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Evaluation of a Sensitive Visual Read Algorithm for Assessing 3R/4R Tau PET Images

Smith, Ruben LU ; Garibotto, Valentina ; Hägerström, Douglas LU ; Jögi, Jonas LU orcid ; Ohlsson, Tomas ; Strandberg, Olof LU ; Tonietto, Matteo LU ; Janelidze, Shorena LU ; Palmqvist, Sebastian LU orcid and Stomrud, Erik LU orcid , et al. (2025) In Journal of nuclear medicine : official publication, Society of Nuclear Medicine 66(11). p.1764-1770
Abstract

Developing and validating sensitive visual read algorithms for assessing Alzheimer disease-related tau in tau PET imaging is imperative, considering the implementation of the methodology in clinical practice and trials. Our aim was to compare 2 visual read algorithms for tau PET images to semiquantitative measurements and plasma phospho-tau 217 (p-tau217) status. Methods: In total, 1,654 participants were consecutively recruited from secondary memory clinics in southern Sweden as part of the prospective BioFINDER-2 cohort study (May 2017-September 2023). All participants underwent [18F]RO948 scans, and 37 participants underwent an additional [18F]flortaucipir scan. PET scans were read visually in accordance with the BioFINDER visual... (More)

Developing and validating sensitive visual read algorithms for assessing Alzheimer disease-related tau in tau PET imaging is imperative, considering the implementation of the methodology in clinical practice and trials. Our aim was to compare 2 visual read algorithms for tau PET images to semiquantitative measurements and plasma phospho-tau 217 (p-tau217) status. Methods: In total, 1,654 participants were consecutively recruited from secondary memory clinics in southern Sweden as part of the prospective BioFINDER-2 cohort study (May 2017-September 2023). All participants underwent [18F]RO948 scans, and 37 participants underwent an additional [18F]flortaucipir scan. PET scans were read visually in accordance with the BioFINDER visual read (BF-VR) protocol and the established visual read method for [18F]flortaucipir (FTP-VR). Comparative analyses were conducted with semiquantitative SUV ratios (SUVRs) in the entorhinal cortex (ERC) and a temporal meta-region of interest and with plasma p-tau217 status. The primary endpoints of the study included the accuracy of visual read algorithms in detecting increases in semiquantitative SUVRs and p-tau217. Secondary outcomes included the intrarater and interrater reliabilities of the BF-VR. Results: Both visual read methods exhibited strong concordance with semiquantitative SUVRs. However, the BF-VR method demonstrated superior accuracy for tau in the ERC (93.9%; 95% CI, 92.6%-95.0%) compared with the FTP-VR method (89.9%; 95% CI, 88.3%-91.3%; P < 0.0001). The BF-VRs displayed lower accuracy when detecting tau in the temporal meta-region of interest (91.8%; 95% CI, 90.4%-93.1%) compared with the FTP-VRs (94.7%; 95% CI, 93.6%-95.8%; P = 0.002). Further, the BF-VRs exhibited similar accuracy (0.866; 95% CI, 0.847-0.884) to the FTP-VRs (0.857; 95% CI, 0.837-0.875; P = 0.54) for detection of p-tau217 abnormality. The interrater reliability of the BF-VR algorithm was excellent (weighted Cohen κ, 0.87; range, 0.82-0.93), and intrarater reliability was almost perfect (Cohen κ, 0.94; range, 0.89-0.98). The concordance of the BF-VR assessments of [18F]RO948 and [18F]flortaucipir images was excellent (Cohen κ, 0.94; range, 0.86-1.00). Conclusion: Visual reads offer a straightforward method for evaluating tau PET scans. The BF-VR algorithm provides a more accurate algorithm for detecting tau uptake in the ERC compared with the established FTP-VR algorithm and exhibits similar performance when using [18F]RO948 and [18F]flortaucipir images. The BF-VR algorithm further showed excellent interrater and intrarater reliabilities.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
AD, biomarkers, diagnostic accuracy, tau PET, visual read
in
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
