007;22:1229-1238.