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

Hellwig, Sabine; Frings, Lars; Bormann, Tobias; Vach, Werner; Buchert, Ralph; Meyer, Philipp T.

doi:10.1007/s00259-018-4111-3

Cited by 22 publications

(21 citation statements)

References 36 publications

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“…Taken together, the findings across studies with [ 11 C]PiB, [ 18 F]florbetaben, [ 18 F]florbetapir, and [ 18 F]flutemetamol suggest that amyloid imaging leads to diagnostic revision in approximately one third of cases, and increases diagnostic confidence in over half of cases, especially when the PET result is positive. In the clinical cohort reported in this paper, 34% of diagnoses were revised following disclosure of PET results, which is comparable with previous reports and within the observed range of 19-67% for different patient populations [34][35][36][37][38][39]. Apart from descriptive evidence (from discussions with the referring physicians), it was not possible in this study to analyze systematically the impact of amyloid imaging on patient management.…”

Section: Discussionsupporting

confidence: 83%

“…Considerable evidence supports the use of amyloid PET for accurately detecting brain amyloid in patients along the AD continuum [12,[31][32][33]. Beyond validation of PET amyloid as a research biomarker, questions of its utility in clinical practice are also being addressed [34][35][36][37][38][39]. Studies on the impact of amyloid PET in aiding differential diagnosis, improving diagnostic confidence, or influencing patient management have been analyzed at individual patient or summary level [23,40].…”

Section: Discussionmentioning

confidence: 99%

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Initial Physician Experience with [18F]Flutemetamol Amyloid PET Imaging Following Availability for Routine Clinical Use in Japan

Hattori

Sherwin²,

Farrar

2020

ADR

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Background: Brain amyloid is a neuropathological hallmark of Alzheimer's disease (AD). By visualizing brain amyloid, positron emission tomography (PET) may influence the diagnostic assessment and management of patients with cognitive impairment. Objective: As part of a Japanese post-approval study to measure the safety of [ 18 F]flutemetamol PET, the association of amyloid PET results with changes in diagnosis and diagnostic confidence was assessed. Methods: Fifty-seven subjects were imaged for amyloid PET using [ 18 F]flutemetamol at a single Japanese memory clinic. The cognitive diagnosis and referring physician's confidence in the diagnosis were recorded before and after availability of PET results. Imaging started approximately 90 minutes after [ 18 F]flutemetamol administration with approximately 185 MBq injected. PET images were acquired for 30 minutes. Results: Amyloid PET imaging led to change in diagnosis in 15/44 clinical subjects (34%). Mean diagnostic confidence increased by approximately 20%, from 73% pre-scan to 93% post-scan, and this rise was fairly consistent across the main patient subgroups (mild cognitive impairment, AD, and non-AD) irrespective of the pre-scan diagnosis and scan result. Conclusion: The study examined the utility of amyloid PET imaging in a Japanese clinical cohort and highlighted the use of an etiological diagnosis in the presence of the amyloid scan. [ 18 F]Flutemetamol PET led to a change in diagnosis in over 30% of cases and to an increase in diagnostic confidence by approximately 20% consistent with other reports.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Initial Physician Experience with [18F]Flutemetamol Amyloid PET Imaging Following Availability for Routine Clinical Use in Japan

Hattori

Sherwin²,

Farrar

2020

ADR

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“…Consistent with that previous report [19], we found low occurrence of diagnostic change in cases with a preliminary diagnosis of specific dementia, while the largest diagnostic change was in cases with dementia "of unclear etiology" (63%) and in atypical/unclear dementia (60%). Previous studies have compared the baseline diagnosis and FDG-PET classification to the final diagnosis provided by either a follow-up investigation or by the neuropathological diagnosis [20][21][22][23]. Nevertheless, we have not found any study investigating the change in diagnostic accuracy when comparing pre-and post-FDG-PET diagnosis to a common reference standard, which is considered critical to evaluate the incremental diagnostic value [9].…”

Section: Discussionmentioning

confidence: 89%

“…Previous studies have compared the baseline diagnosis and FDG-PET classification to the final diagnosis provided by either a follow-up investigation or by the neuropathological diagnosis [ 20 – 23 ]. Nevertheless, we have not found any study investigating the change in diagnostic accuracy when comparing pre- and post-FDG-PET diagnosis to a common reference standard, which is considered critical to evaluate the incremental diagnostic value [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of 18F-FDG-PET among memory clinic patients with uncertain diagnosis

