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Juengling F, Wuest F, Schirrmacher R, Abele J, Thiel A, Soucy JP, Camicioli R, Garibotto V. PET Imaging in Dementia: Mini-Review and Canadian Perspective for Clinical Use. Can J Neurol Sci 2024:1-13. [PMID: 38433571 DOI: 10.1017/cjn.2024.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
PET imaging is increasingly recognized as an important diagnostic tool to investigate patients with cognitive disturbances of possible neurodegenerative origin. PET with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), assessing glucose metabolism, provides a measure of neurodegeneration and allows a precise differential diagnosis among the most common neurodegenerative diseases, such as Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies. PET tracers specific for the pathological deposits characteristic of different neurodegenerative processes, namely amyloid and tau deposits typical of Alzheimer's Disease, allow the visualization of these aggregates in vivo. [18F]FDG and amyloid PET imaging have reached a high level of clinical validity and are since 2022 investigations that can be offered to patients in standard clinical care in most of Canada.This article will briefly review and summarize the current knowledge on these diagnostic tools, their integration into diagnostic algorithms as well as perspectives for future developments.
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Affiliation(s)
- Freimut Juengling
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
- Medical Faculty, University of Bern, Bern, Switzerland
| | - Frank Wuest
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
| | - Ralf Schirrmacher
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
- Medical Isotope and Cyclotron Facility, University of Alberta, Edmonton, AB, Canada
| | - Jonathan Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, Lady Davis Institute for Medical Research, McGill University, Montréal, QC, Canada
| | - Jean-Paul Soucy
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Valentina Garibotto
- Diagnostic Department, Nuclear Medicine and Molecular Imaging Division, University Hospitals of Geneva, Geneva, Switzerland
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Ruch F, Gnörich J, Wind K, Köhler M, Zatcepin A, Wiedemann T, Gildehaus FJ, Lindner S, Boening G, von Ungern-Sternberg B, Beyer L, Herms J, Bartenstein P, Brendel M, Eckenweber F. Validity and value of metabolic connectivity in mouse models of β-amyloid and tauopathy. Neuroimage 2024; 286:120513. [PMID: 38191101 DOI: 10.1016/j.neuroimage.2024.120513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/25/2023] [Accepted: 01/05/2024] [Indexed: 01/10/2024] Open
Abstract
Among functional imaging methods, metabolic connectivity (MC) is increasingly used for investigation of regional network changes to examine the pathophysiology of neurodegenerative diseases such as Alzheimer's disease (AD) or movement disorders. Hitherto, MC was mostly used in clinical studies, but only a few studies demonstrated the usefulness of MC in the rodent brain. The goal of the current work was to analyze and validate metabolic regional network alterations in three different mouse models of neurodegenerative diseases (β-amyloid and tau) by use of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography (FDG-PET) imaging. We compared the results of FDG-µPET MC with conventional VOI-based analysis and behavioral assessment in the Morris water maze (MWM). The impact of awake versus anesthesia conditions on MC read-outs was studied and the robustness of MC data deriving from different scanners was tested. MC proved to be an accurate and robust indicator of functional connectivity loss when sample sizes ≥12 were considered. MC readouts were robust across scanners and in awake/ anesthesia conditions. MC loss was observed throughout all brain regions in tauopathy mice, whereas β-amyloid indicated MC loss mainly in spatial learning areas and subcortical networks. This study established a methodological basis for the utilization of MC in different β-amyloid and tau mouse models. MC has the potential to serve as a read-out of pathological changes within neuronal networks in these models.
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Affiliation(s)
- François Ruch
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Johannes Gnörich
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Karin Wind
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Mara Köhler
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Artem Zatcepin
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Thomas Wiedemann
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Franz-Joseph Gildehaus
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Simon Lindner
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Guido Boening
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | | | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Jochen Herms
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Center of Neuropathology and Prion Research, University of Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
| | - Florian Eckenweber
- Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
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Bi S, Yan S, Chen Z, Cui B, Shan Y, Yang H, Qi Z, Zhao Z, Han Y, Lu J. Comparison of 18F-FDG PET and arterial spin labeling MRI in evaluating Alzheimer's disease and amnestic mild cognitive impairment using integrated PET/MR. EJNMMI Res 2024; 14:9. [PMID: 38270821 PMCID: PMC10811308 DOI: 10.1186/s13550-024-01068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Developing biomarkers for early stage AD patients is crucial. Glucose metabolism measured by 18F-FDG PET is the most common biomarker for evaluating cellular energy metabolism to diagnose AD. Arterial spin labeling (ASL) MRI can potentially provide comparable diagnostic information to 18F-FDG PET in patients with neurodegenerative disorders. However, the conclusions about the diagnostic performance of AD are still controversial between 18F-FDG PET and ASL. This study aims to compare quantitative cerebral blood flow (CBF) and glucose metabolism measured by 18F-FDG PET diagnostic values in patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI) using integrated PET/MR. RESULTS Analyses revealed overlapping between decreased regional rCBF and 18F-FDG PET SUVR in patients with AD compared with NC participants in the bilateral parietotemporal regions, frontal cortex, and cingulate cortex. Compared with NC participants, patients with aMCI exclusively demonstrated lower 18F-FDG PET SUVR in the bilateral temporal cortex, insula cortex, and inferior frontal cortex. Comparison of the rCBF in patients with aMCI and NC participants revealed no significant difference (P > 0.05). The ROC analysis of rCBF in the meta-ROI could diagnose patients with AD (AUC, 0.87) but not aMCI (AUC, 0.61). The specificity of diagnosing aMCI has been improved to 75.56% when combining rCBF and 18F-FDG PET SUVR. CONCLUSION ASL could detect similar aberrant patterns of abnormalities compared to 18F-FDG PET in patients with AD compared with NC participants but not in aMCI. The diagnostic efficiency of 18F-FDG-PET for AD and aMCI patients remained higher to ASL. Our findings support that applying 18F-FDG PET may be preferable for diagnosing AD and aMCI.
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Affiliation(s)
- Sheng Bi
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Shaozhen Yan
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Zhigeng Chen
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Bixiao Cui
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Yi Shan
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Hongwei Yang
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Zhigang Qi
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Zhilian Zhao
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China.
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4
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Cerina V, Crivellaro C, Morzenti S, Pozzi FE, Bigiogera V, Jonghi-Lavarini L, Moresco RM, Basso G, De Bernardi E. A ROI-based quantitative pipeline for 18F-FDG PET metabolism and pCASL perfusion joint analysis: Validation of the 18F-FDG PET line. Heliyon 2024; 10:e23340. [PMID: 38163125 PMCID: PMC10755331 DOI: 10.1016/j.heliyon.2023.e23340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
In Mild Cognitive Impairment (MCI), the study of brain metabolism, provided by 18F-FluoroDeoxyGlucose Positron Emission Tomography (18F-FDG PET) can be integrated with brain perfusion through pseudo-Continuous Arterial Spin Labeling Magnetic Resonance sequences (MR pCASL). Cortical hypometabolism identification generally relies on wide control group datasets; pCASL control groups are instead not publicly available yet, due to lack of standardization in the acquisition parameters. This study presents a quantitative pipeline to be applied to PET and pCASL data to coherently analyze metabolism and perfusion inside 16 matching cortical regions of interest (ROIs) derived from the AAL3 atlas. The PET line is tuned on 36 MCI patients and 107 healthy control subjects, to agree in identifying hypometabolic regions with clinical reference methods (visual analysis supported by a vendor tool and Statistical Parametric Mapping, SPM, with two parametrizations here identified as SPM-A and SPM-B). The analysis was conducted for each ROI separately. The proposed PET analysis pipeline obtained accuracy 78 % and Cohen's к 60 % vs visual analysis, accuracy 79 % and Cohen's к 58 % vs SPM-A, accuracy 77 % and Cohen's к 54 % vs SPM-B. Cohen's к resulted not significantly different from SPM-A and SPM-B Cohen's к when assuming visual analysis as reference method (p-value 0.61 and 0.31 respectively). Considering SPM-A as reference method, Cohen's к is not significantly different from SPM-B Cohen's к as well (p-value = 1.00). The complete PET-pCASL pipeline was then preliminarily applied on 5 MCI patients and metabolism-perfusion regional correlations were assessed. The proposed approach can be considered as a promising tool for PET-pCASL joint analyses in MCI, even in the absence of a pCASL control group, to perform metabolism-perfusion regional correlation studies, and to assess and compare perfusion in hypometabolic or normo-metabolic areas.
