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We studied the diagnostic accuracy of single-photon emission computed tomography(SPECT)with technetium 99m-labeled hexamethylpropylene amine oxime(Tc 99m HMPAO)in 48 patients with probable Alzheimer's disease(AD) according to NINCDS-ADRDA criteria and in 60 controls recruited from a population-based study.With logistic regression,we identified decreased temporal regional cerebral blood flow as the best discriminating variable between patients and controls.Receiver-operator characteristic curves showed that the discriminative ability of SPECT improved with increasing dementia severity.With specificity set at 90%,sensitivity figures were 42% in mild,56%in moderate,and 79%in severe AD.The diagnostic gain as a function of the prior probability of the disease being present was computed for those with mild AD.When the prior probability varied at around 50%,the diagnostic gain for mild AD patients was substantial(a maximum of 34%)for a positive test result but poor for a negative test result.The results suggest that the practical usefulness of SPECT as a diagnostic adjunct in patients suspected of having mild AD is confined to situations in which,on clinical grounds,there is considerable diagnostic doubt. |
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Alzheimer's disease
Alzheimer's disease,diagnosis of
dementia
dementia,diagnostic evaluation of
neurologic disease,diagnoses of
single photon emission computed tomography
single photon emission computed tomography,false negative
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