Skip to main content
×
Home
    • Aa
    • Aa

A comparison of 99mTc-exametazime and 123I-FP-CIT SPECT imaging in the differential diagnosis of Alzheimer's disease and dementia with Lewy bodies

  • Sean J. Colloby (a1), Michael J. Firbank (a1), Sanjeet Pakrasi (a1), Jim J. Lloyd (a2), Ian Driver (a3), Ian G. McKeith (a1), E. David Williams (a4) and John T. O'Brien (a1)...
Abstract
ABSTRACT

Background: The aim of this study is to investigate the diagnostic value of perfusion 99mTc-exametazime single photon emission computed tomography (SPECT) in the diagnosis of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) in comparison with dopaminergic 123I-2β-carbomethoxy-3β-(4-iodophenyl)-n-(3-fluoropropyl) nortropane (FP-CIT) SPECT imaging.

Methods: Subjects underwent 99mTc-exametazime scanning (39 controls, 36 AD, 30 DLB) and 123I-FP-CIT scanning (33 controls, 33 AD, 28 DLB). For each scan, five raters performed visual assessments blind to clinical diagnosis on selected transverse 99mTc-exametazime images in standard stereotactic space. Diagnostic accuracy of 99mTc-exametazime was compared to 123I-FP-CIT results for the clinically relevant subgroups AD and DLB using receiver operating characteristic (ROC) curve analysis.

Results: Inter-rater agreement for categorizing uptake was “moderate” (mean κ = 0.53) for 99mTc-exametazime and “excellent” (mean κ = 0.88) for 123I-FP-CIT. For AD and DLB, consensus rating matched clinical diagnosis in 56% of cases using 99mTc-exametazime and 84% using 123I-FP-CIT. In distinguishing AD from DLB, ROC analysis revealed superior diagnostic accuracy with 123I-FP-CIT (ROC curve area 0.83, sensitivity 78.6%, specificity 87.9%) compared to occipital 99mTc-exametazime (ROC curve area 0.64, sensitivity 64.3%, specificity 63.6%) p = 0.03.

Conclusion: Diagnostic accuracy was superior with 123I-FP-CIT compared to 99mTc-exametazime in the differentiation of DLB from AD.

Copyright
Corresponding author
Correspondence should be addressed to: Dr. Sean J. Colloby, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, U.K. Phone: +44 191 248 1321; Fax: +44 191 248 1301; Email: s.j.colloby@ncl.ac.uk.
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

D. Aarsland , U. P. Mosimann and I. G. McKeith (2004). Role of cholinesterase inhibitors in Parkinson's disease and dementia with Lewy bodies. Journal of Geriatric Psychiatry and Neurology, 17, 164171.

D. Aarsland (2005). Neuroleptic sensitivity in Parkinson's disease and parkinsonian dementias. Journal of Clinical Psychiatry, 66, 633637.

T. S. Benamer (2000). Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: the [123I]-FP-CIT study group. Movement Disorders, 15, 503510.

R. Ceravolo (2003). Dopaminergic degeneration and perfusional impairment in Lewy body dementia and Alzheimer's disease. Neurological Sciences, 24, 162163.

M. Firbank , S. J. Colloby , D. Burn , I. G. McKeith and J. T. O'Brien (2003). Regional cerebral blood flow in Parkinson's disease with and without dementia. Neuroimage, 20, 13091319.

M. F. Folstein , S. E. Folstein and P. R. McHugh (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.

S. Gilman (2005). Differentiation of Alzheimer's disease from dementia with Lewy bodies utilizing positron emission tomography with [18 F]fluorodeoxyglucose and neuropsychological testing. Experimental Neurology, 191 (Suppl. 1), S95S103.

H. Hanyu (2006a). Comparative value of brain perfusion SPECT and [(123)I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer's disease. European Journal of Nuclear Medicine and Molecular Imaging, 33, 248253.

