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Applications of Receiver Operating Characteristic (ROC) Analysis in Nuclear Cardiology and Neurology: A Narrative Review


Authors : S. Kumar; N. Anbazhagan; R. V. Rithika; C. Sankar

Volume/Issue : Volume 11 - 2026, Issue 9 - September


Google Scholar : https://tinyurl.com/4rh6k639

DOI : https://doi.org/10.38124/ijisrt/26sep337

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.


Abstract : Background: Receiver operating characteristic (ROC) analysis and the area under the curve (AUC) are the principal quantitative tools used to establish diagnostic thresholds in nuclear cardiology and neuroimaging, allowing comparison of imaging modalities and biomarkers independent of an arbitrarily chosen cut-point.  Objective: To synthesise the methodological basis of ROC/AUC analysis and to review its principal clinical applications in nuclear cardiology (myocardial perfusion imaging, absolute myocardial blood flow, and myocardial flow reserve) and nuclear neurology (amyloid and tau positron emission tomography [PET] and amino-acid PET in neuro-oncology).  Methods: A narrative review was conducted of the peer-reviewed literature indexed in PubMed/MEDLINE, Embase and Scopus supplemented by hand-searching of reference lists, covering methodological ROC literature and diagnostic-accuracy studies in nuclear cardiology and nuclear neurology.

Keywords : ROC Curve; Area Under the Curve; Diagnostic Accuracy; Nuclear Cardiology; Myocardial Perfusion Imaging; Nuclear Neurology; Positron Emission Tomography; Amyloid; Tau; Neuro-Oncology.

References :

