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General Research Article

Impact of Tracer Retention Levels on Visual Analysis of Cerebral [18F]- Florbetaben Pet Images

Author(s): Giampiero Giovacchini, Elisabetta Giovannini, Elisa Borsò, Patrizia Lazzeri, Valerio Duce, Ornella Ferrando, Franca Foppiano and Andrea Ciarmiello*

Volume 14, Issue 1, 2021

Published on: 29 July, 2020

Page: [70 - 77] Pages: 8

DOI: 10.2174/1874471013666200729155717

Price: $65

Abstract

Background: To compare visual and semi-quantitative analysis of brain [18F]Florbetaben PET images in Mild Cognitive Impairment (MCI) patients and relate this finding to the degree of ß-amyloid burden.

Methods: A sample of 71 amnestic MCI patients (age 74 ± 7.3 years, Mini Mental State Examination 24.2 ± 5.3) underwent cerebral [18F]Florbetaben PET/CT. Images were visually scored as positive or negative independently by three certified readers blinded to clinical and neuropsychological assessment. Amyloid positivity was also assessed by semiquantitative approach by means of a previously published threshold (SUVr ≥ 1.3). Fleiss kappa coefficient was used to compare visual analysis (after consensus among readers) and semi-quantitative analysis. Statistical significance was taken at P<0.05.

Results: After the consensus reading, 43/71 (60.6%) patients were considered positive. Cases that were interpreted as visually positive had higher SUVr than visually negative patients (1.48 ± 0.19 vs 1.11 ± 0.09) (P<0.05). Agreement between visual analysis and semi-quantitative analysis was excellent (k=0.86, P<0.05). Disagreement occurred in 7/71 patients (9.9%) (6 false positives and 1 false negative). Agreement between the two analyses was 90.0% (18/20) for SUVr < 1.1, 83% (24/29) for SUVr between 1.1 and 1.5, and 100% (22/22) for SUVr > 1.5 indicating lowest agreement for the group with intermediate amyloid burden.

Conclusion: Inter-rater agreement of visual analysis of amyloid PET images is high. Agreement between visual analysis and SUVr semi-quantitative analysis decreases in the range of 1.1< SUVr <=1.5, where the clinical scenario is more challenging.

Keywords: PET images, cognitive impairment, Alzheimer's disease, brain PET, nuclear medicine, neurology.

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