Feasibility evaluation of middle-phase 18F-florbetaben positron emission tomography imaging using centiloid quantification and visual assessment

Cheng-Han Wu; Yueh-Hsun Lu; Tse-Hao Lee; Chun-Yuan Tu; Jong-Ling Fuh; Yuh-Feng Wang; Bang-Hung Yang

doi:10.21037/qims-23-58

Feasibility evaluation of middle-phase ¹⁸F-florbetaben positron emission tomography imaging using centiloid quantification and visual assessment

Quant Imaging Med Surg. 2023 Aug 1;13(8):4806-4815. doi: 10.21037/qims-23-58. Epub 2023 Jun 14.

Authors

Cheng-Han Wu¹, Yueh-Hsun Lu^{1

2

3}, Tse-Hao Lee⁴, Chun-Yuan Tu^{5

6}, Jong-Ling Fuh^{3

7}, Yuh-Feng Wang^{4

5}, Bang-Hung Yang^{4

8}

Affiliations

¹ Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei.
² Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
³ School of Medicine, National Yang Ming Chiao Tung University, Taipei.
⁴ Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei.
⁵ Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu.
⁶ Association of Medical Radiation Technologists, Taipei.
⁷ Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei.
⁸ Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei.

Abstract

Background: ¹⁸F-florbetaben (FBB) positron emission tomography (PET) scan has been widely used in research and routine clinical practice. Most studies used late-phase (scanning from 90 to 110 min after injection) FBB scans to generate beta-amyloid accumulation data. The feasibility of middle-phase scan is seldom discussed. Using the middle-phase data can shorten the patients' waiting between the injection and scan, and hospital can acquire more flexible schedule of routine scan.

Methods: Paired middle-phase (60-80 min) FBB scans and standard (90-110 min) FBB scans were obtained from 27 subjects (12 neurodegenerative dementia, 8 mild cognitive impairment, 3 normal control, and 4 patients not suffering from neurodegenerative dementia). Standardized uptake value ratios (SUVRs) were calculated and converted to centiloid (CL) scale to investigate the impact on image quantification. CL pipeline validation were performed to build an equation converting the middle-phase data into equivalent standard scans. Cohen's kappa of binary interpretation and brain amyloid plaque load (BAPL) score were also used to evaluate the intrareader agreement of the FBB image from the two protocols.

Results: The middle-phase FBB SUVR showed an excellent correlation, which provided a linear regression equation of SUVR_FBB60-80 = 0.88 × SUVR_FBB90-110 + 0.07, with R²=0.98. The slope of the equation indicated that there was bias between the middle and standard acquisition. This can be converted into the CL scale using CL = 174.68 × SUVR - 166.39. Cohen's kappa of binary interpretation and BAPL score were 1.0 (P<0.0001).

Conclusions: Our findings indicate that the middle-phase FBB protocol is feasible in clinical applications for scans that are at either end of beta-amyloid spectrum, which provides comparable semiquantitative results to standard scan. Patient's waiting time between the injection and scan can be shortened.

Keywords: Florbetaben (FBB); brain amyloid plaque load (BAPL); centiloid (CL); standardized uptake value ratio (SUVR); visual assessment.