    1. Metz CE. Basic principles of ROC analysis. Semin Nucl Med. 1978;8(4):283-298.
    2. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29-36.
    3. Obuchowski NA, Bullen JA. Receiver operating characteristic (ROC) curves: review of methods with applications in diagnostic medicine. Phys Med Biol. 2018;63(7):07TR01.
    4. Zhou XH, Obuchowski NA, McClish DK. Statistical Methods in Diagnostic Medicine. 2nd ed. Hoboken: John Wiley & Sons; 2011.
    5. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32-35.
    6. Perkins NJ, Schisterman EF. The inconsistency of optimal cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163(7):670-675.
    7. Pepe MS. The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford: Oxford University Press; 2003.
    8. Park SH, Goo JM, Jo CH. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Korean J Radiol. 2004;5(1):11-18.
    9. Obuchowski NA. ROC analysis in diagnostic imaging: basic principles and advanced MRMC designs. AJR Am J Roentgenol. 2005;184(2):364-372.
    10. Gur D, Bandos AI, Rockette HE. Comparing image modalities: ROC, LROC, and FROC analyses. AJR Am J Roentgenol. 2008;191(6):1611-1615.
    11. Chakraborty DP. Observer Performance Methods for Diagnostic Imaging: Foundations, Historical Development, and Future Directions. Boca Raton: CRC Press; 2017.
    12. Dorfman DD, Berbaum KS, Metz CE. Receiver operating characteristic rating analysis: generalization to the population of readers and patients with the jackknife method. Invest Radiol. 1992;27(9):723-731.
    13. Obuchowski NA, McClish DK. Sample size determination for diagnostic accuracy studies involving binormal ROC curves. Stat Med. 1997;16(13):1529-1542.
    14. Hillis SL. A unified formulation of DBM and OR methods for multireader multicase ROC analysis. Acad Radiol. 2014;21(12):1458-1468.
    15. Hillis SL, Berbaum KS, Metz CE. Recent developments in the Dorfman-Berbaum-Metz approach to multireader multicase ROC data analysis. Acad Radiol. 2008;15(5):647-661.
    16. McClish DK. Analyzing a portion of the ROC curve. Med Decis Making. 1989;9(3):190-195.
    17. Dodd LE, Pepe MS. Partial area under the receiver operating characteristic curve. Biometrics. 2003;59(3):614-623.
    18. Begg CB, Greenes RA. Assessment of diagnostic tests when verification is subject to selection bias. Biometrics. 1983;39(1):207-215.
    19. Walter SD. Properties of the summary receiver operating characteristic (SROC) curve for diagnostic test data. Stat Med. 2002;21(9):1237-1256.
    20. Bandos AI, Rockette HE, Song T, Gur D. Area under the free-response ROC curve (FROC) and its estimation. Acad Radiol. 2009;16(1):98-106.
    21. Chakraborty DP, Yoon HJ. Operating characteristics of lesion detection in medical imaging. Phys Med Biol. 2008;53(15):3901-3921.
    22. Popescu LM. Non-parametric signal detection evaluation in spatial location-dependent imaging (LROC): applications to PET/CT. Phys Med Biol. 2011;56(4):1215-1231.
    23. Abbey CK, Eckstein MP. Observer models as a surrogate for human performance in medical imaging ROC tasks. Acad Radiol. 2002;9(1):49-60.
    24. Barrett HH, Yao J, Rolland JP, Myers KJ. Model observers for assessment of image quality in SPECT and PET. J Opt Soc Am A. 1993;10(5):892-901.
    25. King MA, deVries DJ, Pan TS. Tomographic image reconstruction and evaluation in nuclear medicine using channels and model observers. IEEE Trans Nucl Sci. 1997;44(3):1302-1308.
    26. Zhou XH. Correcting for verification bias in ROC analysis of diagnostic tests in nuclear medicine. Stat Med. 1998;17(12):1371-1383.
    27. Gonen M. Analyzing Receiver Operating Characteristic Curves with SAS. Cary: SAS Institute; 2007.
    28. Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ, Harbinson M, et al. Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging. 2004;31(2):261-291.
    29. Di Carli MF, Murthy VL. Cardiac PET/CT for the evaluation of ischemic heart disease: quantitative perfusion and ROC validation. Curr Cardiol Rep. 2011;13(2):123-133.