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Affiliation(s)
- Valeria Cerina
- PhD program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Cinzia Crivellaro
- Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Sabrina Morzenti
- Medical Physics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Federico E. Pozzi
- PhD program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Italy
- Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
- Milan center for Neuroscience (NeuroMI), University of Milano-Bicocca, Italy
| | | | | | - Rosa M. Moresco
- School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Gianpaolo Basso
- Milan center for Neuroscience (NeuroMI), University of Milano-Bicocca, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Italy
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
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Chouliaras L, O'Brien JT. The use of neuroimaging techniques in the early and differential diagnosis of dementia. Mol Psychiatry 2023; 28:4084-4097. [PMID: 37608222 PMCID: PMC10827668 DOI: 10.1038/s41380-023-02215-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
Dementia is a leading cause of disability and death worldwide. At present there is no disease modifying treatment for any of the most common types of dementia such as Alzheimer's disease (AD), Vascular dementia, Lewy Body Dementia (LBD) and Frontotemporal dementia (FTD). Early and accurate diagnosis of dementia subtype is critical to improving clinical care and developing better treatments. Structural and molecular imaging has contributed to a better understanding of the pathophysiology of neurodegenerative dementias and is increasingly being adopted into clinical practice for early and accurate diagnosis. In this review we summarise the contribution imaging has made with particular focus on multimodal magnetic resonance imaging (MRI) and positron emission tomography imaging (PET). Structural MRI is widely used in clinical practice and can help exclude reversible causes of memory problems but has relatively low sensitivity for the early and differential diagnosis of dementia subtypes. 18F-fluorodeoxyglucose PET has high sensitivity and specificity for AD and FTD, while PET with ligands for amyloid and tau can improve the differential diagnosis of AD and non-AD dementias, including recognition at prodromal stages. Dopaminergic imaging can assist with the diagnosis of LBD. The lack of a validated tracer for α-synuclein or TAR DNA-binding protein 43 (TDP-43) imaging remain notable gaps, though work is ongoing. Emerging PET tracers such as 11C-UCB-J for synaptic imaging may be sensitive early markers but overall larger longitudinal multi-centre cross diagnostic imaging studies are needed.
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Affiliation(s)
- Leonidas Chouliaras
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Specialist Dementia and Frailty Service, Essex Partnership University NHS Foundation Trust, St Margaret's Hospital, Epping, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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6
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Towards high sensitivity and high-resolution PET scanners: imaging-guided proton therapy and total body imaging. BIO-ALGORITHMS AND MED-SYSTEMS 2022. [DOI: 10.2478/bioal-2022-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Quantitative imaging (i.e., providing not just an image but also the related data) guidance in proton radiation therapy to achieve and monitor the precision of planned radiation energy deposition field in-vivo (a.k.a. proton range verification) is one of the most under-invested aspects of radiation cancer treatment despite that it may dramatically enhance the treatment accuracy and lower the exposure related toxicity improving the entire outcome of cancer therapy. In this article, we briefly describe the effort of the TPPT Consortium (a collaborative effort of groups from the University of Texas and Portugal) on building a time-of-flight positron-emission-tomography (PET) scanner to be used in pre-clinical studies for proton therapy at MD Anderson Proton Center in Houston. We also discuss some related ideas towards improving and expanding the use of PET detectors, including the total body imaging.
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Spatial normalization and quantification approaches of PET imaging for neurological disorders. Eur J Nucl Med Mol Imaging 2022; 49:3809-3829. [PMID: 35624219 DOI: 10.1007/s00259-022-05809-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/19/2022] [Indexed: 12/17/2022]
Abstract
Quantification approaches of positron emission tomography (PET) imaging provide user-independent evaluation of pathophysiological processes in living brains, which have been strongly recommended in clinical diagnosis of neurological disorders. Most PET quantification approaches depend on spatial normalization of PET images to brain template; however, the spatial normalization and quantification approaches have not been comprehensively reviewed. In this review, we introduced and compared PET template-based and magnetic resonance imaging (MRI)-aided spatial normalization approaches. Tracer-specific and age-specific PET brain templates were surveyed between 1999 and 2021 for 18F-FDG, 11C-PIB, 18F-Florbetapir, 18F-THK5317, and etc., as well as adaptive PET template methods. Spatial normalization-based PET quantification approaches were reviewed, including region-of-interest (ROI)-based and voxel-wise quantitative methods. Spatial normalization-based ROI segmentation approaches were introduced, including manual delineation on template, atlas-based segmentation, and multi-atlas approach. Voxel-wise quantification approaches were reviewed, including voxel-wise statistics and principal component analysis. Certain concerns and representative examples of clinical applications were provided for both ROI-based and voxel-wise quantification approaches. At last, a recipe for PET spatial normalization and quantification approaches was concluded to improve diagnosis accuracy of neurological disorders in clinical practice.
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8
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Correlación entre el metabolismo de la glucosa cerebral (18F-FDG) y el flujo sanguíneo cerebral con marcadores de amiloide (18F-florbetapir) en práctica clínica: evidencias preliminares. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Smith NM, Ford JN, Haghdel A, Glodzik L, Li Y, D’Angelo D, RoyChoudhury A, Wang X, Blennow K, de Leon MJ, Ivanidze J. Statistical Parametric Mapping in Amyloid Positron Emission Tomography. Front Aging Neurosci 2022; 14:849932. [PMID: 35547630 PMCID: PMC9083453 DOI: 10.3389/fnagi.2022.849932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Alzheimer's disease (AD), the most common cause of dementia, has limited treatment options. Emerging disease modifying therapies are targeted at clearing amyloid-β (Aβ) aggregates and slowing the rate of amyloid deposition. However, amyloid burden is not routinely evaluated quantitatively for purposes of disease progression and treatment response assessment. Statistical Parametric Mapping (SPM) is a technique comparing single-subject Positron Emission Tomography (PET) to a healthy cohort that may improve quantification of amyloid burden and diagnostic performance. While primarily used in 2-[18F]-fluoro-2-deoxy-D-glucose (FDG)-PET, SPM's utility in amyloid PET for AD diagnosis is less established and uncertainty remains regarding optimal normal database construction. Using commercially available SPM software, we created a database of 34 non-APOE ε4 carriers with normal cognitive testing (MMSE > 25) and negative cerebrospinal fluid (CSF) AD biomarkers. We compared this database to 115 cognitively normal subjects with variable AD risk factors. We hypothesized that SPM based on our database would identify more positive scans in the test cohort than the qualitatively rated [11C]-PiB PET (QR-PiB), that SPM-based interpretation would correlate better with CSF Aβ42 levels than QR-PiB, and that regional z-scores of specific brain regions known to be involved early in AD would be predictive of CSF Aβ42 levels. Fisher's exact test and the kappa coefficient assessed the agreement between SPM, QR-PiB PET, and CSF biomarkers. Logistic regression determined if the regional z-scores predicted CSF Aβ42 levels. An optimal z-score cutoff was calculated using Youden's index. We found SPM identified more positive scans than QR-PiB PET (19.1 vs. 9.6%) and that SPM correlated more closely with CSF Aβ42 levels than QR-PiB PET (kappa 0.13 vs. 0.06) indicating that SPM may have higher sensitivity than standard QR-PiB PET images. Regional analysis demonstrated the z-scores of the precuneus, anterior cingulate and posterior cingulate were predictive of CSF Aβ42 levels [OR (95% CI) 2.4 (1.1, 5.1) p = 0.024; 1.8 (1.1, 2.8) p = 0.020; 1.6 (1.1, 2.5) p = 0.026]. This study demonstrates the utility of using SPM with a "true normal" database and suggests that SPM enhances diagnostic performance in AD in the clinical setting through its quantitative approach, which will be increasingly important with future disease-modifying therapies.
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Affiliation(s)
- Natasha M. Smith
- Department of Radiology and MD Program, Weill Cornell Medicine, New York City, NY, United States
| | - Jeremy N. Ford
- Department of Radiology, Weill Cornell Medicine, New York City, NY, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Arsalan Haghdel
- Department of Radiology and MD Program, Weill Cornell Medicine, New York City, NY, United States
| | - Lidia Glodzik
- Department of Radiology, Weill Cornell Medicine, New York City, NY, United States
| | - Yi Li
- Department of Radiology, Weill Cornell Medicine, New York City, NY, United States
| | - Debra D’Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, New York City, NY, United States
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, New York City, NY, United States
| | - Xiuyuan Wang
- Department of Radiology, Weill Cornell Medicine, New York City, NY, United States
| | - Kaj Blennow
- Department of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mony J. de Leon
- Department of Radiology, Weill Cornell Medicine, New York City, NY, United States
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medicine, New York City, NY, United States
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Abstract
Positron emission tomography greatly advanced our understanding on the underlying neural mechanisms of movement disorders. PET with flurodeoxyglucose (FDG) is especially useful as it depicts regional metabolic activity level that can predict patients' symptoms. Multivariate pattern analysis has been used to determine and quantify the co-varying brain networks associated with specific clinical traits of neurodegenerative disease. The result is a biomarker, useful for diagnosis, treatments, and follow up studies. Parkinsonian traits and parkinsonisms are associated with specific spatial pattern of metabolic abnormality useful for differential diagnosis. This approach has also been used for monitoring disease progression and novel treatment responses mostly in Parkinson's disease. In this book chapter, we, illustrate and discuss the significance of the brain networks associated with disease and their modification with neuroplastic changes.
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11
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PET imaging in dementia. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Abstract
In this partial review and partial attempt at vision of what may be the future of dedicated brain PET scanners, the key implementations of the PET technique, we postulate that we are still on a development path and there is still a lot to be done in order to develop optimal brain imagers. Optimized for particular imaging tasks and protocols, and also mobile, that can be used outside the PET center, in addition to the expected improvements in sensitivity and resolution. For this multi-application concept to be more practical, flexible, adaptable designs are preferred. This task is greatly facilitated by the improved TOF performance that allows for more open, adjustable, limited angular coverage geometries without creating image artifacts. As achieving uniform very high resolution in the whole body is not practical due to technological limits and high costs, hybrid systems using a moderate-resolution total body scanner (such as J-PET) combined with a very high performing brain imager could be a very attractive approach. As well, as using magnification inserts in the total body or long-axial length imagers to visualize selected targets with higher resolution. In addition, multigamma imagers combining PET with Compton imaging should be developed to enable multitracer imaging.
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Piersson AD, Mohamad M, Suppiah S, Rajab NF. Topographical patterns of whole-brain structural alterations in association with genetic risk, cerebrospinal fluid, positron emission tomography biomarkers of Alzheimer’s disease, and neuropsychological measures. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Albano D, Premi E, Peli A, Camoni L, Bertagna F, Turrone R, Borroni B, Calhoun VD, Rodella C, Magoni M, Padovani A, Giubbini R, Paghera B. Correlation between brain glucose metabolism (18F-FDG) and cerebral blood flow with amyloid tracers (18F-Florbetapir) in clinical routine: Preliminary evidences. Rev Esp Med Nucl Imagen Mol 2021; 41:146-152. [DOI: 10.1016/j.remnie.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
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15
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Lau TY, Kao YH, Toh HB, Sivaratnam D, Lichtenstein M, Velakoulis D, Walterfang M. Brain hypometabolic changes in 14 adolescent-adult patients with Niemann-Pick disease type C assessed by 18F-fluorodeoxyglucose positron emission tomography. J Neurol 2021; 268:3878-3885. [PMID: 33830335 DOI: 10.1007/s00415-021-10535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Niemann Pick disease type C (NPC) is a rare progressive neurovisceral lysosomal disorder caused by autosomal recessive mutations in the NPC1 or NPC2 genes. 18F-fluorodeoxyglucose (FDG) is a positron-emitting glucose analogue for non-invasive imaging of brain metabolism. FDG PET is commonly used for dementia imaging but its specific application to NPC is rarely described. METHODS This is a retrospective study of all baseline brain FDG PET performed for NPC patients. Images were assessed using a normal database statistical comparison of metabolic changes expressed in standard deviations and three-dimensional Stereotactic Surface Projection maps. Typical hypometabolic patterns in NPC were identified. We further investigated any correlation between the degree of regional brain hypometabolism and the Iturriaga clinical severity scale. RESULTS Brain FDG PET images of 14 adolescent-adult NPC patients were analysed, with mean age of 35 years. We found significant frontal lobe hypometabolism in 12 patients (86%), thalamic hypometabolism in eight patients (57%) and variable parietal lobe hypometabolism in 13 patients (93%). Hypometabolic changes were usually bilateral and symmetric. Ten out of 13 ataxic patients showed cerebellar or thalamic hypometabolism (sensitivity 77%, specificity 100%). Linear regression analysis showed frontal lobe hypometabolism to have the best correlation with the Iturriaga clinical scale (R2 = 0.439; p = 0.01). CONCLUSIONS We found bilateral symmetric hypometabolism of the frontal lobes, thalami and parietal lobes (especially posterior cingulate gyrus) to be typical of adolescent-adult NPC. Ataxia was commonly associated with cerebellar or thalamic hypometabolism. Frontal lobe hypometabolism showed the best inverse correlation with clinical severity.
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Affiliation(s)
- Theodore Y Lau
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Yung Hsiang Kao
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - H B Toh
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Dinesh Sivaratnam
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Meir Lichtenstein
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, The Royal Melbourne Hospital, Level 2, John Cade Building, Melbourne, 3050, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne and North Western Mental Health, Melbourne, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, The Royal Melbourne Hospital, Level 2, John Cade Building, Melbourne, 3050, Australia. .,Melbourne Neuropsychiatry Centre, University of Melbourne and North Western Mental Health, Melbourne, Australia. .,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
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16
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Garibotto V, Trombella S, Antelmi L, Bosco P, Redolfi A, Tabouret-Viaud C, Rager O, Gold G, Giannakopoulos P, Morbelli S, Nobili F, Perneczky R, Didic M, Guedj E, Drzezga A, Ossenkoppele R, Berckel BV, Ratib O, Frisoni GB. A Comparison of Two Statistical Mapping Tools for Automated Brain FDG-PET Analysis in Predicting Conversion to Alzheimer's Disease in Subjects with Mild Cognitive Impairment. Curr Alzheimer Res 2021; 17:1186-1194. [PMID: 33583380 DOI: 10.2174/1567205018666210212162443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/24/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Automated voxel-based analysis methods are used to detect cortical hypometabolism typical of Alzheimer's Disease (AD) on FDG-PET brain scans. We compared the accuracy of two clinically validated tools for their ability to identify those MCI subjects progressing to AD at followup, to evaluate the impact of the analysis method on FDG-PET diagnostic performance. METHODS SPMGrid and BRASS (Hermes Medical Solutions, Stockholm, Sweden) were tested on 131 MCI and elderly healthy controls from the EADC PET dataset. The concordance between the tools was tested by correlating the quantitative parameters (z- and t-values), calculated by the two software tools, and by measuring the topographical overlap of the abnormal regions (Dice score). Three independent expert readers blindly assigned a diagnosis based on the two map sets. We used conversion to AD dementia as the gold standard. RESULTS The t-map and z-map calculated with SPMGrid and BRASS, respectively, showed a good correlation (R > .50) for the majority of individual cases (128/131) and for the majority of selected regions of interest (ROIs) (98/116). The overlap of the hypometabolic patterns from the two tools was, however, poor (Dice score .36). The diagnostic performance was comparable, with BRASS showing significantly higher sensitivity (.82 versus .59) and SPMGrid showing higher specificity (.87 versus .52). CONCLUSION Despite similar diagnostic performance in predicting conversion to AD in MCI subjects, the two tools showed significant differences, and the maps provided by the tools showed limited overlap. These results underline the urgency for standardization across FDG-PET analysis methods for their use in clinical practice.
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Affiliation(s)
- Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracer, University of Geneva, Geneva, Switzerland
| | - Sara Trombella
- Laboratory of Neuroimaging and Innovative Molecular Tracer, University of Geneva, Geneva, Switzerland
| | - Luigi Antelmi
- University of Cote d'Azur, Inria Sophia Antipolis, Epione Research Project, Nice, France
| | - Paolo Bosco
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, Italy
| | - Alberto Redolfi
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Claire Tabouret-Viaud
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Olivier Rager
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Silvia Morbelli
- Department of Nuclear Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Flavio Nobili
- Department of Nuclear Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, Ludwig, Maximilians-Universitaet Muenchen, Munich, Germany
| | - Mira Didic
- Aix-Marseille Universite, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, Marseille, France
| | - Eric Guedj
- Aix-Marseille Universite, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, Marseille, France
| | - Alexander Drzezga
- Department of Nuclear Medicine, Technische Universitaet, Munich, Germany
| | - Rik Ossenkoppele
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, Netherlands
| | - Bart Van Berckel
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, Netherlands
| | - Osman Ratib
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
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17
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Caminiti SP, Sala A, Presotto L, Chincarini A, Sestini S, Perani D, Schillaci O, Berti V, Calcagni ML, Cistaro A, Morbelli S, Nobili F, Pappatà S, Volterrani D, Gobbo CL. Validation of FDG-PET datasets of normal controls for the extraction of SPM-based brain metabolism maps. Eur J Nucl Med Mol Imaging 2021; 48:2486-2499. [PMID: 33423088 DOI: 10.1007/s00259-020-05175-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/20/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE An appropriate healthy control dataset is mandatory to achieve good performance in voxel-wise analyses. We aimed at evaluating [18F]FDG PET brain datasets of healthy controls (HC), based on publicly available data, for the extraction of voxel-based brain metabolism maps at the single-subject level. METHODS Selection of HC images was based on visual rating, after Cook's distance and jack-knife analyses, to exclude artefacts and/or outliers. The performance of these HC datasets (ADNI-HC and AIMN-HC) to extract hypometabolism patterns in single patients was tested in comparison with the standard reference HC dataset (HSR-HC) by means of Dice score analysis. We evaluated the performance and comparability of the different HC datasets in the assessment of single-subject SPM-based hypometabolism in three independent cohorts of patients, namely, ADD, bvFTD and DLB. RESULTS Two-step Cook's distance analysis and the subsequent jack-knife analysis resulted in the selection of n = 125 subjects from the AIMN-HC dataset and n = 75 subjects from the ADNI-HC dataset. The average concordance between SPM hypometabolism t-maps in the three patient cohorts, as obtained with the new datasets and compared to the HSR-HC standard reference dataset, was 0.87 for the AIMN-HC dataset and 0.83 for the ADNI-HC dataset. Pattern expression analysis revealed high overall accuracy (> 80%) of the SPM t-map classification according to different statistical thresholds and sample sizes. CONCLUSIONS The applied procedures ensure validity of these HC datasets for the single-subject estimation of brain metabolism using voxel-wise comparisons. These well-selected HC datasets are ready-to-use in research and clinical settings.
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Affiliation(s)
- Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy.,In vivo human molecular and structural neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arianna Sala
- Vita-Salute San Raffaele University, Milan, Italy.,In vivo human molecular and structural neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Presotto
- Nuclear Medicine Unit, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | | | | | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy. .,In vivo human molecular and structural neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Nuclear Medicine Unit, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
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18
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Tripathi M, Tripathi M, Parida GK, Kumar R, Dwivedi S, Nehra A, Bal C. Biomarker-Based Prediction of Progression to Dementia: F-18 FDG-PET in Amnestic MCI. Neurol India 2020; 67:1310-1317. [PMID: 31744965 DOI: 10.4103/0028-3886.271245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Metabolic patterns on brain F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) can predict the decline in amnestic mild cognitive impairment (aMCI) to Alzheimer's disease dementia (AD) or other dementias. Objective This study was undertaken to evaluate the diagnostic accuracy of baseline F-18 FDG-PET in aMCI for predicting conversion to AD or other dementias on follow-up. Patients and Methods A total of 87 patients with aMCI were enrolled in the study. Each patient underwent a detailed clinical and neuropsychological examination and FDG-PET at baseline. Each PET scan was visually classified based on predefined dementia patterns. Automated analysis of FDG PET was performed using Cortex ID (GE Healthcare). The mean follow-up duration was 30.4 ± 9.3 months (range: 18-48 months). Diagnosis of dementia at follow-up (obtained using clinical diagnostic criteria) constituted the reference standard, and all the included aMCI patients were divided into two groups: the aMCI converters (MCI-C) and MCI nonconverters (MCI-NC). Diagnostic accuracy of FDG PET was calculated using this reference standard. Results There were 23 MCI-C and 64 MCI-NC. Of the 23 MCI-C, 19 were diagnosed as probable AD, 1 as frontotemporal demetia (FTD), and 3 as vascular dementia (VD). Of the 64 MCI-NC, 9 had subjective improvement in cognition, and 55 remained stable. The conversion rate for all types of dementia in our series was 26.4% (23/87) and for Alzheimer's type dementia was 21.8% (19/87). The of PET-based visual interpretation was 91.9%. Sensitivity, specificity, positive predictive value, and negative predictive value for FDG-PET-based prediction of dementia conversion were 86.9% [confidence interval (CI) 66.4%-97.2%)], 93.7% (CI 84.7%-98.2%), 83.3% (CI 65.6%-92.9%), and 95.2% (CI 87.4%-98.9%), respectively. Kappa for agreement between visual and Cortex ID was 0.94 indicating excellent agreement. In the three aMCI patients progressing to VD, no specific abnormality in metabolic pattern was noted; however, there was marked cortical atrophy on computed tomography. Conclusion FDG-PET-based visual and cortex ID classification has a good accuracy in predicting progression to dementia including AD in the prodromal aMCI phase. Absence of typical metabolic patterns on FDG-PET can play an important exclusionary role for progression to dementia. Vascular cognitive impairment with cerebral atrophy needs further studies to confirm and uncover potential mechanisms.
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Affiliation(s)
- Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sadanand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Department of Neurology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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19
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McWhirter L, Ritchie C, Stone J, Carson A. Functional cognitive disorders: a systematic review. Lancet Psychiatry 2020; 7:191-207. [PMID: 31732482 DOI: 10.1016/s2215-0366(19)30405-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.
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Affiliation(s)
- Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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20
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Ceccarini J, Bourgeois S, Van Weehaeghe D, Goffin K, Vandenberghe R, Vandenbulcke M, Sunaert S, Van Laere K. Direct prospective comparison of 18F-FDG PET and arterial spin labelling MR using simultaneous PET/MR in patients referred for diagnosis of dementia. Eur J Nucl Med Mol Imaging 2020; 47:2142-2154. [PMID: 31960098 DOI: 10.1007/s00259-020-04694-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/12/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE 18F-FDG PET is routinely used as an imaging marker in the early and differential diagnosis of dementing disorders and has incremental value over the clinical neurological and neuropsychological evaluation. Perfusion MR imaging by means of arterial spin labelling (ASL) is an alternative modality to indirectly measure neuronal functioning and could be used as complement measurement in a single MR session in the workup of dementia. Using simultaneous PET-MR, we performed a direct head-to-head comparison between enhanced multiplane tagging ASL (eASL) and 18F-FDG PET in a true clinical context of subjects referred for suspicion of neurodegenerative dementia. METHODS Twenty-seven patients underwent a 20-min 18F-FDG PET/MR and simultaneously acquired eASL on a GE Signa PET/MR. Data were compared with 30 screened age- and gender-matched healthy controls. Both integral eASL and 18F-FDG datasets were analysed visually by two readers unaware of the final clinical diagnosis, either in normal/abnormal classes, or full differential diagnosis (normal, Alzheimer type dementia [AD], dementia with Lewy Bodies [LBD], frontotemporal dementia [FTD] or other). Reader confidence was assessed with a rating scale (range 1-4). Data were also analysed semiquantitatively by VOI and voxel-based analyses. RESULTS The ground truth diagnosis for the patient group resulted in 14 patients with a neurodegenerative cognitive disorder (AD, FTD, LBD) and 13 patients with no arguments for an underlying neurodegenerative cause. Visual analysis resulted in equal specificity (0.70) for differentiating normal and abnormal cases between the two modalities, but in a higher sensitivity (0.93), confidence rating (0.64) and interobserver agreement for 18F-FDG PET compared with eASL. The same was true for assigning a specific differential diagnosis (sensitivity: and 0.39 for 18F-FDG PET and eASL, respectively). Semiquantitative analyses revealed prototypical patterns for AD and FTD, with both higher volumes of abnormality and intensity differences on 18F-FDG PET. CONCLUSION In a direct head-to-head comparison on a simultaneous GE Signa PET/MR, 18F-FDG PET performed better compared with ASL in terms of sensitivity and reader confidence, as well as volume and intensity of abnormalities. However, using pure semiquantitative analysis, similar diagnostic accuracy between the two modalities was obtained. Therefore, ASL may still serve as complement to neuroreceptor or protein deposition PET studies when a single simultaneous investigation is warranted.
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Affiliation(s)
- Jenny Ceccarini
- Department of Imaging and Pathology, University Hospitals Leuven and KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Sophie Bourgeois
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Donatienne Van Weehaeghe
- Department of Imaging and Pathology, University Hospitals Leuven and KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Imaging and Pathology, University Hospitals Leuven and KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rik Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | - Stefan Sunaert
- Department of Imaging and Pathology, University Hospitals Leuven and KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Van Laere
- Department of Imaging and Pathology, University Hospitals Leuven and KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
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21
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18F-FDG in the differential diagnosis of neurodegenerative dementias. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Mukku SSR, Sivakumar PT, Nagaraj C, Mangalore S, Harbishettar V, Varghese M. Clinical utility of 18F-FDG-PET/MRI brain in dementia: Preliminary experience from a geriatric clinic in South India. Asian J Psychiatr 2019; 44:99-105. [PMID: 31336358 DOI: 10.1016/j.ajp.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND 18F-FDG-PET is a potential sensitive biomarker indicating neuronal damage. 18F-FDG-PET has proven to be useful in subtyping dementia. Utility of simultaneous 18F-FDG-PET and MRI-brain was investigated in the evaluation of dementia in this facility. METHOD All case notes of patients who underwent 18 F-FDG-PET/MRI brain attending the Geriatric Clinic for 18 month period between January 2017 and June 2018 were retrospectively reviewed. Their socio-demographic details, MRI-brain finding, 18F- FDG-PET findings and comorbid illnesses were studied. RESULTS A total of 21 patients underwent 18F-FDG-PET/MRI brain during study period. The mean age was 61.23, SD-8.6 years (range: 36-75 years). Among them 5 (23.8%) had Mild Cognitive Impairment (MCI) and 16 (76.2%) had dementia. Majority of patients had early onset cognitive decline (76.2%). Based on the pattern of hypometabolism, the MCI group had one patient each indicative of AD, Semantic-Frontotemporal dementia (Semantic-FTD), mixed Alzheimer's dementia (AD + FTD) and two patients had patterns suggestive of Behaviour Variant of FTD (Bv-FTD). In Dementia group the pattern of hypometabolism was indicative of Bv-FTD in seven, AD in four, Posterior Cortical Atrophy (PCA) in one, Semantic-FTD in one, Mixed AD-Diffuse Lewy Body Dementia (DLBD) in one and no specific pattern in two patients. MRI and 18 F-FDG-PET brain had concordance in 9 (56.26%) patients. DISCUSSION 18F-FDG-PET/MRI helped in overall clinical diagnosis and management in 19 (90.5%) patients especially with early onset dementia. In MCI group it indicated underlying aetiology and in dementia group it helped in subtyping. CONCLUSION The study supports the role of 18F-FDG-PET/MRI as an emerging diagnostic tool to assist in dementia evaluation in India.
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Affiliation(s)
- Shiva Shanker Reddy Mukku
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Chandana Nagaraj
- Department of Neuroimaging and interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Sandhya Mangalore
- Department of Neuroimaging and interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Vijaykumar Harbishettar
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Mathew Varghese
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
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23
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Smailagic N, Lafortune L, Kelly S, Hyde C, Brayne C. 18F-FDG PET for Prediction of Conversion to Alzheimer's Disease Dementia in People with Mild Cognitive Impairment: An Updated Systematic Review of Test Accuracy. J Alzheimers Dis 2019; 64:1175-1194. [PMID: 30010119 PMCID: PMC6218118 DOI: 10.3233/jad-171125] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: A previous Cochrane systematic review concluded there is insufficient evidence to support the routine use of 18F-FDG PET in clinical practice in people with mild cognitive impairment (MCI). Objectives: To update the evidence and reassess the accuracy of 18F-FDG-PET for detecting people with MCI at baseline who would clinically convert to Alzheimer’s disease (AD) dementia at follow-up. Methods: A systematic review including comprehensive search of electronic databases from January 2013 to July 2017, to update original searches (1999 to 2013). All key review steps, including quality assessment using QUADAS 2, were performed independently and blindly by two review authors. Meta-analysis could not be conducted due to heterogeneity across studies. Results: When all included studies were examined across all semi-quantitative and quantitative metrics, exploratory analysis for conversion of MCI to AD dementia (n = 24) showed highly variable accuracy; half the studies failed to meet four or more of the seven sets of QUADAS 2 criteria. Variable accuracy for all metrics was also found across eleven newly included studies published in the last 5 years (range: sensitivity 56–100%, specificity 24–100%). The most consistently high sensitivity and specificity values (approximately ≥80%) were reported for the sc-SPM (single case statistical parametric mapping) metric in 6 out of 8 studies. Conclusion: Systematic and comprehensive assessment of studies of 18FDG-PET for prediction of conversion from MCI to AD dementia reveals many studies have methodological limitations according to Cochrane diagnostic test accuracy gold standards, and shows accuracy remains highly variable, including in the most recent studies. There is some evidence, however, of higher and more consistent accuracy in studies using computer aided metrics, such as sc-SPM, in specialized clinical settings. Robust, methodologically sound prospective longitudinal cohort studies with long (≥5 years) follow-up, larger consecutive samples, and defined baseline threshold(s) are needed to test these promising results. Further evidence of the clinical validity and utility of 18F-FDG PET in people with MCI is needed.
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Affiliation(s)
- Nadja Smailagic
- Cambridge Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Louise Lafortune
- Cambridge Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah Kelly
- Cambridge Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Chris Hyde
- Exeter Test Group and South West CLAHRC, University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
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24
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Blum D, Liepelt-Scarfone I, Berg D, Gasser T, la Fougère C, Reimold M. Controls-based denoising, a new approach for medical image analysis, improves prediction of conversion to Alzheimer's disease with FDG-PET. Eur J Nucl Med Mol Imaging 2019; 46:2370-2379. [PMID: 31338550 DOI: 10.1007/s00259-019-04400-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The pattern expression score (PES), i.e., the degree to which a pathology-related pattern is present, is frequently used in FDG-brain-PET analysis and has been shown to be a powerful predictor of conversion to Alzheimer's disease (AD) in mild cognitive impairment (MCI). Since, inevitably, the PES is affected by non-pathological variability, our aim was to improve classification with the simple, yet novel approach to identify patterns of non-pathological variance in a separate control sample using principal component analysis and removing them from patient data (controls-based denoising, CODE) before calculating the PES. METHODS Multi-center FDG-PET from 220 MCI patients (64 non-converter, follow-up ≥ 4 years; 156 AD converter, time-to-conversion ≤ 4 years) were obtained from the ADNI database. Patterns of non-pathological variance were determined from 262 healthy controls. An AD pattern was calculated from AD patients and controls. We predicted AD conversion based on PES only and on PES combined with neuropsychological features and ApoE4 genotype. We compared classification performance achieved with and without CODE and with a standard machine learning approach (support vector machine). RESULTS Our model predicts that CODE improves the signal-to-noise ratio of AD-PES by a factor of 1.5. PES-based prediction of AD conversion improved from AUC 0.80 to 0.88 (p= 0.001, DeLong's method), sensitivity 69 to 83%, specificity 81% to 88% and Matthews correlation coefficient (MCC) 0.45 to 0.66. Best classification (0.93 AUC) was obtained when combining the denoised PES with clinical features. CONCLUSIONS CODE, applied in its basic form, significantly improved prediction of conversion based on PES. The achieved classification performance was higher than with a standard machine learning algorithm, which was trained on patients, explainable by the fact that CODE used additional information (large sample of healthy controls). We conclude that the proposed, novel method is a powerful tool for improving medical image analysis that offers a wide spectrum of biomedical applications, even beyond image analysis.
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Affiliation(s)
- Dominik Blum
- Institute for Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tuebingen, Germany.
| | - Inga Liepelt-Scarfone
- German Center of Neurodegenerative Diseases, Eberhard Karls University, Tuebingen, Germany.,Hertie-Institute for Clinical Brain Research, Eberhard Karls University, Tuebingen, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Thomas Gasser
- German Center of Neurodegenerative Diseases, Eberhard Karls University, Tuebingen, Germany.,Hertie-Institute for Clinical Brain Research, Eberhard Karls University, Tuebingen, Germany
| | - Christian la Fougère
- Institute for Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tuebingen, Germany
| | - Matthias Reimold
- Institute for Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tuebingen, Germany
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Kaltoft NS, Marner L, Larsen VA, Hasselbalch SG, Law I, Henriksen OM. Hybrid FDG PET/MRI vs. FDG PET and CT in patients with suspected dementia - A comparison of diagnostic yield and propagated influence on clinical diagnosis and patient management. PLoS One 2019; 14:e0216409. [PMID: 31048902 PMCID: PMC6497285 DOI: 10.1371/journal.pone.0216409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background Both 18F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET), computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used in the evaluation of memory clinic patients. Hybrid PET/MR systems now allow simultaneous PET and MRI imaging within the duration of the PET emission scan. Purpose To compare the diagnostic yield of PET/MRI using an abbreviated MR protocol with that of separate PET and CT in a mixed memory clinic population, and the propagated influences on clinical diagnosis and patient management. Material and methods Consecutive memory clinic patients (n = 78) undergoing both CT and hybrid FDG PET/MRI scans were identified retrospectively. MRI and CT were separately evaluated for vascular and structural pathology. PET scans were classified according to the presence of neurodegenerative or vascular disease using CT or MRI, respectively, for anatomical guiding. A memory clinic expert assessed the clinical impact of the additional findings and/or change of PET classification achieved by MRI anatomical guiding as compared to CT guiding. Results MRI lead to significantly higher Fazekas scores, higher medial temporal and global cortical atrophy scores, and identified more patients with infarcts (28 vs 8, p<0.001) compared to CT. MRI changed PET classification in 13 (17%) patients. Addition of MRI to CT had minor clinical impact in 4/78 (5%) and major clinical impact in 13/78 (17%) of patients. Conclusion The study demonstrates the capabilities of PET/MRI systems for routine clinical imaging of memory clinic patients, and that even an abbreviated hybrid PET/MRI protocol provides significant additional information influencing clinical diagnosis and patient management in a substantial fraction of patients when compared to separate PET and CT.
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Affiliation(s)
- Nicolai Stefan Kaltoft
- Department of Radiology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Andree Larsen
- Department of Radiology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Dept. of Neurology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
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Sörensen A, Blazhenets G, Rücker G, Schiller F, Meyer PT, Frings L. Prognosis of conversion of mild cognitive impairment to Alzheimer's dementia by voxel-wise Cox regression based on FDG PET data. NEUROIMAGE-CLINICAL 2018; 21:101637. [PMID: 30553760 PMCID: PMC6411907 DOI: 10.1016/j.nicl.2018.101637] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/07/2018] [Accepted: 12/09/2018] [Indexed: 11/17/2022]
Abstract
Aim The value of 18F-fluorodeoxyglucose (FDG) PET for the prognosis of conversion from mild cognitive impairment (MCI) to Alzheimer's dementia (AD) is controversial. In the present work, the identification of cerebral metabolic patterns with significant prognostic value for conversion of MCI patients to AD is investigated with voxel-based Cox regression, which in contrast to common categorical comparisons also utilizes time information. Methods FDG PET data of 544 MCI patients from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database were randomly split into two equally-sized datasets (training and test). Within a median follow-up duration of 47 months (95% CI: 46–48 months) 181 patients developed AD. In the training dataset, voxel-wise Cox regressions were used to identify regions associated with conversion of MCI to AD. These were compared to regions identified by a classical group comparison (analysis of covariance (ANCOVA) with statistical parametric mapping (SPM) 8) between converters and non-converters (both adjusted for apolipoprotein E (APOE) genotype, mini-mental state examination (MMSE) score, age, sex and education). In the test dataset, normalized FDG uptake within significant brain regions from voxel-wise Cox- and ANCOVA analyses (Cox- and ANCOVA- regions of interest (ROI), respectively) and clinical variables APOE status, MMSE score and education were tested in different Cox models (adjusted for age, sex) including: (1) only clinical variables, (2) only normalized FDG uptake in ANCOVA-ROI, (3) only normalized FDG uptake from Cox-ROI, (4) clinical variables plus FDG uptake in ANCOVA-ROI, (5) clinical variables plus FDG uptake from Cox-ROI. Results Conversion-related regions with relative hypometabolism comprised parts of the temporo-parietal and posterior cingulate cortex/precuneus for voxel-wise ANCOVA, plus frontal regions for voxel-wise Cox regression (both p < .01, false discovery rate (FDR) corrected). The clinical-only model (1) and the models based on normalized FDG uptake from Cox-ROI only (2) and ANCOVA-ROI only (3) all significantly predicted conversion to AD (Wald Test (WT): p < .001). The clinical model (1) was significantly improved by adding imaging information in model (4) (Akaike information criterion (AIC) relative likelihood (RL) (1) vs (4): RL < 0.018). There were no significant differences between models (2) and (3), as well as (4) and (5). Conclusions Voxel-wise Cox regression identifies conversion-related patterns of cerebral glucose metabolism, but is not superior to classical group contrasts in this regard. With imaging information from both FDG PET patterns, the prediction of conversion to AD was improved. Voxel-wise Cox regression identifies regions relevant for development AD. Hypometabolism of these regions poses a significant hazard for AD development. Inclusion of FDG PET data improves the accuracy of prognosis significantly.
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Affiliation(s)
- Arnd Sörensen
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Ganna Blazhenets
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Florian Schiller
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Philipp Tobias Meyer
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Lars Frings
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany; Center for Geriatrics and Gerontology Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Blazhenets G, Ma Y, Sörensen A, Rücker G, Schiller F, Eidelberg D, Frings L, Meyer PT. Principal Components Analysis of Brain Metabolism Predicts Development of Alzheimer Dementia. J Nucl Med 2018; 60:837-843. [PMID: 30389825 DOI: 10.2967/jnumed.118.219097] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022] Open
Abstract
The value of 18F-FDG PET for predicting conversion from mild cognitive impairment (MCI) to Alzheimer dementia (AD) is currently under debate. We used a principal components analysis (PCA) to identify a metabolic AD conversion-related pattern (ADCRP) and investigated the prognostic value of the resulting pattern expression score (PES). Methods: 18F-FDG PET scans of 544 MCI patients were obtained from the Alzheimer Disease Neuroimaging Initiative database and analyzed. We implemented voxel-based PCA and standard Statistical Parametric Mapping analysis (as a reference) to disclose cerebral metabolic patterns associated with conversion from MCI to AD. By Cox proportional hazards regression, we examined the prognostic value of candidate predictors. Also, we constructed prognostic models with clinical, imaging, and clinical and imaging variables in combination. Results: PCA revealed an ADCRP that involved regions with relative decreases in metabolism (temporoparietal, frontal, posterior cingulate, and precuneus cortices) and relative increases in metabolism (sensorimotor and occipital cortices, cerebellum, and left putamen). Among the predictor variables age, sex, Functional Activities Questionnaire, Mini-Mental State Examination, apolipoprotein E, PES, and normalized 18F-FDG uptake (regions with significant hypo- and hypermetabolism in patients with conversion vs. those without conversion), PES was the best independent predictor of conversion (hazard ratio, 1.77, per z score increase; 95% CI, 1.24-2.52; P < 0.001). Moreover, adding PES to the model including the clinical variables significantly increased its prognostic value. Conclusion: The ADCRP expression score was a valid predictor of conversion. A combination of clinical variables and PES yielded a higher accuracy than each single tool in predicting conversion from MCI to AD, underlining the incremental utility of 18F-FDG PET.
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Affiliation(s)
- Ganna Blazhenets
- Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yilong Ma
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, New York
| | - Arnd Sörensen
- Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; and
| | - Florian Schiller
- Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, New York
| | - Lars Frings
- Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Geriatrics and Gerontology Freiburg, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Nobili F, Arbizu J, Bouwman F, Drzezga A, Agosta F, Nestor P, Walker Z, Boccardi M. European Association of Nuclear Medicine and European Academy of Neurology recommendations for the use of brain 18 F-fluorodeoxyglucose positron emission tomography in neurodegenerative cognitive impairment and dementia: Delphi consensus. Eur J Neurol 2018; 25:1201-1217. [PMID: 29932266 DOI: 10.1111/ene.13728] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Recommendations for using fluorodeoxyglucose positron emission tomography (FDG-PET) to support the diagnosis of dementing neurodegenerative disorders are sparse and poorly structured. METHODS Twenty-one questions on diagnostic issues and on semi-automated analysis to assist visual reading were defined. Literature was reviewed to assess study design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiver operating characteristic curve, and positive/negative likelihood ratio of FDG-PET in detecting the target conditions. Using the Delphi method, an expert panel voted for/against the use of FDG-PET based on published evidence and expert opinion. RESULTS Of the 1435 papers, 58 papers provided proper quantitative assessment of test performance. The panel agreed on recommending FDG-PET for 14 questions: diagnosing mild cognitive impairment due to Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD) or dementia with Lewy bodies (DLB); diagnosing atypical AD and pseudo-dementia; differentiating between AD and DLB, FTLD or vascular dementia, between DLB and FTLD, and between Parkinson's disease and progressive supranuclear palsy; suggesting underlying pathophysiology in corticobasal degeneration and progressive primary aphasia, and cortical dysfunction in Parkinson's disease; using semi-automated assessment to assist visual reading. Panellists did not support FDG-PET use for pre-clinical stages of neurodegenerative disorders, for amyotrophic lateral sclerosis and Huntington disease diagnoses, and for amyotrophic lateral sclerosis or Huntington-disease-related cognitive decline. CONCLUSIONS Despite limited formal evidence, panellists deemed FDG-PET useful in the early and differential diagnosis of the main neurodegenerative disorders, and semi-automated assessment helpful to assist visual reading. These decisions are proposed as interim recommendations.
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Affiliation(s)
- F Nobili
- Department of Neuroscience (DINOGMI), University of Genoa and Polyclinic San Martino Hospital, Genoa, Italy
| | - J Arbizu
- Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - F Bouwman
- Department of Neurology and Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - A Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Cologne, Germany
| | - F Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - P Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Z Walker
- Division of Psychiatry, Essex Partnership University NHS Foundation Trust, University College London, London, UK
| | - M Boccardi
- Department of Psychiatry, Laboratoire du Neuroimagerie du Vieillissement (LANVIE), University of Geneva, Geneva, Switzerland
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Tomše P, Peng S, Pirtošek Z, Zaletel K, Dhawan V, Eidelberg D, Ma Y, Trošt M. The effects of image reconstruction algorithms on topographic characteristics, diagnostic performance and clinical correlation of metabolic brain networks in Parkinson's disease. Phys Med 2018; 52:104-112. [PMID: 30139598 DOI: 10.1016/j.ejmp.2018.06.637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the effects of different image reconstruction algorithms on topographic characteristics and diagnostic performance of the Parkinson's disease related pattern (PDRP). METHODS FDG-PET brain scans of 20 Parkinson's disease (PD) patients and 20 normal controls (NC) were reconstructed with six different algorithms in order to derive six versions of PDRP. Additional scans of 20 PD, 25 atypical parkinsonism (AP) patients and 20 NC subjects were used for validation. PDRP versions were compared by assessing differences in topographies, individual subject scores and correlations with patient's clinical ratings. Discrimination of PD from NC and AP subjects was evaluated across cohorts. RESULTS The region weights of the six PDRPs highly correlated (R ≥ 0.991; p < 0.0001). All PDRPs' expressions were significantly elevated in PD relative to NC and AP subjects (p < 0.0001) and correlated with clinical ratings (R ≥ 0.47; p < 0.05). Subject scores of the six PDRPs highly correlated within each of individual healthy and parkinsonian groups (R ≥ 0.972, p < 0.0001) and were consistent across the algorithms when using the same reconstruction methods in PDRP derivation and validation. However, when derivation and validation reconstruction algorithms differed, subject scores were notably lower compared to the reference PDRP, in all subject groups. CONCLUSION PDRP proves to be highly reproducible across FDG-PET image reconstruction algorithms in topography, ability to differentiate PD from NC and AP subjects and clinical correlation. When calculating PDRP scores in scans that have different reconstruction algorithms and imaging systems from those used for PDRP derivation, a calibration with NC subjects is advisable.
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Affiliation(s)
- Petra Tomše
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia.
| | - Shichun Peng
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA.
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104 Ljubljana, Slovenia.
| | - Katja Zaletel
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia.
| | - Vijay Dhawan
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA.
