Dataset Information

Practical utility of amyloid and FDG-PET in an academic dementia center.

ABSTRACT:

Objective

To evaluate the effect of amyloid imaging on clinical decision making.

Methods

We conducted a retrospective analysis of 140 cognitively impaired patients (mean age 65.0 years, 46% primary ?-amyloid (A?) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed for changes between the pre- and post-PET clinical diagnosis (from A? to non-A? diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using ?(2) and multivariate logistic regression. Postmortem diagnosis was available for 24 patients (17%).

Results

Concordance between scan results and baseline diagnosis was high (PiB 84%, FDG 82%). The primary diagnosis changed after PET in 13/140 patients (9%) overall but in 5/13 (38%) patients considered pre-PET diagnostic dilemmas. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (unadjusted p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (adjusted p = 0.00013). Changes in treatment were associated with discordant PiB in patients with non-A? diagnoses (adjusted p = 0.028), while FDG had no effect on therapy. Both PiB (96%) and FDG (91%) showed high agreement with autopsy diagnosis.

Conclusions

PET had a moderate effect on clinical outcomes. Discordant PiB had a greater effect than discordant FDG, and influence on diagnosis was greater than on treatment. Prospective studies are needed to better characterize the clinical role of amyloid PET.

SUBMITTER: Sanchez-Juan P

PROVIDER: S-EPMC3902757 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Publications

Practical utility of amyloid and FDG-PET in an academic dementia center.

Sánchez-Juan Pascual P Ghosh Pia M PM Hagen Jayne J Gesierich Benno B Henry Maya M Grinberg Lea T LT O'Neil James P JP Janabi Mustafa M Huang Eric J EJ Trojanowski John Q JQ Vinters Harry V HV Gorno-Tempini Marilu M Seeley William W WW Boxer Adam L AL Rosen Howard J HJ Kramer Joel H JH Miller Bruce L BL Jagust William J WJ Rabinovici Gil D GD

Neurology 20131218 3

<h4>Objective</h4>To evaluate the effect of amyloid imaging on clinical decision making.<h4>Methods</h4>We conducted a retrospective analysis of 140 cognitively impaired patients (mean age 65.0 years, 46% primary β-amyloid (Aβ) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose ...[more]

PMID: 24353340

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Project description:Disease-modifying treatment trials are increasingly advanced to the prodromal or preclinical phase of Alzheimer's disease (AD), and inclusion criteria are based on biomarkers rather than clinical symptoms. Therefore, it is of great interest to determine which biomarkers should be combined to accurately predict conversion from mild cognitive impairment (MCI) to AD dementia. However, up to date, only few studies performed a complete A/T/N subject characterization using each of the CSF and imaging markers, or they only investigated long-term (? 2?years) prognosis. This study aimed to investigate the association between cerebrospinal fluid (CSF), magnetic resonance imaging (MRI), amyloid- and 18F-FDG positron emission tomography (PET) measures at baseline, in relation to cognitive changes and conversion to AD dementia over a short-term (12-month) period. We included 13 healthy controls, 49 MCI and 16 AD dementia patients with a clinical-based diagnosis and a complete A/T/N characterization at baseline. Global cortical amyloid-? (A?) burden was quantified using the 18F-AV45 standardized uptake value ratio (SUVR) with two different reference regions (cerebellar grey and subcortical white matter), whereas metabolism was assessed based on 18F-FDG SUVR. CSF measures included A?1-42, A?1-40, T-tau, P-tau181, and their ratios, and MRI markers included hippocampal volumes (HV), white matter hyperintensities, and cortical grey matter volumes. Cognitive functioning was measured by MMSE and RBANS index scores. All statistical analyses were corrected for age, sex, education, and APOE ?4 genotype. As a result, faster cognitive decline was most strongly associated with hypometabolism (posterior cingulate) and smaller hippocampal volume (e.g., ?story recall: ??=?+0.43 [p?<?0.001] and +?0.37 [p?=?0.005], resp.) at baseline. In addition, faster cognitive decline was significantly associated with higher baseline A? burden only if SUVR was referenced to the subcortical white matter (e.g., ?story recall: ??=?-0.28 [p?=?0.020]). Patients with MCI converted to AD dementia at an annual rate of 31%, which could be best predicted by combining neuropsychological testing (visuospatial construction skills) with either MRI-based HV or 18F-FDG-PET. Combining all three markers resulted in 96% specificity and 92% sensitivity. Neither amyloid-PET nor CSF biomarkers could discriminate short-term converters from non-converters.

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Dataset Information

Practical utility of amyloid and FDG-PET in an academic dementia center.

Objective

Methods

Results

Conclusions

Publications

Practical utility of amyloid and FDG-PET in an academic dementia center.

Similar Datasets

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