    30. Slomka PJ, Dey D, Sitek A, Ke Q, Berman DS, Germano G. Automated approaches to image availability and quantification in cardiac PET and SPECT: ROC metrics. J Nucl Cardiol. 2017;24(3):980-994.
    31. Camici PG, Rimoldi O. The clinical value of myocardial blood flow measurement. J Nucl Med. 2009;50(7):1076-1087.
    32. Schindler TH, Schelbert HR, Quercioli A, Dilsizian V. Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging. 2010;3(6):623-640.
    33. Bateman TM, Heller GV, McGhie AI, O'Keefe JH, Case JA, Garske WH, et al. Diagnostic accuracy of 82Rb PET myocardial perfusion imaging vs 99mTc-sestamibi SPECT: a multicenter MRMC ROC study. J Nucl Cardiol. 2006;13(1):24-33.
    34. McArdle BA, Dowsley TF, deKemp RA, Wells GA, Beanlands RS, Chow BJ. Does Rb-82 PET have superior diagnostic accuracy compared to Tl-201 and Tc-99m SPECT for ischemic heart disease? A systematic review and ROC meta-analysis. J Am Coll Cardiol. 2012;60(18):1828-1837.
    35. Nandalur KR, Dwamena BA, Choudhri AF, Nandalur MR, Carlos RC. Diagnostic performance of positron emission tomography in the detection of coronary artery disease: a meta-analysis. Atherosclerosis. 2008;198(1):32-40.
    36. Jaarsma C, Schwitter J, Timmis AD, Bramer WM, Yu J, Nieman K, et al. Diagnostic performance of noninvasive imaging tests in patients with stable coronary artery disease: a meta-analysis. Eur Heart J. 2012;33(20):2580-2589.
    37. Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of calcium scoring and noninvasive coronary angiography in patients with suspected coronary artery disease: an ROC meta-analysis. J Am Coll Cardiol. 2012;59(17):1538-1549.
    38. Danad I, Raijmakers PG, Appelman Y, Harms HJ, de Haan S, Lubberink M, et al. Hybrid PET/CT imaging in the diagnosis of ischemic heart disease: ROC comparison with invasive angiography. J Am Coll Cardiol. 2013;61(12):1280-1290.
    39. Klocke FR, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging. J Am Coll Cardiol. 2003;42(7):1318-1333.
    40. Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging. J Am Coll Cardiol. 2009;53(23):2201-2229.
    41. Sharir T, Slomka PJ, Hayes SW, DiCarli MF, Berman DS. Multicenter trial of attenuation-corrected 99mTc-sestamibi SPECT myocardial perfusion imaging: ROC evaluation. J Nucl Med. 2004;45(1):21-28.
    42. Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: optimized ROC performance. Eur Heart J. 2010;31(5):600-608.
    43. Fiechter M, Ghadri JR, Wolfrum M, Patriki D, Ackermann F, Haegeli LM, et al. Diagnostic value of quantitative CZT-SPECT myocardial perfusion imaging: ROC evaluation against invasive fractional flow reserve. Eur Heart J Cardiovasc Imaging. 2015;16(5):505-511.
    44. Dorbala S, Di Carli MF, Beanlands RS, Merhige ME, Williams KA, Veledar E, et al. Prognostic value of stress myocardial blood flow ratio in cardiac Rb-82 PET: ROC analysis. JACC Cardiovasc Imaging. 2013;6(2):251-258.
    45. Merhige ME, Breen WJ, Shelton V, Houston T, D'Arcy BJ, Perna SJ. Assessment of myocardial perfusion and vascular reactivity with 82Rb PET: ROC discrimination of clinical events. J Nucl Med. 2007;48(7):1069-1076.
    46. Yoshinaga K, Chow BJ, Williams K, Chen L, deKemp RA, Garrard L, et al. What is the optimal cutoff value of myocardial blood flow for diagnosing triple-vessel disease? An ROC analysis with 82Rb PET. J Nucl Med. 2006;47(12):1922-1929.
    47. Garcia EV, DePuey EG, Sonnemaker RE, Gallimore X, DeJong R, Folks R, et al. Quantitative attenuation-corrected SPECT myocardial perfusion imaging: ROC multi-center trial. J Nucl Cardiol. 2007;14(5):666-675.
    48. Slomka PJ, Nishina H, Berman DS, Kang X, Akincioglu C, Englobel H, et al. Automated quantification of myocardial perfusion SPECT using simplified normal databases: ROC validation. J Nucl Med. 2005;46(8):1243-1251.
    49. Gimelli A, Bottai M, Genovesi D, Giorgetti A, Marzullo P, L'Abbate A. High diagnostic accuracy of dedicated CZT camera in patients with suspected coronary artery disease: ROC comparison. Eur J Nucl Med Mol Imaging. 2011;38(10):1890-1898.
