Visual versus semiquantitative analysis of 18F- fluorodeoxyglucose-positron emission tomography brain images in patients with dementia

Ismet Sarikaya 1, Walaa A Kamel 2 3, Khattab Khaled Ateyah 4, Nooraessa Bin Essa 5, Samira AlTailji 3, Ali Sarikaya 6

Affiliations

20 January 2021

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doi: 10.4103/wjnm.WJNM_53_18

Abstract

Various studies have reported to the superiority of semiquantitative (SQ) analysis over visual analysis in detecting metabolic changes in the brain. In this study, we aimed to determine the limitations of SQ analysis programs and the current status of 18F- fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan in dementia. 18F- FDG-PET/computed tomography (CT) brain images of 39 patients with a history of dementia were analyzed both visually and semiquantitatively. Using the visually markedly abnormal 18F- FDG-PET images as standard, we wanted to test the accuracy of two commercially available SQ analysis programs. SQ analysis results were classified as matching, partially matching and nonmatching with visually markedly abnormal studies. On visual analysis, 18F- FDG-PET showed marked regional hypometabolism in 19 patients, mild abnormalities in 8 and was normal in 12 patients. SQ analysis-1 results matched with visual analysis in 8 patients (42.1%) and partially matched in 11. SQ analysis-2 findings matched with visual analysis in 11 patients (57.8%) and partially matched in 7 and did not match in 1. Marked regional hypometabolism was either on the left side of the brain or was more significant on the left than the right in 63% of patients. Preservation of metabolism in sensorimotor cortex was seen in various dementia subtypes. Reviewing images in color scale and maximum intensity projection (MIP) image was helpful in demonstrating and displaying regional abnormalities, respectively. SQ analysis provides less accurate results as compared to visual analysis by experts. Due to suboptimal image registration and selection of brain areas, SQ analysis provides inaccurate results, particularly in small areas and areas in close proximity. Image registration and selection of areas with SQ programs should be checked carefully before reporting the results.

Keywords: 18F- fluorodeoxyglucose-positron emission tomography; Brain imaging; dementia; semiquantitative analysis; visual analysis.

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1 An 80-year-old male with a history of visual hallucinations and cognitive decline with Parkinsonian feature, which was clinically suspicious for diffuse Lewy body dementia. 18F- fluorodeoxyglucose-positron emission tomography images demonstrated reduced metabolism in bilateral parietal, frontal, temporal, and occipital cortices. There was preservation of metabolic activity in bilateral sensorimotor cortices

Figure 1 An 80-year-old male with a history of visual hallucinations and cognitive decline with Parkinsonian feature, which was clinically suspicious for diffuse Lewy body dementia. 18F- fluorodeoxyglucose-positron emission tomography images demonstrated reduced metabolism in bilateral parietal, frontal, temporal, and occipital cortices. There was preservation of metabolic activity in bilateral sensorimotor cortices

Figure 2 18F- fluorodeoxyglucose-positron emission tomography transaxial images of the brain (a), semiquantitative analysis-1 results (b), and semiquantitative analysis-2 results (c) in a patient with Alzheimer's disease demonstrating suboptimal results with semiquantitative analysis programs

Figure 2 18F- fluorodeoxyglucose-positron emission tomography transaxial images of the brain (a), semiquantitative analysis-1 results (b), and semiquantitative analysis-2 results (c) in a patient with Alzheimer's disease demonstrating suboptimal results with semiquantitative analysis programs

Figure 3 18F- fluorodeoxyglucose-positron emission tomography transaxial images of the brain (a), semiquantitative analysis-1 results (b), and semiquantitative analysis-2 results (c) in a patient with Alzheimer's disease demonstrating suboptimal results with semiquantitative analysis programs

Figure 3 18F- fluorodeoxyglucose-positron emission tomography transaxial images of the brain (a), semiquantitative analysis-1 results (b), and semiquantitative analysis-2 results (c) in a patient with Alzheimer's disease demonstrating suboptimal results with semiquantitative analysis programs

Figure 4 Image registration and selection of areas with semiquantitative analysis-2 (a). Note the suboptimal selection of areas (arrows). Suboptimal reformatted patient images with semiquantitative analysis-1 (b)

Figure 4 Image registration and selection of areas with semiquantitative analysis-2 (a). Note the suboptimal selection of areas (arrows). Suboptimal reformatted patient images with semiquantitative analysis-1 (b)

Figure 5 Selected transaxial fluorodeoxyglucose-positron emission tomography images in color and grayscales. Note that color scale better demonstrates hypometabolic regions in bilateral frontal and parietal lobes as compared to grayscale

Figure 5 Selected transaxial fluorodeoxyglucose-positron emission tomography images in color and grayscales. Note that color scale better demonstrates hypometabolic regions in bilateral frontal and parietal lobes as compared to grayscale

Figure 6 Fluorodeoxyglucose-positron emission tomography maximum intensity projection images of patients in Figure 2 (a) and Figure 3 (b). Note that maximum intensity projection images better present abnormalities in a three-dimensional display

Figure 6 Fluorodeoxyglucose-positron emission tomography maximum intensity projection images of patients in Figure 2 (a) and Figure 3 (b). Note that maximum intensity projection images better present abnormalities in a three-dimensional display

Figure 7 Selected computed tomography, 18F- fluorodeoxyglucose-positron emission tomography and positron emission tomography/computed tomography fusion images of 57-year-old male with 2 years history of memory disturbance. Computed tomography image shows left temporal infarct. Positron emission tomography image shows reduced left temporal glucose metabolism due to old infarct

Figure 7 Selected computed tomography, 18F- fluorodeoxyglucose-positron emission tomography and positron emission tomography/computed tomography fusion images of 57-year-old male with 2 years history of memory disturbance. Computed tomography image shows left temporal infarct. Positron emission tomography image shows reduced left temporal glucose metabolism due to old infarct

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