Perini

Rodriguez‐Vieitez

Kadir

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose To assess the clinical impact and incremental diagnostic value of 18 F-fluorodeoxyglucose (FDG-PET) among memory clinic patients with uncertain diagnosis. Methods The study population consisted of 277 patients who, despite extensive baseline cognitive assessment, MRI, and CSF analyses, had an uncertain diagnosis of mild cognitive impairment (MCI) (n = 177) or dementia (n = 100). After baseline diagnosis, each patient underwent an FDG-PET, followed by a post-FDG-PET diagnosis formulation. We evaluated (i) the change in diagnosis (baseline vs. post-FDG-PET), (ii) the change in diagnostic accuracy when comparing each baseline and post-FDG-PET diagnosis to a long-term follow-up (3.6 ± 1.8 years) diagnosis used as reference, and (iii) comparative FDG-PET performance testing in MCI and dementia conditions. Results FDG-PET led to a change in diagnosis in 86 of 277 (31%) patients, in particular in 57 of 177 (32%) MCI and in 29 of 100 (29%) dementia patients. Diagnostic change was greater than twofold in the sub-sample of cases with dementia "of unclear etiology" (change in diagnosis in 20 of 32 (63%) patients). In the dementia group, after results of FDG-PET, diagnostic accuracy improved from 77 to 90% in Alzheimer's disease (AD) and from 85 to 94% in frontotemporal lobar degeneration (FTLD) patients (p < 0.01). FDG-PET performed better in dementia than in MCI (positive likelihood ratios >5 and < 5, respectively). Conclusion Within a selected clinical population, FDG-PET has a significant clinical impact, both in early and differential diagnosis of uncertain dementia. FDG-PET provides significant incremental value to detect AD and FTLD over a clinical diagnosis of uncertain dementia. Keywords 18 F-Fluorodeoxyglucose-PET. Clinical impact. Incremental diagnostic value. Dementia. Mild cognitive impairment This article is part of the Topical Collection on Neurology.

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“…transcranial sonography, MRI, CT, and dopamine transporter SPECT), and was incorporated into a standardized clinical case vignette derived from the current diagnostic criteria of LBD and APS 3 – 6 , 34 . In analogy to an earlier study 35 , we developed the structure of the vignette for this study specifically, which contained sections with demographic information, symptomatology, diagnostic findings, therapy, and disease course, covering all relevant information before and after imaging procedures (see Supplementary Data 1 for the template of the vignette). Of note, results of FDG PET and MIBG scintigraphy, as well as the diagnosis of the treating neurologists were not recorded.…”

Section: Methodsmentioning

confidence: 99%

Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy

Brumberg

Schröter

Blazhenets

et al. 2020

npj Parkinsons Dis.

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Abstract[18F]fluorodeoxyglucose (FDG) PET and [123I]metaiodobenzylguanidine (MIBG) scintigraphy may contribute to the differential diagnosis of neurodegenerative parkinsonism. To identify the superior method, we retrospectively evaluated 54 patients with suspected neurodegenerative parkinsonism, who were referred for FDG PET and MIBG scintigraphy. Two investigators visually assessed FDG PET scans using an ordinal 6-step score for disease-specific patterns of Lewy body diseases (LBD) or atypical parkinsonism (APS) and assigned the latter to the subgroups multiple system atrophy (MSA), progressive supranuclear palsy (PSP), or corticobasal syndrome. Regions-of-interest analysis on anterior planar MIBG images served to calculate the heart-to-mediastinum ratio. Movement disorder specialists blinded to imaging results established clinical follow-up diagnosis by means of guideline-derived case vignettes. Clinical follow-up (1.7 ± 2.3 years) revealed the following diagnoses: n = 19 LBD (n = 17 Parkinson’s disease [PD], n = 1 PD dementia, and n = 1 dementia with Lewy bodies), n = 31 APS (n = 28 MSA, n = 3 PSP), n = 3 non-neurodegenerative parkinsonism; n = 1 patient could not be diagnosed and was excluded. Receiver operating characteristic analyses for discriminating LBD vs. non-LBD revealed a larger area under the curve for FDG PET than for MIBG scintigraphy at statistical trend level for consensus rating (0.82 vs. 0.69, p = 0.06; significant for investigator #1: 0.83 vs. 0.69, p = 0.04). The analysis of PD vs. MSA showed a similar difference (0.82 vs. 0.69, p = 0.11; rater #1: 0.83 vs. 0.69, p = 0.07). Albeit the notable differences in diagnostic performance did not attain statistical significance, the authors consider this finding clinically relevant and suggest that FDG PET, which also allows for subgrouping of APS, should be preferred.

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

Cited by 22 publications

References 36 publications

Initial Physician Experience with [18F]Flutemetamol Amyloid PET Imaging Following Availability for Routine Clinical Use in Japan

Initial Physician Experience with [18F]Flutemetamol Amyloid PET Imaging Following Availability for Routine Clinical Use in Japan

Clinical impact of 18F-FDG-PET among memory clinic patients with uncertain diagnosis

Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy

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