Comparison of automatic versus manual procedures for the quantification of dopamine D2 receptor availability using I-123-IBZM-SPECT

Alexander Heinzel*, Siamak Mohammadkhani Shali, Manuel Dafotakis, Frederik A. Verburg, Felix M. Mottaghy, Oliver H. Winz

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction I-123-IBZM-SPECT is often used to differentiate between idiopathic Parkinson's syndrome and atypical parkinsonian syndromes. The aim of this study was to compare three different procedures to quantify the receptor availability of striatal dopamine D2 receptors. (a) Manual quantification performed using individually adjusted volume of interests sets (mVoi). (b) Automatic quantification applying the commercially available Hermes BRASS software (BRASS). (c) Automatic quantification applying the open-source software IBZM Toolbox (TBX).Materials and methods Using the three methods, we analyzed 100 scans. For the mVOI methods, three different investigators (two experienced, one inexperienced) carried out the analysis. We compared the different methods with each other and with the reference standard established by clinical follow-up. The diagnostic performance was assessed by calculating receiver-operating characteristic (ROC) curves.Results Correlation analyses resulted in the following: mVOI versus BRASS (r(2)=0.694) (P<0.005), mVOI versus TBX (r(2)=0.557) (P<0.005); BRASS versus TBX (r(2)=0.466) (P<0.005). We found a fair agreement for mVOI versus BRASS; slight agreement for mVOI versus TBX; and fair agreement for BRASS versus TBX. Moreover, we found a substantial agreement between the experienced investigators, but not with the inexperienced investigator in the case of mVOI. The ROC analysis shows the largest area under the ROC curve (Az=0.7295) for mVOI, followed by BRASS (Az=0.709) and TBX (Az=0.627).Conclusion In direct comparison, the manual quantification used by experienced observers shows the best results, although it does not differ significantly from the commercial Hermes BRASS software. Both are superior to TBX. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)1120-1126
JournalNuclear Medicine Communications
Issue number11
Publication statusPublished - Nov 2015


  • atypical parkinsonian syndromes
  • Hermes BRASS
  • IBZM Toolbox
  • idiopathic Parkinson's syndrome
  • manual quantification

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