    50. Nakazato R, Berman DS, Dey D, Le Meunier L, Hayes SW, Thomson LE, et al. Automated quantitative SPECT perfusion for detection of coronary artery disease: ROC threshold assessment. J Nucl Cardiol. 2013;20(4):599-609.
    51. Gould KL, Johnson NP, Bateman TM, Beanlands RS, Clerc OF, DePuey EG, et al. Anatomical versus physiological assessment of coronary artery disease: PET myocardial blood flow cutoff optimization. J Am Coll Cardiol. 2013;62(18):1639-1653.
    52. Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, Di Carli MF. Improved risk stratification of patients with coronary artery disease using absolute myocardial blood flow quantification: ROC thresholds. Circulation. 2011;124(20):2215-2224.
    53. Herzog BA, Husmann L, Valenta I, Gaemperli O, Siegrist PT, Tay FM, et al. Determinants of myocardial blood flow in healthy humans: ROC analysis of physiological ranges. Eur J Nucl Med Mol Imaging. 2008;35(4):720-727.
    54. Lortie M, Beanlands RS, Yoshinaga K, Klein R, DaSilva JN, deKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET: ROC validation of kinetic models. Eur J Nucl Med Mol Imaging. 2007;34(11):1765-1774.
    55. Danad I, Raijmakers PG, Harms HJ, Lubberink M, van Royen N, Voskuil M, et al. Determination of absolute myocardial blood flow with 15O-water PET: ROC threshold for ischemia. JACC Cardiovasc Imaging. 2014;7(6):546-555.
    56. Patel KK, Spertus JA, Chan PS, Sperry BW, Thompson RC, Al-Mallah MH, et al. Extent of myocardial ischemia on PET and benefit of revascularization: ROC threshold analysis. J Am Coll Cardiol. 2019;74(13):1645-1654.
    57. Ziadi MC, deKemp RA, Williams KA, Guo A, Chow BJ, Renaud JM, et al. Impaired myocardial flow reserve on Rubidium-82 PET imaging predicts adverse cardiac events: ROC analysis. J Am Coll Cardiol. 2011;58(7):740-748.
    58. Fukushima K, Javadi MS, Higuchi T, Lautamäki R, Merrill J, Nekolla SG, et al. Absolute myocardial blood flow determination with 82Rb PET: ROC cutoffs for cardiac event prediction. J Am Coll Cardiol. 2011;58(14):1471-1477.
    59. Kajander S, Joutsiniemi E, Saraste M, Ukkonen H, Saraste A, Sipilä HT, et al. Cardiac positron emission tomography/computed tomography imaging in reasonable detection of coronary artery disease: ROC threshold study. J Am Coll Cardiol. 2010;55(16):1709-1716.
    60. Taqueti VR, Hachamovitch R, Murthy VL, Naya M, Foster CR, Hainer J, et al. Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity: ROC stratification. Circulation. 2015;131(1):19-27.
    61. Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Neurology. 2001;56(9):1143-1153.
    62. Minoshima S, Giordani B, Berent S, Frey KA, Foster NL, Kuhl DE. Metabolic reduction in the posterior cingulate cortex in early Alzheimer's disease: ROC analysis of 18F-FDG PET maps. Ann Neurol. 1997;42(1):85-94.
    63. Silverman DH, Small GW, Chang CY, Lu CS, Kung De Aburto MA, Chen W, et al. Positron emission tomography in evaluation of dementia: Regional brain metabolism and ROC performance. JAMA. 2001;286(17):2120-2127.
    64. Bohnen NI, D'Amato CJ, Gilman S, Giordani B, Aldrich MS, Frey KA. Diagnostic accuracy of FDG PET in dementia with Lewy bodies: an ROC pathology-validated study. Brain. 2003;126(6):1391-1398.
    65. Mosconi L, Tsui WH, Herholz K, Pupi A, Drzezga A, Lucignani G, et al. Multicenter standardized 18F-FDG PET diagnosis of mild cognitive impairment and Alzheimer's disease: ROC analysis. Eur J Nucl Med Mol Imaging. 2008;35(11):2090-2102.
    66. Klunk WE, Engler H, Nordberg A, Wang Y, Blomqvist G, Holt DP, et al. Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B: ROC evaluation of cortical binding ratios. Ann Neurol. 2004;55(3):306-319.
    67. Clark CM, Schneider JA, Bedell BJ, Beach TG, Bilker WB, Mintun MA, et al. Use of florbetapir-PET for imaging amyloid pathology in Alzheimer disease: a multicenter study and ROC validation. JAMA. 2011;305(3):275-283.
    68. Johnson KA, Sperling RA, Gidicsin CM, Carmasin JS, Maye JE, Coleman RE, et al. Florbetapir (18F) PET in amyloid imaging: threshold determination for cortical SUVr. Brain. 2012;135(11):3399-3408.
