Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia

Boccardi, Marina; Festari, Cristina; Altomare, Daniele; Gandolfo, Federica; Orini, Stefania; Nobili, Flavio; Frisoni, Giovanni B.

doi:10.1007/s00259-018-4024-1

Cited by 21 publications

(32 citation statements)

References 47 publications

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“…Consensus recommendations were reached through a Delphi procedure which was based on the expertise of the panellists. The panellists were provided with comprehensive data regarding the availability and quality of evidence, which was assessed by an independent methodology team, as described by Boccardi et al [6]. Briefly, we searched the literature using harmonized PICO (Population, Intervention, Comparison, Outcome) questions.…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, we searched the literature using harmonized PICO (Population, Intervention, Comparison, Outcome) questions. Thematic keywords were generated by experts, and studies were selected based on eligibility criteria described elsewhere [6]. Relevant data were extracted from selected studies and assessed for quality of methodology, according to European Federation of Neurological Societies guidance [7] and for their relevance to FDG PET studies [6].…”

Section: Methodsmentioning

confidence: 99%

“…The strings contained a common part for FDG PET and a PICO question-specific part [6]. The MEDLINE, Embase and Google Scholar databases were searched for studies published up to November 2015.…”

Section: Methodsmentioning

confidence: 99%

“…To assess the evidence, data on study features, population of interest, index test, gold/reference standard, and critical/proxy outcomes were extracted (for more details see, Boccardi et al [6]). Data assessors for this review were D.A.…”

Section: Methodsmentioning

confidence: 99%

“…This ranking was summarized as ‘very poor/lacking’, ‘poor’, ‘fair’ or ‘good’. For further details about data extraction and quality assessment see Boccardi et al [6]. …”

Section: Methodsmentioning

confidence: 99%

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Clinical utility of FDG PET in Parkinson’s disease and atypical parkinsonism associated with dementia

Walker

Gandolfo

Orini

et al. 2018

Eur J Nucl Med Mol Imaging

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PurposeThere are no comprehensive guidelines for the use of FDG PET in the following three clinical scenarios: (1) diagnostic work-up of patients with idiopathic Parkinson’s disease (PD) at risk of future cognitive decline, (2) discriminating idiopathic PD from progressive supranuclear palsy, and (3) identifying the underlying neuropathology in corticobasal syndrome.MethodsWe therefore performed three literature searches and evaluated the selected studies for quality of design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were the sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiving operating characteristic curve, and positive/negative likelihood ratio of FDG PET in detecting the target condition. Using the Delphi method, a panel of seven experts voted for or against the use of FDG PET based on published evidence and expert opinion.ResultsOf 91 studies selected from the three literature searches, only four included an adequate quantitative assessment of the performance of FDG PET. The majority of studies lacked robust methodology due to lack of critical outcomes, inadequate gold standard and no head-to-head comparison with an appropriate reference standard. The panel recommended the use of FDG PET for all three clinical scenarios based on nonquantitative evidence of clinical utility.ConclusionDespite widespread use of FDG PET in clinical practice and extensive research, there is still very limited good quality evidence for the use of FDG PET. However, in the opinion of the majority of the panellists, FDG PET is a clinically useful imaging biomarker for idiopathic PD and atypical parkinsonism associated with dementia.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…This ranking was summarized as ‘very poor/lacking’, ‘poor’, ‘fair’ or ‘good’. For further details about data extraction and quality assessment see Boccardi et al [6]. …”

Section: Methodsmentioning

confidence: 99%

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Clinical utility of FDG PET in Parkinson’s disease and atypical parkinsonism associated with dementia

Walker

Gandolfo

Orini

et al. 2018

Eur J Nucl Med Mol Imaging

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Clinical research in dementia: A perspective on implementing innovation

Boccardi

Handels

Gold

et al. 2022

Alzheimer's & Dementia

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The increasing global prevalence of dementia demands concrete actions that are aimed strategically at optimizing processes that drive clinical innovation. The first step in this direction requires outlining hurdles in the transition from research to practice. The different parties needed to support translational processes have communication mismatches; methodological gaps hamper evidence‐based decision‐making; and data are insufficient to provide reliable estimates of long‐term health benefits and costs in decisional models. Pilot projects are tackling some of these gaps, but appropriate methods often still need to be devised or adapted to the dementia field. A consistent implementation perspective along the whole translational continuum, explicitly defined and shared among the relevant stakeholders, should overcome the “research‐versus‐adoption” dichotomy, and tackle the implementation cliff early on. Concrete next steps may consist of providing tools that support the effective participation of heterogeneous stakeholders and agreeing on a definition of clinical significance that facilitates the selection of proper outcome measures.

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European consensus for the diagnosis of MCI and mild dementia: Preparatory phase

Festari

Massa

Ramusino

et al. 2022

Alzheimer's & Dementia

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Introduction Etiological diagnosis of neurocognitive disorders of middle‐old age relies on biomarkers, although evidence for their rational use is incomplete. A European task force is defining a diagnostic workflow where expert experience fills evidence gaps for biomarker validity and prioritization. We report methodology and preliminary results. Methods Using a Delphi consensus method supported by a systematic literature review, 22 delegates from 11 relevant scientific societies defined workflow assumptions. Results We extracted diagnostic accuracy figures from literature on the use of biomarkers in the diagnosis of main forms of neurocognitive disorders. Supported by this evidence, panelists defined clinical setting (specialist outpatient service), application stage (MCI‐mild dementia), and detailed pre‐assessment screening (clinical‐neuropsychological evaluations, brain imaging, and blood tests). Discussion The Delphi consensus on these assumptions set the stage for the development of the first pan‐European workflow for biomarkers’ use in the etiological diagnosis of middle‐old age neurocognitive disorders at MCI‐mild dementia stages. Highlights Rational use of biomarkers in neurocognitive disorders lacks consensus in Europe. A consensus of experts will define a workflow for the rational use of biomarkers. The diagnostic workflow will be patient‐centered and based on clinical presentation. The workflow will be updated as new evidence accrues.

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Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia

Cited by 21 publications

References 47 publications

Clinical utility of FDG PET in Parkinson’s disease and atypical parkinsonism associated with dementia

Clinical utility of FDG PET in Parkinson’s disease and atypical parkinsonism associated with dementia

Clinical research in dementia: A perspective on implementing innovation

European consensus for the diagnosis of MCI and mild dementia: Preparatory phase

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