Standardized Uptake Value Ratio-Independent Evaluation of Brain Amyloidosis

Andrea Chincarini, F. Sensi, Luca Rei, I. Bossert, Silvia Daniela Morbelli, Ugo Paolo Guerra, Giovanni Battista Frisoni, A. Padovani, Flavio Nobili

Research output: Contribution to journalArticlepeer-review


The assessment of in vivo 18F images targeting amyloid deposition is currently carried on by visual rating with an optional quantification based on standardized uptake value ratio (SUVr) measurements. We target the difficulties of image reading and possible shortcomings of the SUVr methods by validating a new semi-quantitative approach named ELBA. ELBA involves a minimal image preprocessing and does not rely on small, specific regions of interest (ROIs). It evaluates the whole brain and delivers a geometrical/intensity score to be used for ranking and dichotomic assessment. The method was applied to adniimages 18F-florbetapir images from the ADNI database. Five expert readers provided visual assessment in blind and open sessions. The longitudinal trend and the comparison to SUVr measurements were also evaluated. ELBA performed with area under the roc curve (AUC) = 0.997 versus the visual assessment. The score was significantly correlated to the SUVr values (r = 0.86, p < 10-4). The longitudinal analysis estimated a test/retest error of ≃2.3. Cohort and longitudinal analysis suggests that the ELBA method accurately ranks the brain amyloid burden. The expert readers confirmed its relevance in aiding the visual assessment in a significant number (85) of difficult cases. Despite the good performance, poor and uneven image quality constitutes the major limitation.

Original languageEnglish
Pages (from-to)1437-1457
Number of pages21
JournalJournal of Alzheimer's Disease
Issue number4
Publication statusPublished - Oct 18 2016


  • Alzheimer's disease
  • amyloid
  • image analysis
  • mild cognitive impairment
  • PET
  • standardized uptake value ratio

ASJC Scopus subject areas

  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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