Semiquantitative analysis using standardized uptake value in ¹²³I-FP-CIT SPECT/CT

To evaluate potential of a semiquantitative method using standardized uptake value (SUV) in ¹²³I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (¹²³I-FP-CIT) single photon emission computed tomography/computed tomography (SPECT/CT) compared with specific binding ratio (SBR).

First, we performed a phantom study to validate the accuracy of measuring SUV. 52 patients (25 male, 27 female; mean age of 75.1-year-old; 40 and 12 patients with neurodegenerative diseases with or without presynaptic dopaminergic deficits, respectively) were enrolled in a retrospective study. We measured SBR, maximum SUV, peak SUV, mean SUV, and striatum-to-background ratio of SUV (SUV_ratio) for striatum with lower ¹²³I-FP-CIT uptake using commercial software. We calculated Pearson's correlation coefficient between SBR and SUV. We also calculated the sensitivity, specificity, and accuracy of each parameter for differential diagnosis.

The phantom study revealed errors of <10% between theoretical and actual SUVs. Although there were significant correlations between SBR and all SUV-based parameters, SUV_ratio showed the most strong correlation with SBR (r = 0.877, p < 0.001). However, diagnostic capability of SUV_ratio (cutoff = 2.35) yielded to that of SBR (cutoff = 3.90) for diagnosing neurodegenerative diseases with presynaptic dopaminergic deficits (sensitivity of 85.0% vs 92.5%, specificity of 100% vs 91.7%, and accuracy of 88.5% vs 92.3%, respectively).

SBR is a promising parameter to aid differential diagnosis of neurodegenerative diseases with or without presynaptic dopaminergic deficit. Although technically acceptable, SUV may not be superior to SBR when clinically applied in ¹²³I-FP-CIT SPECT/CT.