    69. Sabri O, Seibyl J, Gottlieb K, Opanasoglu R, Sabri O, Barthel H. 18F-Florbetaben PET imaging for detection of brain amyloid plaques: multi-reader multi-case (MRMC) ROC study. Alzheimers Dement. 2015;11(8):964-974.
    70. Curtis C, Gamez JE, Singh U, Sadowsky CH, Villena T, Sabbagh MN, et al. Phase 3 trial of flutemetamol labeled with fluorine 18 imaging and neuritic plaque pathology: ROC cutoffs. JAMA Neurol. 2015;72(3):287-294.
    71. Ikonomovic MD, Klunk WE, Abrahamson EE, Mathis CA, Price JC, Tsopelas ND, et al. Post-mortem verification of 11C-PiB amyloid-binding in a patient in the PIB-PET study: ROC validation. Brain. 2008;131(6):1630-1645.
    72. Clark CM, Pontecorvo MJ, Beach TG, Bedell BJ, Coleman RE, Doraiswamy PM, et al. Cerebral PET with florbetapir F 18 and postmortem amyloid etiology: ROC autopsy validation. Lancet Neurol. 2012;11(8):669-678.
    73. Villemagne VL, Burnham S, Bourgeat P, Brown B, Ellis KA, Salvado O, et al. Amyloid β deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer's disease: ROC timeline models. Lancet Neurol. 2013;12(4):357-367.
    74. Fleisher AS, Chen K, Liu X, Roontiva A, Thiyyagura P, Ayutyanont N, et al. Using positron emission tomography and Florbetapir F18 to benchmark amyloid burden thresholds in normal aging and Alzheimer's disease. Arch Neurol. 2011;68(11):1404-1411.
    75. Landau SM, Breault C, Joshi AD, Pontecorvo M, Mathis CA, Jagust WJ, et al. Amyloid-β imaging with Pittsburgh Compound B and florbetapir: ROC comparison in the ADNI cohort. J Nucl Med. 2013;54(1):70-77.
    76. Jack CR Jr, Wiste HJ, Lesnick TG, Weigand SD, Knopman DS, Vemuri P, et al. Brain β-amyloid load and longitudinal cognitive decline in healthy old people: ROC cutpoint optimization. Lancet Neurol. 2013;12(6):564-573.
    77. Morris E, Chalkidou A, Hammers A, Peacock J, Summers J, Keevil S. Diagnostic accuracy of 18F-florbetapir PET for Alzheimer's disease: ROC systematic review and meta-analysis. Eur J Radiol. 2016;85(3):618-627.
    78. Chien DT, Bahri S, Szardenings AK, Walsh JC, Mu F, Su MY, et al. Early clinical PET imaging results with 18F-T807, a tau-specific PET tracer: ROC discrimination of AD vs controls. J Alzheimers Dis. 2013;38(1):171-184.
    79. Xia CF, Arteaga J, Chen G, Gangadharmath U, Gomez LF, Kasi D, et al. 18F-T807, a novel tau positron emission tomography imaging agent: quantitative ROC analysis. Alzheimers Dement. 2013;9(6):666-676.
    80. Ossenkoppele R, Rabinovici GD, Smith R, Cho H, Schöll M, Strandberg O, et al. Discriminative accuracy of 18F-AV-1451 tau PET in Alzheimer disease vs other neurodegenerative disorders: an ROC study. JAMA. 2018;320(11):1151-1162.
    81. Schöll M, Lockhart SN, Schonhaut DR, O'Neil JP, Janabi M, Ossenkoppele R, et al. PET imaging of tau deposition in the aging brain: ROC analysis of regional cortical binding. Neuron. 2016;89(5):971-982.
    82. Fleisher AS, Pontecorvo MJ, Devous MD Sr, Lu M, Arora AK, Truocchio SP, et al. Positron emission tomography imaging with 18F-flortaucipir and postmortem tau pathology: ROC autopsy validation. JAMA Neurol. 2020;77(7):829-839.
    83. Mattsson N, Schöll M, Strandberg O, Smith R, Palmqvist S, Insel PS, et al. 18F-AV-1451 tau PET in Alzheimer's disease and non-Alzheimer's neurodegenerative disorders: ROC thresholds. EMBO Mol Med. 2017;9(9):1212-1223.
    84. Cho H, Choi JY, Hwang MS, Kim YJ, Lee HM, Lee JH, et al. In vivo cortical spreading pattern of tau and amyloid in Alzheimer's disease: ROC threshold modeling. Ann Neurol. 2016;80(2):247-258.
    85. Pontecorvo MJ, Devous MD Sr, Navitsky M, Lu M, Salloway S, Schaerf FW, et al. 18F-AV-1451 tau PET imaging in healthy aging, mild cognitive impairment, and Alzheimer's disease: ROC evaluation. Brain. 2017;140(3):748-763.
    86. Jack CR Jr, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease: ROC validation. Alzheimers Dement. 2018;14(4):535-562.
    87. Therriault J, Benedet AL, Pascoal TA, Mathotaarachchi S, Chamoun M, Savard G, et al. Determining tau PET positivity thresholds using ROC analysis in the Alzheimer's continuum. Neurology. 2021;97(18):e1772-e1784.
