Calvini P, Rodriguez G, Inguglia F, et al. The basal ganglia matching tools package for striatal uptake semi-quantification: description and validation
To design a novel algorithm (BasGan) for automatic segmentation of striatal (123)I-FP-CIT SPECT.
The BasGan algorithm is based on a high-definition, three-dimensional (3D) striatal template, derived from Talairach's atlas. A blurred template, obtained by convolving the former with a 3D Gaussian kernel (FWHM = 10 mm), approximates striatal activity distribution. The algorithm performs translations and scale transformation on the bicommissural aligned image to set the striatal templates with standard size in an appropriate initial position. An optimization protocol automatically performs fine adjustments in the positioning of blurred templates to best match the radioactive counts, and locates an occipital ROI for background evaluation. Partial volume effect correction is included in the process of uptake computation of caudate, putamen and background. Experimental validation was carried out by means of six acquisitions of an anthropomorphic striatal phantom. The BasGan software was applied to a first set of patients with Parkinson's disease (PD) versus patients affected by essential tremor.
A highly significant correlation was achieved between true binding potential and measured (123)I activity from the phantom. (123)I-FP-CIT uptake was significantly lower in all basal ganglia in the PD group versus controls with both BasGan and a conventional ROI method used for comparison, but particularly with the former. Correlations with the motor UPDRS score were far more significant with the BasGan.
The novel BasGan algorithm automatically performs the 3D segmentation of striata. Because co-registered MRI is not needed, it can be used by all nuclear medicine departments, since it is freely available on the Web.
Available from: Andrea Ciarmiello
- "MNI space) (Ashburner and Friston, 1999). This process consists in registering an individual scan into a tracer-specific template of controls and then to apply a standardized 3D VOI map to extract regional data and compute semi-quantitative binding ratios (Calvini et al., 2007; Koch et al., 2005). To register a subject scan to a template, specific features of 123 I-FP-CIT images should be taken into account. "
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ABSTRACT: PURPOSE: To test whether the use of a striatum weighted image may improve registration accuracy and diagnostic outcome in patients with parkinsonian syndromes (PS). METHODS: Weighted images were generated by increasing signal intensity of striatal voxels and used as intermediate dataset for co-registering the brain image onto template. Experimental validation was performed using an anthropomorphic striatal phantom. (123) I-FP-CIT SPECT binding ratios were manually determined in 67 PS subjects an and compared to those obtained using unsupervised standard (UWR) and weighted registered (WR) approach. Normalized cost function was used to evaluate the accuracy of phantom and subjects registered images to the template. Reproducibility between unsupervised and manual ratios was assessed by using intra-class correlation coefficient (ICC) and Bland and Altman analysis. Correlation coefficient was used to assess the dependence of semi-quantitative ratios on clinical findings. RESULTS: Weighted method improves accuracy of brain registration onto template as determined by cost function in phantom (0.86 ± 0.06vs.0.98 ± 0.02; Student's t test, P = 0.04) and in subject scans (0.69 ± 0.06vs.0.53 ± 0.06; Student's t test, P < 0.0001). Agreement between manual and unsupervised derived binding ratios as measured by ICC was significantly higher on WR as compared to UWR images (0.91vs.0.76). Motor UPDRS score was significantly correlated with manual and unsupervised derived binding potential. In phantom as well as in subjects studies, correlations were more significant using the WR method (BPm:R(2) = 0.36,p = 0.0001; BPwr:R(2) = 0.368,P = 0.0001; BPuwr:R(2) = 0.300,P = 0.0008). CONCLUSION: Weighted registration improves accuracy of binding potential estimates and may be a promising approach to enhance the diagnostic outcome of SPECT imaging, correlation with disease severity, and for monitoring disease progression in parkinsonian syndromes. © 2013 Wiley Periodicals, Inc.
