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  • 1
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-11-25)
    Abstract: This study used explainable artificial intelligence for data-driven identification of extrastriatal brain regions that can contribute to the interpretation of dopamine transporter SPECT with 123 I-FP-CIT in parkinsonian syndromes. A total of 1306 123 I-FP-CIT-SPECT were included retrospectively. Binary classification as ‘reduced’ or ‘normal’ striatal 123 I-FP-CIT uptake by an experienced reader served as standard-of-truth. A custom-made 3-dimensional convolutional neural network (CNN) was trained for classification of the SPECT images with 1006 randomly selected images in three different settings: “full image”, “striatum only” (3-dimensional region covering the striata cropped from the full image), “without striatum” (full image with striatal region removed). The remaining 300 SPECT images were used to test the CNN classification performance. Layer-wise relevance propagation (LRP) was used for voxelwise quantification of the relevance for the CNN-based classification in this test set. Overall accuracy of CNN-based classification was 97.0%, 95.7%, and 69.3% in the “full image”, “striatum only”, and “without striatum” setting. Prominent contributions in the LRP-based relevance maps beyond the striatal signal were detected in insula, amygdala, ventromedial prefrontal cortex, thalamus, anterior temporal cortex, superior frontal lobe, and pons, suggesting that 123 I-FP-CIT uptake in these brain regions provides clinically useful information for the differentiation of neurodegenerative and non-neurodegenerative parkinsonian syndromes.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2615211-3
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  • 2
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Clinical Nuclear Medicine Vol. 45, No. 2 ( 2020-2), p. 95-99
    In: Clinical Nuclear Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 2 ( 2020-2), p. 95-99
    Abstract: The present study investigated possible associations between cortical dysfunction/degeneration as measured by 18 F-FDG PET and nigrostriatal degeneration according to the specific 123 I-FP-CIT binding ratio (SBR) in striatal subregions defined by striato-cortical anatomical connectivity in Parkinson disease (PD) patients. Materials and Methods The study included 41 patients (61.4 ± 12.8 years) with PD-typical reduction of striatal FP-CIT SBR and no sign of atypical parkinsonian syndrome on FDG PET. FP-CIT SBR was determined separately in the cognitive (composite of executive and limbic) and sensorimotor part of the striatum according to the Oxford-GSK-Imanova Striatal Connectivity Atlas. Scaled FDG uptake was tested voxelwise for correlation with FP-CIT SBR (familywise error corrected P 〈 0.05). Results A large cluster (17.6 mL) of significant correlation of scaled FDG uptake with FP-CIT SBR in the cognitive part of the striatum, corrected for SBR in the sensorimotor part, was detected in the bilateral medial frontal cortex and the anterior cingulate cortex (partial correlation coefficient R = 0.767); small clusters were detected in ipsilateral caudate and ipsilateral thalamus. There was a small contralateral occipital cluster (3.0 mL) of significant correlation between FDG uptake and sensorimotor SBR corrected for cognitive SBR ( R = 0.709). Conclusions The correlation between nigrostriatal degeneration in the cognitive striatum and reduced cerebral glucose metabolism in the medial parts of the frontal cortex including the anterior cingulate suggests that nigrostriatal degeneration is specifically involved in the pathogenesis of cognitive deficits associated with medial frontal dysfunction such as impaired inhibitory control.