    88. Leuzy A, Chiotis K, Lemoine L, Gillberg PG, Almkvist O, Rodriguez-Vieitez E, et al. Tau PET imaging in neurodegenerative tauopathies-still a challenge: ROC model insights. Mol Psychiatry. 2019;24(8):1112-1134.
    89. Wester HJ, Herz M, Senekowitsch-Schmidtke R, Schwaiger M, Stöcklin G, Hamacher K. Preclinical evaluation of 18F-FET as an amino acid tracer for tumor PET: ROC parameters. J Nucl Med. 1999;40(1):205-212.
    90. Pauleit D, Floeth F, Hamacher K, Riemenschneider MJ, Reifenberger G, Müller HW, et al. O-(2-[18F]fluoroethyl)-L-tyrosine PET for grading of brain tumors: ROC optimization. Brain. 2005;128(3):678-687.
    91. Langen KJ, Galldiks N, Hattingen E, Shah NJ. Imaging of brain tumors using cerebral amino acid PET: ROC evaluation. Nat Rev Neurol. 2017;13(2):85-99.
    92. Galldiks N, Langen KJ, Albert NL, Chamberlain M, Soffietti R, Kim MM, et al. Assessment of treatment response in high-grade gliomas using amino acid PET: RANO working group recommendations. Neuro Oncol. 2019;21(5):585-596.
    93. Unterrainer M, Vettermann F, Brendel M, Holzgreve A, Suchorska B, Unterrainer L, et al. 18F-FET PET SUVmax/background ratio in differentiating recurrent glioma from treatment-related changes. J Nucl Med. 2020;61(3):346-351.
    94. Popperl G, Kreth FW, Herms J, Koch W, Mehrkens JH, Gildehaus FJ, et al. Analysis of 18F-FET PET for grading and prognostication of untreated gliomas: ROC threshold study. Eur J Nucl Med Mol Imaging. 2005;32(9):1018-1028.
    95. Rachinger W, Stoehr O, Terpolilli NA, Siller S, Grau S, Jacobs AH, et al. Increased 18F-FET uptake in low-grade gliomas defines high-risk tumor subregions: ROC mapping. Neuro Oncol. 2015;17(11):1464-1472.
    96. Ceccon G, Rapp M, Soffietti R, Furtner J, Law I, Kim MM, et al. 18F-FET PET for differentiation of brain metastasis recurrence from radiation necrosis: ROC meta-analysis. Neuro Oncol. 2022;24(3):405-416.
    97. Kebir S, Fimmers R, Galldiks N, Schäfer N, Mack F, Schaub C, et al. Late 18F-FET PET for discrimination of pseudoprogression in glioblastoma: ROC curve optimization. Neuro Oncol. 2016;18(6):881-888.
    98. Suchorska B, Tonn JC, Jansen NL, Bartenstein P, Niyazi M, Kreth FW, et al. PET-guided biopsy in glioma: 18F-FET ROC analysis for targeting aggressive subregions. Neuro Oncol. 2016;18(3):398-405.
    99. Rapp M, Heinzel A, Galldiks N, Stoffels G, Felsberg J, Sabel M, et al. Diagnostic performance of 18F-FET PET in newly diagnosed cerebral lesions: ROC validation. J Nucl Med. 2013;54(10):1712-1718.
    100. Jansen NL, Graute V, Suchorska B, Thorsteinsdottir J, Schmid-Tannwald C, Bartenstein P, et al. Prognostic significance of dynamic 18F-FET PET in non-contrast-enhancing glioma: ROC curve analysis. J Nucl Med. 2015;56(1):9-15.

Background: Receiver operating characteristic (ROC) analysis and the area under the curve (AUC) are the principal quantitative tools used to establish diagnostic thresholds in nuclear cardiology and neuroimaging, allowing comparison of imaging modalities and biomarkers independent of an arbitrarily chosen cut-point.  Objective: To synthesise the methodological basis of ROC/AUC analysis and to review its principal clinical applications in nuclear cardiology (myocardial perfusion imaging, absolute myocardial blood flow, and myocardial flow reserve) and nuclear neurology (amyloid and tau positron emission tomography [PET] and amino-acid PET in neuro-oncology).  Methods: A narrative review was conducted of the peer-reviewed literature indexed in PubMed/MEDLINE, Embase and Scopus supplemented by hand-searching of reference lists, covering methodological ROC literature and diagnostic-accuracy studies in nuclear cardiology and nuclear neurology.

Keywords : ROC Curve; Area Under the Curve; Diagnostic Accuracy; Nuclear Cardiology; Myocardial Perfusion Imaging; Nuclear Neurology; Positron Emission Tomography; Amyloid; Tau; Neuro-Oncology.

Paper Submission Last Date
30 - September - 2026

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