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. 2011 Nov 10;3(6):31.
doi: 10.1186/alzrt93.

Amyloid imaging in the differential diagnosis of dementia: review and potential clinical applications

Robert Laforce Jr  1 , Gil D Rabinovici
Affiliations

Amyloid imaging in the differential diagnosis of dementia: review and potential clinical applications

Robert Laforce Jr et al. Alzheimers Res Ther. .

Abstract

In the past decade, positron emission tomography (PET) with carbon-11-labeled Pittsburgh Compound B (PIB) has revolutionized the neuroimaging of aging and dementia by enabling in vivo detection of amyloid plaques, a core pathologic feature of Alzheimer's disease (AD). Studies suggest that PIB-PET is sensitive for AD pathology, can distinguish AD from non-AD dementia (for example, frontotemporal lobar degeneration), and can help determine whether mild cognitive impairment is due to AD. Although the short half-life of the carbon-11 radiolabel has thus far limited the use of PIB to research, a second generation of tracers labeled with fluorine-18 has made it possible for amyloid PET to enter the clinical era. In the present review, we summarize the literature on amyloid imaging in a range of neurodegenerative conditions. We focus on potential clinical applications of amyloid PET and its role in the differential diagnosis of dementia. We suggest that amyloid imaging will be particularly useful in the evaluation of mildly affected, clinically atypical or early age-at-onset patients, and illustrate this with case vignettes from our practice. We emphasize that amyloid imaging should supplement (not replace) a detailed clinical evaluation. We caution against screening asymptomatic individuals, and discuss the limited positive predictive value in older populations. Finally, we review limitations and unresolved questions related to this exciting new technique.

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Figures

Figure 1
Figure 1
Amyloid tracer binding. Typical 11C-labeled Pittsburgh Compound B (PIB) binding and 18F-fluorodeoxyglucose (FDG) hypometabolism patterns in normal controls (NC), Alzheimer's disease (AD), logopenic variant of primary progressive aphasia (lvPPA), behavioral variant frontotemporal dementia (bvFTD), and semantic variant of primary progressive aphasia (svPPA). DVR, distribution volume ratio; SUVR, standardized uptake value ratio.
Figure 2
Figure 2
Clinically challenging cases imaged with 11C-labeled Pittsburgh Compound B and 18F-fluorodeoxyglucose. Autopsy diagnosis is available in three cases. See text for a description of the cases. FDG, 18F-fluorodeoxyglucose; PIB, 11carbon-labeled Pittsburgh Compound B; DVR, distribution volume ratio; SUVR, standardized uptake value ratio.
See this image and copyright information in PMC

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