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Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis.

ABSTRACT: BACKGROUND:Patients with cognitive impairment or dementias of uncertain etiology are frequently referred to a memory disorders specialty clinic. The impact of and role for amyloid PET imaging (A?-PET) may be most appropriate in this clinical setting. OBJECTIVE:The primary objective of this study was to perform a systematic review and meta-analysis of the impact of A?-PET on etiological diagnosis and clinical management in the memory clinic setting. METHODS:A search of the literature on the impact of A?-PET in the memory clinic setting between 1 January 2004 and 12 February 2018 was conducted. Meta-analysis using a random effects model was performed to determine the pooled estimate of the impact of A?-PET in the changes of diagnoses and changes in management plan. RESULTS:After rigorous review, results from 13 studies were extracted, involving 1,489 patients. Meta-analysis revealed a pooled effect of change in diagnoses of 35.2% (95% CI 24.6-47.5). Sub-analyses showed that the pooled effect in change in diagnoses if A?-PET was used under the appropriate use criteria (AUC) or non-AUC criteria were 47.8% (95% CI 25.9-70.5) and 29.6% (95% CI: 21.5-39.3), respectively. The pooled effect of a change of diagnosis from Alzheimer's disease (AD) to non-AD and from non-AD to AD were 22.7% (95% CI: 17.1-29.5) and 25.6% (95% CI: 17.6-35.8), respectively. The pooled effect leading to a change of management was 59.6% (95% CI 39.4-77.0). CONCLUSIONS:A?-PET has a highly significant impact on both changes in diagnosis and management among patients being seen at a specialty memory clinic.

SUBMITTER: Shea YF

PROVIDER: S-EPMC6323639 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis.

Shea Yat-Fung YF Barker Warren W Greig-Gusto Maria T MT Loewenstein David A DA Duara Ranjan R DeKosky Steven T ST

Journal of Alzheimer's disease : JAD 20180101 1

<h4>Background</h4>Patients with cognitive impairment or dementias of uncertain etiology are frequently referred to a memory disorders specialty clinic. The impact of and role for amyloid PET imaging (Aβ-PET) may be most appropriate in this clinical setting.<h4>Objective</h4>The primary objective of this study was to perform a systematic review and meta-analysis of the impact of Aβ-PET on etiological diagnosis and clinical management in the memory clinic setting.<h4>Methods</h4>A search of the l ...[more]

PMID: 29889075

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Project description:Imaging or tissue biomarker evidence has been introduced into the core diagnostic pathway for Alzheimer's disease (AD). PET using (18)F-labelled beta-amyloid PET tracers has shown promise for the early diagnosis of AD. However, most studies included only small numbers of participants and no consensus has been reached as to which radiotracer has the highest diagnostic accuracy. First, we performed a systematic review of the literature published between 1990 and 2014 for studies exploring the diagnostic accuracy of florbetaben, florbetapir and flutemetamol in AD. The included studies were analysed using the QUADAS assessment of methodological quality. A meta-analysis of the sensitivity and specificity reported within each study was performed. Pooled values were calculated for each radiotracer and for visual or quantitative analysis by population included. The systematic review identified nine studies eligible for inclusion. There were limited variations in the methods between studies reporting the same radiotracer. The meta-analysis results showed that pooled sensitivity and specificity values were in general high for all tracers. This was confirmed by calculating likelihood ratios. A patient with a positive ratio is much more likely to have AD than a patient with a negative ratio, and vice versa. However, specificity was higher when only patients with AD were compared with healthy controls. This systematic review and meta-analysis found no marked differences in the diagnostic accuracy of the three beta-amyloid radiotracers. All tracers perform better when used to discriminate between patients with AD and healthy controls. The sensitivity and specificity for quantitative and visual analysis are comparable to those of other imaging or biomarker techniques used to diagnose AD. Further research is required to identify the combination of tests that provides the highest sensitivity and specificity, and to identify the most suitable position for the tracer in the clinical pathway.

Dataset Information

Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis.

Publications

Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis.

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