Clinical utility of the normal database of ¹²³I-iodoamphetamine brain perfusion single photon emission computed tomography for statistical analysis using computed tomography-based attenuation correction: a multicenter study

Objectives: We have established a common normal database (NDB) with applicability in multicenter settings for the statistical analysis of brain perfusion single photon emission computed tomography (SPECT) with triple energy window scatter correction, computed tomography-based attenuation correction (CTAC), and spatial resolution compensation. This study aimed to compare the CTAC normal database (CTAC-NDB) with conventional normal databases for the statistical analysis of ¹²³I-iodoamphetamine (¹²³I-IMP) brain perfusion SPECT at three institutions and to assess the clinical efficiency of CTAC-NDB. Methods: We recruited 45 patients (26 men and 19 women; mean age, 74.2 ± 3.9 years; Mini-Mental State Examination score, 19.8 ± 6.1) with Alzheimer’s disease (AD, n = 26), dementia with Lewy bodies (DLB, n = 9), and mild cognitive impairment (n = 10) from three institutions. Three-dimensional stereotactic surface projection (3D-SSP) technique was used to analyze data obtained from the ¹²³I-IMP brain perfusion SPECT images compared with both CTAC-NDB and conventional NDB. We visually assessed each 3D-SSP z score map to determine the changes in specific findings, such as AD/DLB pattern. Furthermore, the stereotactic extraction estimation analysis software was used to measure the regional z score severity and extent as a semiquantitative assessment. Results: In the visual assessment, all cases exhibited clearer findings with CTAC-NDB than with conventional NDB in the parietotemporal association cortex as well as in the inferior temporal, frontal, and lateral occipital cortices. Contrarily, the findings from the medial cerebral regions, including the precuneus and the posterior cingulate, became indistinct in 71% of the cases and remained unchanged in 25% of the cases. In the semiquantitative analysis, a similar tendency was observed in the mean z score in the three institutions included in the study. Conclusion: Using the CTAC-NDB, the findings in the vicinity of the cranium became increasingly clear, whereas those in the medial surface of the brain became less defined or remained unchanged. These findings were confirmed via a semiquantitative analysis. Moreover, similar changes in the reduction pattern were observed in the three institutions. Therefore, the new database with CTAC might be applicable in other institutions. Data collected in this study may serve as a CTAC-NDB.