    Type of Medium: Online Resource
    ISSN: 1536-0229 , 0363-9762
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2045053-9
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  • 3
    In: Clinical Nuclear Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 4 ( 2020-4), p. 261-266
    Abstract: Cognitive decline in diseases of the Lewy body spectrum (LBS) is linked to dysfunction/degeneration of the basal forebrain (BF). Assessment of glucose metabolism in the BF by FDG PET is hampered by the small size of the BF and limited spatial resolution of conventional PET. This pilot study tested the feasibility of assessing BF glucose metabolism by high-resolution digital PET (dPET). Patients and Methods The retrospective study included 12 LBS patients (61–86 years, 5 demented). Whole-brain stereotactic normalization to anatomical standard space was followed by local stereotactic normalization of a 7 × 7 × 7-cm 3 box around the BF to a custom-made 1 × 1 × 1-mm 3 FDG dPET template. FDG uptake was scaled voxelwise to mean FDG uptake in the pons. Scaled FDG uptake in the BF was compared between demented and nondemented LBS patients and tested for correlation with cortical FDG uptake. Results Scaled FDG uptake in the BF was significantly lower in demented compared with nondemented patients (1.14 ± 0.09 vs 1.25 ± 0.06, P = 0.031). Brain-wide voxel-based testing for correlations with scaled FDG uptake in the BF revealed a large cluster comprising medial and ventrolateral frontal cortex, anterior cingulate cortex, insular cortex, and striatum as well as smaller clusters in motor cortex and occipital cortex ( P 〈 0.001, uncorrected). Conclusions These results suggest that dementia-associated BF degeneration in LBS can be sensitively measured as reduced BF FDG uptake on dPET. More accurate delineation of the BF based on individual high-resolution MRI might be useful to make optimal use of improved spatial resolution of dPET and to correct for possible disease- and age-dependent partial volume effects.
    Type of Medium: Online Resource
    ISSN: 1536-0229 , 0363-9762
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2045053-9
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  • 4
    Online Resource
    Online Resource
    Wiley ; 2019
    In:  Alzheimer's & Dementia Vol. 15, No. 7S_Part_14 ( 2019-07)
    In: Alzheimer's & Dementia, Wiley, Vol. 15, No. 7S_Part_14 ( 2019-07)
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2201940-6
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  • 5
    In: EJNMMI Research, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-08-17)
    Abstract: Multiple-pinhole (MPH) collimators improve the resolution–sensitivity trade-off compared to parallel-hole collimators. This study evaluated the impact of MPH collimators on intra- and between-rater agreement, and on the certainty of visual interpretation in dopamine transporter (DAT)-SPECT. Methods The study included 71 patients (62.1 ± 12.7 y). Two SPECT acquisitions were performed in randomized order after a single injection of 182 ± 9 MBq 123 I-FP-CIT, one with MPH and one with low-energy–high-resolution–high-sensitivity (LEHRHS) collimators. MPH projections were reconstructed with an iterative 3d Monte Carlo algorithm. LEHRHS projections were reconstructed with filtered backprojection (FBP) or with ordered-subsets expectation–maximization and resolution recovery (OSEM). Images were visually evaluated twice by three independent raters with respect to presence/absence of Parkinson-typical reduction of striatal 123 I-FP-CIT uptake using a Likert 6-score (− 3 = clearly normal, …, 3 = clearly reduced). In case of intra-rater discrepancy, an intra-rater consensus was obtained. Intra- and between-rater agreement with respect to the Likert score (6-score and dichotomized score) was characterized by Cohen’s kappa. Results Intra-rater kappa of visual scoring of MPH/LEHRHS-OSEM/LEHRHS-FBP images was 0.84 ± 0.12/0.73 ± 0.06/0.73 ± 0.08 (6-score, mean of three raters) and 1.00 ± 0.00/0.96 ± 0.04/0.97 ± 0.03 (dichotomized score). Between-rater kappa of visual scoring (intra-rater consensus) of MPH/LEHRHS-OSEM/LEHRHS-FBP images was 0.70 ± 0.06/0.63 ± 0.08/0.48 ± 0.05 (6-score, mean of three pairs of raters) and 1.00 ± 0.00/0.92 ± 0.04/0.90 ± 0.06 (dichotomized score). There was a decrease of (negative) Likert scores in normal DAT-SPECT by 0.87 ± 0.18 points from the LEHRHS-OSEM to the MPH setting. The (positive) Likert scores of reduced DAT-SPECT did not change on average. Conclusions MPH collimators improve intra- and between-rater agreement as well as the certainty of the visual interpretation of DAT-SPECT.
