OBJECTIVES: Cardiac I-MIBG imaging is an established technique for the diagnosis of dementia with Lewy bodies but various analysis methods are reported in the literature. We assessed different methods in the same cohort of patients to inform best practice. PATIENTS AND METHODS: Seventeen patients with dementia with Lewy bodies, 15 with Alzheimer's disease and 16 controls were included. Planar images were acquired 20 min and 4 h after injection. Nine operators produced heart-to-mediastinum ratios (HMRs) using freehand and 6, 7 and 8 cm diameter circular cardiac regions. Interoperator variation was measured using the coefficient of variation. HMR differences between methods were assessed using analysis of variance. Seven raters assessed the images visually. Accuracy was compared using receiver operating characteristic analysis. RESULTS: There were significant differences in HMR between region methods (P=0.006). However, with optimised cut-offs there was no significant difference in accuracy (P=0.2-1.0). The sensitivity was 65-71% and specificity 100% for all HMR methods. Variation was lower with fixed regions than freehand (P<0.001). Visual rating sensitivity and specificity were 65 and 77% on early images and 76 and 71% on delayed images. There was no significant difference in HMR between early and delayed images (P=0.4-0.7) although a greater separation between means was seen on delayed images (0.73 vs. 0.95). CONCLUSION: HMR analysis using a suitable cut-off is more accurate than visual rating. Accuracy is similar for all methods, but freehand regions are more variable and 6 cm circles easiest to place. We recommend calculating HMR using a 6 cm circular cardiac region of interest on delayed images.
OBJECTIVES: Cardiac I-MIBG imaging is an established technique for the diagnosis of dementia with Lewy bodies but various analysis methods are reported in the literature. We assessed different methods in the same cohort of patients to inform best practice. PATIENTS AND METHODS: Seventeen patients with dementia with Lewy bodies, 15 with Alzheimer's disease and 16 controls were included. Planar images were acquired 20 min and 4 h after injection. Nine operators produced heart-to-mediastinum ratios (HMRs) using freehand and 6, 7 and 8 cm diameter circular cardiac regions. Interoperator variation was measured using the coefficient of variation. HMR differences between methods were assessed using analysis of variance. Seven raters assessed the images visually. Accuracy was compared using receiver operating characteristic analysis. RESULTS: There were significant differences in HMR between region methods (P=0.006). However, with optimised cut-offs there was no significant difference in accuracy (P=0.2-1.0). The sensitivity was 65-71% and specificity 100% for all HMR methods. Variation was lower with fixed regions than freehand (P<0.001). Visual rating sensitivity and specificity were 65 and 77% on early images and 76 and 71% on delayed images. There was no significant difference in HMR between early and delayed images (P=0.4-0.7) although a greater separation between means was seen on delayed images (0.73 vs. 0.95). CONCLUSION: HMR analysis using a suitable cut-off is more accurate than visual rating. Accuracy is similar for all methods, but freehand regions are more variable and 6 cm circles easiest to place. We recommend calculating HMR using a 6 cm circular cardiac region of interest on delayed images.
Authors: Gemma Roberts; Joseph P M Kane; Jim Lloyd; Michael Firbank; Paul Christopher Donaghy; George S Petrides; John-Paul Taylor; John O'Brien; Alan J Thomas Journal: Nucl Med Commun Date: 2022-05-20 Impact factor: 1.698
Authors: G Roberts; J J Lloyd; J P M Kane; R Durcan; S Lawley; K Howe; G S Petrides; J T O'Brien; A J Thomas Journal: J Nucl Cardiol Date: 2019-09-16 Impact factor: 5.952
Authors: Gemma Roberts; Rory Durcan; Paul C Donaghy; Sarah Lawley; Joanna Ciafone; Calum A Hamilton; Sean J Colloby; Michael J Firbank; Louise Allan; Nicola Barnett; Sally Barker; Kim Howe; Tamir Ali; George S Petrides; Jim Lloyd; John-Paul Taylor; John O'Brien; Alan J Thomas Journal: Neurology Date: 2021-04-21 Impact factor: 9.910
Authors: Gemma Roberts; Jim J Lloyd; Elizabeth Jefferson; Joseph P M Kane; Rory Durcan; Sarah Lawley; George S Petrides; Kim Howe; Iftikhar Haq; John T O'Brien; Alan J Thomas Journal: J Nucl Cardiol Date: 2019-12-09 Impact factor: 5.952