The Use of Statistical Parametric Mapping (SPM96) as a Decision Aid in the Differential Diagnosis of Dementia Using ^99mTc‐HMPAO SPECT

Abstract

In this study standard patterns of cerebral perfusion based on classifications described in the literature have been chosen and the ability of experienced imaging specialists to categorise the 99m Tc HMPAO SPECT scans of patients referred to the department for investigation of dementia has been compared before and after the calculation of Statistical Parametric Maps (SPM - Wellcome Dept of Cognitive Neurology). The primary aim was to investigate whether SPM is an effective decision aid and whether it impacts on the confidence of image reporting. The secondary aim was to examine the influence of SPM on the agreement between image reporting and clinical diagnosis. The results showed that there was a slight decrease in agreement between the imaging specialists after the introduction of additional information from SPM (K=0.57 to K=0.5) and that agreement between imaging reporting (including information from SPM) and clinical diagnosis was moderate (K=0.28). This study was able to confirm that SPM is capable of producing meaningful significance maps of individual patients in a routine clinical environment. However, there was no overwhelming evidence that SPM was able to resolve many of the dilemmas associated with the use of SPECT for the differential diagnosis of dementia. In particular, interpretation of SPECT perfusion patterns in dementia is a bigger problem than the initial identification of abnormalities.

Frontotemporal dementia: impact of P301L tau mutation on a healthy carrier

“…17 Validation of statistical parametric mapping (SPM) for assessment of functional cerebral changes with SPECT was reported in a simulation study 18 and in a clinical study. 19 Cerebrospinal fluid measurements After obtaining written consent, we collected cerebrospinal fluid (CSF) samples from subject III;10, two patients with sporadic AD and three age matched healthy control (HC) subjects. Levels of Ab1-42 and tau protein in the CSF were determined by enzyme linked immunosorbent assay (Innogenetics, Belgium).…”

Cerebral metabolism and perfusion in MR-negative individuals with refractory focal epilepsy assessed by simultaneous acquisition of 18 F-FDG PET and arterial spin labeling

“…Due to the complexity and variability in the localisation of the epileptic focus, the clinical relevance of different functional alterations needs to be assessed at the individual patient level. Statistical Parametric Mapping [SPM; Wellcome Department of Cognitive Neurology, London, UK] ( Friston et al, 1994 ) and 3D-SSP/Neurostat ( Minoshima et al, 1995 ) are widely used for semi-quantitatively comparing an individual patient to an age-matched normal database, in order to identify areas of statistically altered metabolism or perfusion ( Barnes et al, 2000 , Kim et al, 2002 , Kumar et al, 2010 , Archambaud et al, 2013 ). Nevertheless, unlike 18 F-FDG PET/CT, large datasets from normal subjects are not yet available for 18 F-FDG PET/MR, precluding the possibility to compare patient data to controls and to provide a statistical evaluation of individual patient data.…”

Voxel-Based Investigations of Regional Cerebral Blood Flow Abnormalities in Alzheimers Disease Using a Single-Detector Spect System

“…25,26 This strategy has opened the possibility for using the SPM program in routine, single-case diagnostic applications in Neurology and Psychiatry. 24 Our preliminary results warrant further empirical evaluation as to whether the SPM program could be a useful clinical tool to aid in the assessment of single subjects imaged with onedetector SPECT systems, largely available in routine nuclear medicine services in Brazil.…”