Available from: Flavio Nobili
- "Comparison amongst studies is difficult because of heterogeneity of the clinical features (disease severity, presence of dementia, and so forth), the kinds of cognitive tests and the methodology used to segment basal ganglia . In a group of 30 de novo, drug-naïve PD patients, we conducted automatic, unsupervised extraction of [123I]-FP-CIT SPECT uptake at caudate and putamen level, as a marker of Dopamine Transporter (DAT), by means of the novel BasGan software, also allowing partial volume effect correction  (Fig. 1). We found a direct correlation between executive functions and caudate uptake in both hemispheres , and an inverse correlation between UPDRS-III and, respectively , putamen uptake in the less affected hemisphere, and both putamen and caudate uptake in the more affected hemisphere. "
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ABSTRACT: Cognitive impairment in Parkinson's disease (PD) and atypical parkinsonian syndromes is gaining increased clinical significance. The neurochemical and neuropathological basis in the various parkinsonian forms and even in an individual patient are not fully elucidated yet and could be heterogeneous. Loss of dopaminergic, cholinergic and noradrenergic innervation has been suggested to be the underlying neurochemical deficits for cognitive impairment and dementia in PD, but the onset of cognitive impairment and the progression to dementia may not share the same underlying neurochemical basis. Similarly, pathological evidence is also heterogeneous, ranging from subcortical pathology, limbic or cortical Lewy body type degeneration, and Alzheimer's type pathology that can be found even in the same patient with PD dementia (PDD). Typically, the prototype of early cognitive deficit in PD is a dysexecutive syndrome, but other cognitive domains are more involved when dementia develops, mainly including visuospatial, language and memory dysfunction. Functional radionuclide neuroimaging, by means of single-photon emission computed tomography and positron emission tomography, are contributing to characterize the topographic cortical pattern of cognitive impairment, as well as to define the underlying neurochemical deficit. Lastly, the advent of amyloid PET may help clarifying the meaning of amyloid load in diffuse Lewy body disease and PDD. Knowing the neurochemical and pathophysiological substrate of cognitive deficit in patients with PD or other degenerative Parkinsonisms may help the clinician in understanding the clinical condition of an individual patient in order to plan pharmacological and non-pharmacological intervention. The introduction of acetylcholinesterase inhibitors for therapy of PDD is an example of information integration between clinical-neuropsychological and pathophysiological-neurochemical aspects obtained also with the key contribution of functional neuroimaging.
Available from: Joseph Classen
- "The LC FP-CIT binding values were for two VOIs (for left and right part of LC) created, using WFU Pick Atlas Tool, through the union of six distinct, contiguous Boxes (of 3 mm on the z axis for each side), centered in the mean values on the x and y axis and dimensioned according to the standard deviation as proposed in Table 1 of Keren and coll., 2009 . FP-CIT binding values for the caudate nucleus (CN) and putamen (PT) were calculated on the basis of VOIs defined with the Basal Ganglia Matching Tool . Student's t-test was then applied. "
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ABSTRACT: Studies in animals suggest that the noradrenergic system arising from the locus coeruleus (LC) and dopaminergic pathways mutually influence each other. Little is known however, about the functional state of the LC in patients with Parkinson disease (PD).
We retrospectively reviewed clinical and imaging data of 94 subjects with PD at an early clinical stage (Hoehn and Yahr stage 1-2) who underwent single photon computed tomography imaging with FP-CIT ([¹²³I] N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane). FP-CIT binding values from the patients were compared with 15 healthy subjects: using both a voxel-based whole brain analysis and a volume of interest analysis of a priori defined brain regions.
Average FP-CIT binding in the putamen and caudate nucleus was significantly reduced in PD subjects (43% and 57% on average, respectively; p < 0.001). In contrast, subjects with PD showed an increased binding in the LC (166% on average; p < 0.001) in both analyses. LC-binding correlated negatively with striatal FP-CIT binding values (caudate: contralateral, ρ = -0.28, p < 0.01 and ipsilateral ρ = -0.26, p < 0.01; putamen: contralateral, ρ = -0.29, p < 0.01 and ipsilateral ρ = -0.29, p < 0.01).
These findings are consistent with an up-regulation of noradrenaline reuptake in the LC area of patients with early stage PD, compatible with enhanced noradrenaline release, and a compensating activity for degeneration of dopaminergic nigrostriatal projections.
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