H. Hanyu (2006b). Differentiation of dementia with lewy bodies from Alzheimer's disease using Mini-Mental State Examination and brain perfusion SPECT. Journal of the Neurological Sciences, 250, 97102.

M. B. Imran (1999). Tc-99 m HMPAO SPECT in the evaluation of Alzheimer's disease: correlation between neuropsychiatric evaluation and CBF images. Journal of Neurology, Neurosurgery and Psychiatry, 66, 228232.

K. Ishii (1998). Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer's disease. Neurology, 51, 125130.

K. Ishii , M. Sasaki , S. Sakamoto , S. Yamaji , H. Kitagaki and E. Mori (1999a). Tc-99 m ethyl cysteinate dimer SPECT and 2-[F-18]fluoro-2-deoxy-D-glucose PET in Alzheimer's disease: comparison of perfusion and metabolic patterns. Clinical Nuclear Medicine, 24, 572575.

K. Ishii , S. Yamaji , H. Kitagaki , T. Imamura , N. Hirono and E. Mori (1999b). Regional cerebral blood flow difference between dementia with Lewy bodies and AD. Neurology, 53, 413416.

P. M. Kemp , S. A. Hoffmann , L. Tossici-Bolt , J. S. Fleming and C. Holmes (2007). Limitations of the HMPAO SPECT appearances of occipital lobe perfusion in the differential diagnosis of dementia with Lewy bodies. Nuclear Medicine Communications, 28, 451456.

Y. C. Lee (2003). Statistical parametric mapping of brain SPECT perfusion abnormalities in patients with Alzheimer's disease. European Neurology, 49, 142145.

K. Lobotesis (2001). Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology, 56, 643649.

I. G. McKeith , A. F. Fairbairn , R. H. Perry and P. Thompson (1994). The clinical diagnosis and misdiagnosis of senile dementia of Lewy body type (SDLT). British Journal of Psychiatry, 165, 324332.

I. G. McKeith (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 11131124.

I. G. McKeith (2005). Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology, 65, 18631872.

I. McKeith (2007). Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study. Lancet Neurology, 6, 305313.

G. McKhann , D. Drachman , M. Folstein , R. Katzman , D. Price and E. M. Stadlan (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.

S. Minoshima , N. L. Foster , A. A. F. Sima , K. A. Frey , R. L. Albin and D. E. Kuhl (2001). Alzheimer's disease versus dementia with Lewy bodies: cerebral metabolic distinction with autopsy confirmation. Annals of Neurology, 50, 358365.

J. T. O'Brien (2004). Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy bodies. Archives of Neurology, 61, 919925.

T. Oide (2003). Usefulness of [123I]metaiodobenzylguanidine ([123I]MIBG) myocardial scintigraphy in differentiating between Alzheimer's disease and dementia with Lewy bodies. Internal Medicine, 42, 686690.

J. Pasquier , B. F. Michel , I. Brenot-Rossi , N. Hassan-Sebbag , R. Sauvan and J. L. Gastaut (2002). Value of (99 m)Tc-ECD SPET for the diagnosis of dementia with Lewy bodies. European Journal of Nuclear Medicine and Molecular Imaging, 29, 13421348.

M. Roth (1986). CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698709.

S. Shimizu , H. Hanyu , H. Kanetaka , T. Iwamoto , K. Koizumi and K. Abe (2005). Differentiation of dementia with Lewy bodies from Alzheimer's disease using brain SPECT. Dementia and Geriatric Cognitive Disorders, 20, 2530.

Z. Walker (2002). Differentiation of dementia with Lewy bodies from Alzheimer's disease using a dopaminergic presynaptic ligand. Journal of Neurology, Neurosurgery and Psychiatry, 73, 134140.

Z. Walker (2007). Dementia with Lewy bodies: a comparison of clinical diagnosis, FP-CIT single photon emission computed tomography imaging and autopsy. Journal of Neurology, Neurosurgery and Psychiatry, 78, 11761181.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: