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An evidence-based algorithm for the utility of FDG-PET for diagnosing Alzheimer's disease according to presence of medial temporal lobe atrophy

  • Michael J. Firbank (a1), Jim Lloyd (a2), David Williams (a3), Robert Barber (a3), Sean J. Colloby (a3), Nicky Barnett (a3), Kirsty Olsen (a3), Christopher Davison (a3), Cam Donaldson (a4), Karl Herholz (a5) and John T. O'Brien (a6)...

Abstract

Background

Imaging biomarkers for Alzheimer's disease include medial temporal lobe atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose positron emission tomography (FDG-PET).

Aims

To investigate whether MTLA on head CT predicts the diagnostic usefulness of an additional FDG-PET scan.

Method

Participants had a clinical diagnosis of Alzheimer's disease (n = 37) or dementia with Lewy bodies (DLB; n = 30) or were similarly aged controls (n = 30). We visually rated MTLA on coronally reconstructed CT scans and, separately and blind to CT ratings, abnormal appearances on FDG-PET scans.

Results

Using a pre-defined cut-off of MTLA ⩾5 on the Scheltens (0–8) scale, 0/30 controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET performed well for diagnosing Alzheimer's disease v. DLB in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the high-MTLA group diagnostic performance of FDG-PET was not better than chance.

Conclusions

In the presence of a high degree of MTLA, the most likely diagnosis is Alzheimer's disease, and an FDG-PET scan will probably not provide significant diagnostic information. However, in cases without MTLA, if the diagnosis is unclear, an FDG-PET scan may provide additional clinically useful diagnostic information.

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Copyright

Corresponding author

Dr Michael J. Firbank, Institute of Neuroscience and Newcastle University Institute for Ageing, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK. Email: michael.firbank@ncl.ac.uk

Footnotes

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Declaration of interest

M.F. reports grants from National Institute for Health Research, K.H. reports grants and personal fees from Lilly/Avid Radiopharmacuticals, personal fees from GE Healthcare, Cytox and Elan, other from Herholz Consulting GmbH, J.O.B. reports grants and other from GE Healthcare, grants and other from Lilly, other from Bayer Healthcare, other from TauRx, other from Cytox.

Footnotes

References

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An evidence-based algorithm for the utility of FDG-PET for diagnosing Alzheimer's disease according to presence of medial temporal lobe atrophy

  • Michael J. Firbank (a1), Jim Lloyd (a2), David Williams (a3), Robert Barber (a3), Sean J. Colloby (a3), Nicky Barnett (a3), Kirsty Olsen (a3), Christopher Davison (a3), Cam Donaldson (a4), Karl Herholz (a5) and John T. O'Brien (a6)...
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