Prediction of 123I-FP-CIT SPECT Results from First Acquired Projections Using Artificial Intelligence

<b>Background/Objectives:</b> 123I-FP-CIT dopamine transporter imaging is commonly used for the diagnosis of Parkinsonian syndromes in patients whose clinical presentation is atypical. Prolonged immobility, which can be difficult to maintain in this population, is required to perform SPECT acquisition. In this study we aimed to develop a Convolutional Neural Network (CNN) able to predict the outcome of the full examination based on the first acquired projection, and reliably detect normal patients. <b>Methods:</b> All 123I-FP-CIT SPECT performed in our center between June 2017 and February 2024 were included and split between a training and a validation set (70%/30%). An additional 100 SPECT were used as an independent test set. Examinations were labeled by two independent physicians. A VGG16-like CNN model was trained to assess the probability of examination abnormality from the first acquired projection (anterior and posterior view at 0°), taking age into consideration. A threshold maximizing sensitivity while maintaining good diagnostic accuracy was then determined. The model was validated in the independent testing set. Saliency maps were generated to visualize the most impactful areas in the classification. <b>Results:</b> A total of 982 123I-FP-CIT SPECT were retrieved and labelled (training set: 618; validation set: 264; independent testing set: 100). The trained model achieved a sensibility of 98.0% and a negative predictive value of 96.3% (one false negative) while maintaining an accuracy of 75.0%. The saliency maps confirmed that the regions with the greatest impact on the final classification corresponded to clinically relevant areas (basal ganglia and background noise). <b>Conclusions:</b> Our results suggest that this trained CNN could be used to exclude presynaptic dopaminergic loss with high reliability from the first acquired projection. It could be particularly useful in patients with compliance issues. Confirmation with images from other centers will be necessary.