Reference cluster normalization improves detection of frontotemporal lobar degeneration by means of FDG-PET

PLoS One. 2013;8(2):e55415. doi: 10.1371/journal.pone.0055415. Epub 2013 Feb 25.

Abstract

Positron emission tomography with [18F] fluorodeoxyglucose (FDG-PET) plays a well-established role in assisting early detection of frontotemporal lobar degeneration (FTLD). Here, we examined the impact of intensity normalization to different reference areas on accuracy of FDG-PET to discriminate between patients with mild FTLD and healthy elderly subjects. FDG-PET was conducted at two centers using different acquisition protocols: 41 FTLD patients and 42 controls were studied at center 1, 11 FTLD patients and 13 controls were studied at center 2. All PET images were intensity normalized to the cerebellum, primary sensorimotor cortex (SMC), cerebral global mean (CGM), and a reference cluster with most preserved FDG uptake in the aforementioned patients group of center 1. Metabolic deficits in the patient group at center 1 appeared 1.5, 3.6, and 4.6 times greater in spatial extent, when tracer uptake was normalized to the reference cluster rather than to the cerebellum, SMC, and CGM, respectively. Logistic regression analyses based on normalized values from FTLD-typical regions showed that at center 1, cerebellar, SMC, CGM, and cluster normalizations differentiated patients from controls with accuracies of 86%, 76%, 75% and 90%, respectively. A similar order of effects was found at center 2. Cluster normalization leads to a significant increase of statistical power in detecting early FTLD-associated metabolic deficits. The established FTLD-specific cluster can be used to improve detection of FTLD on a single case basis at independent centers - a decisive step towards early diagnosis and prediction of FTLD syndromes enabling specific therapies in the future.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Fluorodeoxyglucose F18*
  • Frontotemporal Lobar Degeneration / diagnosis*
  • Humans
  • Male
  • Positron-Emission Tomography / methods*

Substances

  • Fluorodeoxyglucose F18

Grants and funding

Henryk Barthel, Osama Sabri and Matthias L. Schroeter are supported by the Leipzig Research Center for Civilization Diseases (LIFE) at the University of Leipzig. LIFE is funded by the European Union, the European Regional Development Fund (ERFD) and the Free State of Saxony within the framework of the excellence initiative. Matthias L. Schroeter, Robert Perneczky, Alexander Kurz and Janine Diehl-Schmid are also supported by the German consortium for frontotemporal lobar degeneration, funded by the German Federal Ministry of Education and Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.