The Image Clarity Paradox: Higher CZT SPECT Contrast Does Not Always Translate to Diagnostic Accuracy for Alzheimer’s Disease

<b>Background</b>: Recent advances in single-photon emission computed tomography (SPECT) technology, particularly cadmium-zinc-telluride (CZT) detectors, have improved spatial resolution and contrast in cerebral blood flow imaging. This study aimed to investigate whether these improvements translate to enhanced diagnostic accuracy for Alzheimer's disease (AD). <b>Methods</b>: We compared conventional SPECT (eCAM) with CZT SPECT in 29 patients (mean age 60.9 ± 17.6 years, 69% female) with suspected neurodegenerative diseases. <b>Results</b>: Gray matter/white matter contrast was significantly higher in CZT SPECT compared to eCAM (1.615 ± 0.096 vs. 1.458 ± 0.068, <i>p</i> < 0.001). However, diagnostic accuracy for AD did not improve with CZT SPECT. For the participating psychiatrist, sensitivity decreased from 0.750 (eCAM) to 0.625 (CZT), while for the radiologist, specificity dropped from 0.571 (eCAM) to 0.429 (CZT). Overall accuracy slightly decreased for both readers. <b>Conclusions</b>: These findings suggest that while CZT SPECT offers superior image quality, it may not immediately translate to improved diagnostic accuracy for AD. The study highlights the importance of specialized training for clinicians in interpreting higher-resolution CZT SPECT images to fully leverage their potential in neurodegenerative disease diagnosis. Future research should focus on developing standardized training protocols and larger, multi-center studies to validate these findings.