Arnoldo Piccardo1, Roberto Cappuccio2, Gianluca Bottoni3, Diego Cecchin4, Luca Mazzella5, Alessio Cirone6,7, Sergio Righi6, Martina Ugolini3, Pietro Bianchi8, Pietro Bertolaccini8, Elena Lorenzini8, Michela Massollo3, Antonio Castaldi9, Francesco Fiz10, Laura Strada11, Angelina Cistaro3, Massimo Del Sette11. 1. Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy. arnoldo.piccardo@galliera.it. 2. I.N.F.N. - Section of Pisa, Pisa, Italy. 3. Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy. 4. Department of Medicine - DIMED, University-Hospital of Padova, Padova, Italy. 5. Department of Neurology, ASL 3 di Genova, Genova, Italy. 6. Medical Physics Department, E.O. "Ospedali Galliera", Genoa, Italy. 7. Department of Physics, Università degli Studi di Genova, I-16146, Genoa, Italy. 8. Department of Nuclear Medicine of Massa Carrara, Azienda USL Toscana NordOvest, Pisa, Italy. 9. Department of Neuroradiology, E.O. "Ospedali Galliera", Genoa, Italy. 10. Nuclear Medicine Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy. 11. Department of Neurology, E.O. "Ospedali Galliera", Genoa, Italy.
Abstract
OBJECTIVES: To test the performance of a 3D convolutional neural network (CNN) in analysing brain [18F]DOPA PET/CT in order to identify patients with nigro-striatal neurodegeneration. We evaluated the robustness of the 3D CNN by testing it against a manual regional analysis of the striata by using a striatal-to-occipital ratio (SOR). METHODS: We analyzed patients who had undergone [18F]DOPA PET/CT from 2016 to 2018. Two examiners interpreted PET/CT images as positive or negative. Only patients with at least 2 years of follow-up and an ascertained neurological diagnosis were included. A 3D CNN was developed to evaluate [18F]DOPA PET/CT and refine the diagnosis of movement disorder. This system required training and testing, which were carried out on 2/3 and 1/3 of patients, respectively. A regional analysis was also conducted by drawing region of interest on T1-weighted 3D MRI scans, on which the [18F]DOPA PET images were first co-registered. RESULTS: Ninety-eight patients were enrolled: 43 presented nigro-striatal degeneration and 55 negative cases used as controls. After training on 69 patients, the diagnostic performance of the 3D CNN was then calculated in 29 patients. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy were 100%, 89%, 100%, 85% and 93%, respectively. When we compared the 3D CNN results with the SOR analysis, we found that the two patients falsely classified as positive by the 3D CNN procedure showed SOR values ≤ 5th percentile of the negative cases' distribution. CONCLUSIONS: 3D CNNs are able to interpret [18F]DOPA PET/CT properly, revealing patients affected by Parkinson's disease. KEY POINTS: • [18F]DOPA PET/CT is a sensitive diagnostic tool to identify patients with nigro-striatal neurodegeneration. • A semiquantitative evaluation of the images allows a more confident interpretation of the PET findings. • 3D convolutional neural network allows an accurate interpretation of 18F-DOPA PET/CT images, revealing patients affected by Parkinson's disease.
OBJECTIVES: To test the performance of a 3D convolutional neural network (CNN) in analysing brain [18F]DOPA PET/CT in order to identify patients with nigro-striatal neurodegeneration. We evaluated the robustness of the 3D CNN by testing it against a manual regional analysis of the striata by using a striatal-to-occipital ratio (SOR). METHODS: We analyzed patients who had undergone [18F]DOPA PET/CT from 2016 to 2018. Two examiners interpreted PET/CT images as positive or negative. Only patients with at least 2 years of follow-up and an ascertained neurological diagnosis were included. A 3D CNN was developed to evaluate [18F]DOPA PET/CT and refine the diagnosis of movement disorder. This system required training and testing, which were carried out on 2/3 and 1/3 of patients, respectively. A regional analysis was also conducted by drawing region of interest on T1-weighted 3D MRI scans, on which the [18F]DOPA PET images were first co-registered. RESULTS: Ninety-eight patients were enrolled: 43 presented nigro-striatal degeneration and 55 negative cases used as controls. After training on 69 patients, the diagnostic performance of the 3D CNN was then calculated in 29 patients. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy were 100%, 89%, 100%, 85% and 93%, respectively. When we compared the 3D CNN results with the SOR analysis, we found that the two patients falsely classified as positive by the 3D CNN procedure showed SOR values ≤ 5th percentile of the negative cases' distribution. CONCLUSIONS: 3D CNNs are able to interpret [18F]DOPA PET/CT properly, revealing patients affected by Parkinson's disease. KEY POINTS: • [18F]DOPA PET/CT is a sensitive diagnostic tool to identify patients with nigro-striatal neurodegeneration. • A semiquantitative evaluation of the images allows a more confident interpretation of the PET findings. • 3D convolutional neural network allows an accurate interpretation of 18F-DOPA PET/CT images, revealing patients affected by Parkinson's disease.
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