    Type of Medium: Online Resource
    ISSN: 2191-219X
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2619892-7
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  • 6
    In: Journal of Alzheimer's Disease, IOS Press, Vol. 77, No. 4 ( 2020-10-13), p. 1609-1622
    Abstract: Background: Positron emission tomography (PET) of the brain with 2-[F-18] -fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.
    Type of Medium: Online Resource
    ISSN: 1387-2877 , 1875-8908
    Language: Unknown
    Publisher: IOS Press
    Publication Date: 2020
    detail.hit.zdb_id: 2070772-1
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  • 7
    In: European Journal of Nuclear Medicine and Molecular Imaging, Springer Science and Business Media LLC, Vol. 46, No. 13 ( 2019-12), p. 2800-2811
    Type of Medium: Online Resource
    ISSN: 1619-7070 , 1619-7089
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2098375-X
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  • 8
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2008
    In:  International Journal of Computer Assisted Radiology and Surgery Vol. 3, No. 1-2 ( 2008-6), p. 105-113
    In: International Journal of Computer Assisted Radiology and Surgery, Springer Science and Business Media LLC, Vol. 3, No. 1-2 ( 2008-6), p. 105-113
    Type of Medium: Online Resource
    ISSN: 1861-6410 , 1861-6429
    RVK:
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2008
    detail.hit.zdb_id: 2235881-X
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  • 9
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2019
    In:  Radiopraxis Vol. 12, No. 04 ( 2019-12), p. E93-E106
    In: Radiopraxis, Georg Thieme Verlag KG, Vol. 12, No. 04 ( 2019-12), p. E93-E106
    Abstract: Deep Learning hat in den letzten Jahren in vielen Bereichen spektakuläre Erfolge erzielt, nicht zuletzt in der medizinischen Bildverarbeitung. Nach einer kurzen Einführung in die grundlegenden Ideen von Deep Learning sollen in diesem Übersichtsartikel einige ausgewählte Anwendungen in der SPECT und PET des Gehirns vorgestellt werden.
    Type of Medium: Online Resource
    ISSN: 1866-1033 , 1866-1041
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
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  • 10
    In: European Journal of Nuclear Medicine and Molecular Imaging, Springer Science and Business Media LLC, Vol. 49, No. 4 ( 2022-03), p. 1176-1186
    Abstract: Deep convolutional neural networks (CNN) provide high accuracy for automatic classification of dopamine transporter (DAT) SPECT images. However, CNN are inherently black-box in nature lacking any kind of explanation for their decisions. This limits their acceptance for clinical use. This study tested layer-wise relevance propagation (LRP) to explain CNN-based classification of DAT-SPECT in patients with clinically uncertain parkinsonian syndromes. Methods The study retrospectively included 1296 clinical DAT-SPECT with visual binary interpretation as “normal” or “reduced” by two experienced readers as standard-of-truth. A custom-made CNN was trained with 1008 randomly selected DAT-SPECT. The remaining 288 DAT-SPECT were used to assess classification performance of the CNN and to test LRP for explanation of the CNN-based classification. Results Overall accuracy, sensitivity, and specificity of the CNN were 95.8%, 92.8%, and 98.7%, respectively. LRP provided relevance maps that were easy to interpret in each individual DAT-SPECT. In particular, the putamen in the hemisphere most affected by nigrostriatal degeneration was the most relevant brain region for CNN-based classification in all reduced DAT-SPECT. Some misclassified DAT-SPECT showed an “inconsistent” relevance map more typical for the true class label. Conclusion LRP is useful to provide explanation of CNN-based decisions in individual DAT-SPECT and, therefore, can be recommended to support CNN-based classification of DAT-SPECT in clinical routine. Total computation time of 3 s is compatible with busy clinical workflow. The utility of “inconsistent” relevance maps to identify misclassified cases requires further investigation.
    Type of Medium: Online Resource
    ISSN: 1619-7070 , 1619-7089
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2098375-X
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