volume
66
issue
11
pages
7 pages
publisher
Society of Nuclear Medicine Inc.
external identifiers
  • scopus:105020790365
  • pmid:40908124
ISSN
0161-5505
DOI
10.2967/jnumed.125.269685
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 by the Society of Nuclear Medicine and Molecular Imaging.
id
63b9fd7d-612f-4129-996d-3a155a498f8c
date added to LUP
2025-12-11 14:44:33
date last changed
2025-12-12 03:24:21
@article{63b9fd7d-612f-4129-996d-3a155a498f8c,
  abstract     = {{<p>Developing and validating sensitive visual read algorithms for assessing Alzheimer disease-related tau in tau PET imaging is imperative, considering the implementation of the methodology in clinical practice and trials. Our aim was to compare 2 visual read algorithms for tau PET images to semiquantitative measurements and plasma phospho-tau 217 (p-tau217) status. Methods: In total, 1,654 participants were consecutively recruited from secondary memory clinics in southern Sweden as part of the prospective BioFINDER-2 cohort study (May 2017-September 2023). All participants underwent [18F]RO948 scans, and 37 participants underwent an additional [18F]flortaucipir scan. PET scans were read visually in accordance with the BioFINDER visual read (BF-VR) protocol and the established visual read method for [18F]flortaucipir (FTP-VR). Comparative analyses were conducted with semiquantitative SUV ratios (SUVRs) in the entorhinal cortex (ERC) and a temporal meta-region of interest and with plasma p-tau217 status. The primary endpoints of the study included the accuracy of visual read algorithms in detecting increases in semiquantitative SUVRs and p-tau217. Secondary outcomes included the intrarater and interrater reliabilities of the BF-VR. Results: Both visual read methods exhibited strong concordance with semiquantitative SUVRs. However, the BF-VR method demonstrated superior accuracy for tau in the ERC (93.9%; 95% CI, 92.6%-95.0%) compared with the FTP-VR method (89.9%; 95% CI, 88.3%-91.3%; P &lt; 0.0001). The BF-VRs displayed lower accuracy when detecting tau in the temporal meta-region of interest (91.8%; 95% CI, 90.4%-93.1%) compared with the FTP-VRs (94.7%; 95% CI, 93.6%-95.8%; P = 0.002). Further, the BF-VRs exhibited similar accuracy (0.866; 95% CI, 0.847-0.884) to the FTP-VRs (0.857; 95% CI, 0.837-0.875; P = 0.54) for detection of p-tau217 abnormality. The interrater reliability of the BF-VR algorithm was excellent (weighted Cohen κ, 0.87; range, 0.82-0.93), and intrarater reliability was almost perfect (Cohen κ, 0.94; range, 0.89-0.98). The concordance of the BF-VR assessments of [18F]RO948 and [18F]flortaucipir images was excellent (Cohen κ, 0.94; range, 0.86-1.00). Conclusion: Visual reads offer a straightforward method for evaluating tau PET scans. The BF-VR algorithm provides a more accurate algorithm for detecting tau uptake in the ERC compared with the established FTP-VR algorithm and exhibits similar performance when using [18F]RO948 and [18F]flortaucipir images. The BF-VR algorithm further showed excellent interrater and intrarater reliabilities.</p>}},
  author       = {{Smith, Ruben and Garibotto, Valentina and Hägerström, Douglas and Jögi, Jonas and Ohlsson, Tomas and Strandberg, Olof and Tonietto, Matteo and Janelidze, Shorena and Palmqvist, Sebastian and Stomrud, Erik and Klein, Gregory and Hansson, Oskar}},
  issn         = {{0161-5505}},
  keywords     = {{AD; biomarkers; diagnostic accuracy; tau PET; visual read}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{11}},
  pages        = {{1764--1770}},
  publisher    = {{Society of Nuclear Medicine Inc.}},
  series       = {{Journal of nuclear medicine : official publication, Society of Nuclear Medicine}},
  title        = {{Evaluation of a Sensitive Visual Read Algorithm for Assessing 3R/4R Tau PET Images}},
  url          = {{http://dx.doi.org/10.2967/jnumed.125.269685}},
  doi          = {{10.2967/jnumed.125.269685}},
  volume       = {{66}},
  year         = {{2025}},
}