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Comparative Study
. 2019 Feb;46(2):312-323.
doi: 10.1007/s00259-018-4111-3. Epub 2018 Aug 10.

Amyloid imaging for differential diagnosis of dementia: incremental value compared to clinical diagnosis and [18F]FDG PET

Sabine Hellwig  1 , Lars Frings  2   3 , Tobias Bormann  4 , Werner Vach  5   6 , Ralph Buchert  7 , Philipp T Meyer  2
Affiliations
Comparative Study

Amyloid imaging for differential diagnosis of dementia: incremental value compared to clinical diagnosis and [18F]FDG PET

Sabine Hellwig et al. Eur J Nucl Med Mol Imaging. 2019 Feb.

Abstract

Purpose: Cerebral beta-amyloid and regional glucose metabolism assessed by positron emission tomography (PET) are used as diagnostic biomarkers for Alzheimer's disease (AD). The present study validates the incremental diagnostic value of amyloid PET in addition to clinical diagnosis and [18F]FDG PET in a real-life memory clinic population.

Methods: Of 138 consecutive patients with cognitive impairment who received combined [18F]FDG and [11C]PIB PET, 84 were diagnosed with major neurocognitive disorder (DSM-5) and included. Baseline clinical and [18F]FDG PET diagnoses were independently established with and without access to amyloid PET results and were dichotomized into AD or non-AD disorders. The incremental value of amyloid PET was evaluated in terms of: (1) the change in clinical and [18F]FDG PET diagnoses, (2) the change in agreement between clinical and [18F]FDG PET diagnoses, and (3) diagnostic accuracy using an interdisciplinary consensus diagnosis after an extended follow-up (2.4 ± 1.3 years after PET) as the reference.

Results: After disclosure of the amyloid PET results, clinical and [18F]FDG PET diagnoses changed in 23% and 18% of patients, respectively, and agreement between both ratings increased from 62% to 86% (p < 0.001). The accuracy of clinical and [18F]FDG PET diagnoses improved from 71% to 89% (p < 0.01) and from 76% to 94% (p < 0.001), respectively. The additional value of amyloid PET was rather uniform in relation to age at onset and consistency with appropriate use criteria.

Conclusion: Amyloid PET provides significant incremental diagnostic value beyond clinical and [18F]FDG PET diagnoses of AD. Given the high diagnostic accuracy of combined clinical and amyloid PET assessment, further studies are needed to clarify the role of an additional [18F]FDG PET scan in these patients.

Keywords: Amyloid imaging; Dementia; Positron emission tomography; [11C]PIB; [18F]FDG.

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Conflict of interest statement

Conflicts of interest

S.H., L.F., T.B., R.B. declare no conflicts of interest. W.V. serves as a consultant for the Nordic Institute for Chiropractice and Clinical Biomechanics, Odense, Denmark. P.T.M. served as consultant for Iba Pharma and received an honorarium for a lecture from Desitin Arzneimittel GmbH.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Patient flow and changes in diagnosis. All 84 included patients with major neurocognitive disorder were classified either as suffering from Alzheimer’s dementia (AD, red) or non-AD (blue) according to the baseline clinical diagnosis (blinded to the PET data, left lower panel) or based on [18F]FDG PET findings (blinded to the clinical data, right lower panel). Changes in diagnosis after disclosure of the beta-amyloid PET results are given. The non-AD group included patients with frontotemporal dementia (FTD), dementia with Lewy bodies (DLB) and a non-neurodegenerative (NND) cause of cognitive impairment
See this image and copyright information in PMC

References

    1. Beach TG, Monsell SE, Phillips LE, Kukull W. Accuracy of the clinical diagnosis of Alzheimer disease at National Institute on Aging Alzheimer disease centers, 2005-2010. J Neurol Neurosurg Psychiatry. 2012;71:266–273. - PMC - PubMed
    1. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984;34:939–944. doi: 10.1212/WNL.34.7.939. - DOI - PubMed
    1. McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:263–269. doi: 10.1016/j.jalz.2011.03.005. - DOI - PMC - PubMed
    1. Apostolova LG, Haider JM, Goukasian N, Rabinovici GD, Chételat G, Ringman JM, et al. Critical review of the Appropriate Use Criteria for amyloid imaging: effect on diagnosis and patient care. Alzheimers Dement. 2016;5:15–22. - PMC - PubMed
    1. Boccardi M, Altomare D, Ferrari C, Festari C, Guerra UP, Paghera B, et al. Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: the Incremental Diagnostic Value of Amyloid PET With [18F]-Florbetapir (INDIA-FBP) study. JAMA Neurol. 2016;73:1417–1424. doi: 10.1001/jamaneurol.2016.3751. - DOI - PubMed

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