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. 2021;79(2):819-832.
doi: 10.3233/JAD-200890.

Heterogeneity of Amyloid Binding in Cognitively Impaired Patients Consecutively Recruited from a Memory Clinic: Evaluating the Utility of Quantitative 18F-Flutemetamol PET-CT in Discrimination of Mild Cognitive Impairment from Alzheimer's Disease and Other Dementias

Yi-Wen Bao  1 , Anson C M Chau  2 , Patrick Ka-Chun Chiu  3 , Yat Fung Shea  3 , Joseph S K Kwan  4 , Felix Hon Wai Chan  3 , Henry Ka-Fung Mak  1   5
Affiliations

Heterogeneity of Amyloid Binding in Cognitively Impaired Patients Consecutively Recruited from a Memory Clinic: Evaluating the Utility of Quantitative 18F-Flutemetamol PET-CT in Discrimination of Mild Cognitive Impairment from Alzheimer's Disease and Other Dementias

Yi-Wen Bao et al. J Alzheimers Dis. 2021.

Abstract

Background: With the more widespread use of 18F-radioligand-based amyloid-β (Aβ) PET-CT imaging, we evaluated Aβ binding and the utility of neocortical 18F-Flutemetamol standardized uptake value ratio (SUVR) as a biomarker.

Objective: 18F-Flutemetamol SUVR was used to differentiate 1) mild cognitive impairment (MCI) from Alzheimer's disease (AD), and 2) MCI from other non-AD dementias (OD).

Methods: 109 patients consecutively recruited from a University memory clinic underwent clinical evaluation, neuropsychological test, MRI and 18F-Flutemetamol PET-CT. The diagnosis was made by consensus of a panel consisting of 1 neuroradiologist and 2 geriatricians. The final cohort included 13 subjective cognitive decline (SCD), 22 AD, 39 MCI, and 35 OD. Quantitative analysis of 16 region-of-interests made by Cortex ID software (GE Healthcare).

Results: The global mean 18F-Flutemetamol SUVR in SCD, MCI, AD, and OD were 0.50 (SD-0.08), 0.53 (SD-0.16), 0.76 (SD-0.10), and 0.56 (SD-0.16), respectively, with SUVR in SCD and MCI and OD being significantly lower than AD. Aβ binding in SCD, MCI, and OD was heterogeneous, being 23%, 38.5%, and 42.9% respectively, as compared to 100% amyloid positivity in AD. Using global SUVR, ROC analysis showed AUC of 0.868 and 0.588 in differentiating MCI from AD and MCI from OD respectively.

Conclusion: 18F-Flutemetamol SUVR differentiated MCI from AD with high efficacy (high negative predictive value), but much lower efficacy from OD. The major benefit of the test was to differentiate cognitively impaired patients (either SCD, MCI, or OD) without AD-related-amyloid-pathology from AD in the clinical setting, which was under-emphasized in the current guidelines proposed by Amyloid Imaging Task Force.

Keywords: 18F-Flutemetamol; Alzheimer’s disease; amyloid; dementia; early-onset Alzheimer’s disease; mild cognitive impairment; positron emission tomography.

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Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/20-0890r1).

Figures

Fig. 1
Fig. 1
A) mean global Aβ binding in MCI, AD, and OD groups with given threshold (0.62); B) mean global Aβ binding in MCI, AD, and OD groups with calculated optimal cut off (0.58).
Fig. 2
Fig. 2
Number of amyloid positive subjects based on visual judgement and quantitative cutoff among groups.
See this image and copyright information in PMC

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References

    1. Jack CR Jr., Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, Holtzman DM, Jagust W, Jessen F, Karlawish J, Liu E, Molinuevo JL, Montine T, Phelps C, Rankin KP, Rowe CC, Scheltens P, Siemers E, Snyder HM, Sperling R, Contributors (2018) NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease. Alzheimers Dement 14, 535–562. - PMC - PubMed
    1. Edmonds EC, Delano-Wood L, Jak AJ, Galasko DR, Salmon DP, Bondi MW (2016) “Missed” mild cognitive impairment: High false-negative error rate based on conventional diagnostic criteria. J Alzheimers Dis 52, 685–691. - PMC - PubMed
    1. Dubois B, Albert M (2004) Amnestic MCI or prodromal Alzheimer’s disease? Lancet Neurol 3, 246–248. - PubMed
    1. Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jelic V, Fratiglioni L (2014) Mild cognitive impairment: A concept in evolution. J Intern Med 275, 214–228. - PMC - PubMed
    1. Schneider JA, Arvanitakis Z, Leurgans SE, Bennett DA (2009) The neuropathology of probable Alzheimer disease and mild cognitive impairment. Ann Neurol 66, 200–208. - PMC - PubMed

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