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Precis Future Med > Epub ahead of print
DOI: https://doi.org/10.23838/pfm.2021.00023    [Epub ahead of print]
Published online June 8, 2021.
Finding the optimal cutoff value for amyloid β positivity using the iterative outlier method and concordance rate
Hang-Rai Kim1,2,3,4  , Yeong Sim Choe1,2,3,5  , Seung Hwan Moon6  , Hee Jin Kim1,2,3,5  , Hyemin Jang1,2,3  , Duk L.Na1,2,3,5,7  , Seongbeom Park8  , Sang Won Seo1,2,3,5,9, 
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Neuroscience Center, Samsung Medical Center, Seoul, Korea
3Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
4Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
5Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
6Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
7Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
8Heuron Co. Ltd., Incheon, Korea
9Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
10Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
Correspondence  Sang Won Seo ,Tel: +82-2-3410-1233, Email: sangwonseo@empal.com
Submitted: January 25, 2021  Accepted after revision: May 3, 2021
*Hang-Rai Kim and Yeong Sim Choe contributed equally to this study as co-first authors.
Abstract
Purpose
The purpose of this study was to calculate the cutoff value for amyloid β (Aβ) positron emission tomography (PET) positivity using the iterative outlier method and to evaluate its validity based on the concordance rate.
Methods
We performed the iterative outlier method on 373 cognitively unimpaired (CU) subjects and calculated the optimal cutoff value for Aβ positivity. The validation was performed using the independent dataset, comprising 83 subjects (27 CU, 27 amnestic mild cognitive impairment, and 29 Alzheimer’s dementia). We evaluated the validity of the Aβ cutoff value by calculating its concordance rate with the visual assessment and between two different Aβ tracers performed in the same subject.
Results
The concordance rate of Aβ cutoff values with the visual assessment ranged from 84.3% to 91.5%, depending on the reference regions. The concordance rate of the cutoff values between the two Aβ tracers ranged from 90.3% to 97.5%, all of which were higher than that of the visual assessment (86.7%).
Conclusion
We demonstrated that the iterative outlier method could identify the cutoff value for Aβ PET positivity.
Keywords: Alzheimer disease; Amyloid; Positron-emission tomography
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