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA.
| | - Yilong Ma
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA.
| | - Maja Trošt
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; Department of Nuclear Medicine, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104 Ljubljana, Slovenia.
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30
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Mainta I, Trombella S, Morbelli S, Frisoni G, Garibotto V. Education-Adjusted Normality Thresholds for FDG-PET in the Diagnosis of Alzheimer Disease. NEURODEGENER DIS 2018; 18:120-126. [DOI: 10.1159/000488915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022] Open
Abstract
Background: A corollary of the reserve hypothesis is that what is regarded as pathological cortical metabolism in patients might vary according to education. Objective: The aim of this study is to assess the incremental diagnostic value of education-adjusted over unadjusted thresholds on the diagnostic accuracy of FDG-PET as a biomarker for Alzheimer disease (AD). Methods: We compared cortical metabolism in 90 healthy controls and 181 AD patients from the Alzheimer Disease Neuroimaging Initiative (ADNI) database. The AUC of the ROC curve did not differ significantly between the whole group and the higher-education patients or the lower-education subjects. Results: The threshold of wMetaROI values providing 80% sensitivity was lower in higher-education patients and higher in the lower-education patients, compared to the standard threshold derived over the whole AD collective, without, however, significant changes in sensitivity and specificity. Conclusion: These data show that education, as a proxy of reserve, is not a major confounder in the diagnostic accuracy of FDG-PET in AD and the adoption of education-adjusted thresholds is not required in daily practice.
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Abstract
PURPOSE OF REVIEW To present the new PET markers that could become in the coming years, relevant to advanced clinical approaches to dementia diagnosis, drug trials, and treatment strategies and discuss their advantages and limitations. RECENT FINDINGS The most advanced new PET tracers are the markers of the amyloid plaques, the τ compounds and the tracers of the translocator protein as markers of neuroinflammation. The main advantages but also the weaknesses of each of these markers are discussed. The main pitfall remains the heterogeneity of the available results that cast doubt to a rapid introduction of these new ligands in clinical practice. SUMMARY With the advent of biomarkers in clinical management and findings of molecular neuroimaging studies in the evaluation of patients with suspected dementia, the impact of functional neuroimaging has increased considerably these last years and has been integrated into many clinical guidelines in the field of dementia. In addition to conventional single PET brain perfusion and dopaminergic neurotransmission, 18F-fluorodeoxyglucose (18F-FDG) PET is used in advanced diagnosis procedures. Furthermore, new tracers are being developed to quantify key neuropathological features in the brain tissue as highly specific diagnosis is crucial to comply with the global medical and public health objectives in this domain. A strategic road map for further developments, adapted from the approach to cancer biomarkers, should be proposed so as to optimize the rationale of the PET-based molecular diagnosis of Alzheimer's disease and related disorders.
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Boccardi M, Festari C, Altomare D, Gandolfo F, Orini S, Nobili F, Frisoni GB. Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia. Eur J Nucl Med Mol Imaging 2018; 45:1470-1486. [DOI: 10.1007/s00259-018-4024-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 12/14/2022]
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Iaccarino L, Chiotis K, Alongi P, Almkvist O, Wall A, Cerami C, Bettinardi V, Gianolli L, Nordberg A, Perani D. A Cross-Validation of FDG- and Amyloid-PET Biomarkers in Mild Cognitive Impairment for the Risk Prediction to Dementia due to Alzheimer's Disease in a Clinical Setting. J Alzheimers Dis 2018; 59:603-614. [PMID: 28671117 DOI: 10.3233/jad-170158] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Assessments of brain glucose metabolism (18F-FDG-PET) and cerebral amyloid burden (11C-PiB-PET) in mild cognitive impairment (MCI) have shown highly variable performances when adopted to predict progression to dementia due to Alzheimer's disease (ADD). This study investigates, in a clinical setting, the separate and combined values of 18F-FDG-PET and 11C-PiB-PET in ADD conversion prediction with optimized data analysis procedures. Respectively, we investigate the accuracy of an optimized SPM analysis for 18F-FDG-PET and of standardized uptake value ratio semiquantification for 11C-PiB-PET in predicting ADD conversion in 30 MCI subjects (age 63.57±7.78 years). Fourteen subjects converted to ADD during the follow-up (median 26.5 months, inter-quartile range 30 months). Receiver operating characteristic analyses showed an area under the curve (AUC) of 0.89 and of 0.81 for, respectively, 18F-FDG-PET and 11C-PiB-PET. 18F-FDG-PET, compared to 11C-PiB-PET, showed higher specificity (1.00 versus 0.62, respectively), but lower sensitivity (0.79 versus 1.00). Combining the biomarkers improved classification accuracy (AUC = 0.96). During the follow-up time, all the MCI subjects positive for both PET biomarkers converted to ADD, whereas all the subjects negative for both remained stable. The difference in survival distributions was confirmed by a log-rank test (p = 0.002). These results indicate a very high accuracy in predicting MCI to ADD conversion of both 18F-FDG-PET and 11C-PiB-PET imaging, the former showing optimal performance based on the SPM optimized parametric assessment. Measures of brain glucose metabolism and amyloid load represent extremely powerful diagnostic and prognostic biomarkers with complementary roles in prodromal dementia phase, particularly when tailored to individual cases in clinical settings.
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Affiliation(s)
- Leonardo Iaccarino
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Konstantinos Chiotis
- Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Radiological Sciences, Nuclear Medicine Unit, San Raffaele G.Giglio Institute, Cefalù, Italy
| | - Ove Almkvist
- Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anders Wall
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,PET Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Chiara Cerami
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Clinical Neurosciences, Neurological Rehabilitation Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Luigi Gianolli
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Agneta Nordberg
- Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
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18F-FDG-PET and MRI in autoimmune encephalitis: a systematic review of brain findings. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0275-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Amyloid load but not regional glucose metabolism predicts conversion to Alzheimer’s dementia in a memory clinic population. Eur J Nucl Med Mol Imaging 2018; 45:1442-1448. [DOI: 10.1007/s00259-018-3983-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/18/2018] [Indexed: 10/17/2022]
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Caminiti SP, Ballarini T, Sala A, Cerami C, Presotto L, Santangelo R, Fallanca F, Vanoli EG, Gianolli L, Iannaccone S, Magnani G, Perani D. FDG-PET and CSF biomarker accuracy in prediction of conversion to different dementias in a large multicentre MCI cohort. Neuroimage Clin 2018; 18:167-177. [PMID: 29387532 PMCID: PMC5790816 DOI: 10.1016/j.nicl.2018.01.019] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 01/29/2023]
Abstract
Background/aims In this multicentre study in clinical settings, we assessed the accuracy of optimized procedures for FDG-PET brain metabolism and CSF classifications in predicting or excluding the conversion to Alzheimer's disease (AD) dementia and non-AD dementias. Methods We included 80 MCI subjects with neurological and neuropsychological assessments, FDG-PET scan and CSF measures at entry, all with clinical follow-up. FDG-PET data were analysed with a validated voxel-based SPM method. Resulting single-subject SPM maps were classified by five imaging experts according to the disease-specific patterns, as "typical-AD", "atypical-AD" (i.e. posterior cortical atrophy, asymmetric logopenic AD variant, frontal-AD variant), "non-AD" (i.e. behavioural variant FTD, corticobasal degeneration, semantic variant FTD; dementia with Lewy bodies) or "negative" patterns. To perform the statistical analyses, the individual patterns were grouped either as "AD dementia vs. non-AD dementia (all diseases)" or as "FTD vs. non-FTD (all diseases)". Aβ42, total and phosphorylated Tau CSF-levels were classified dichotomously, and using the Erlangen Score algorithm. Multivariate logistic models tested the prognostic accuracy of FDG-PET-SPM and CSF dichotomous classifications. Accuracy of Erlangen score and Erlangen Score aided by FDG-PET SPM classification was evaluated. Results The multivariate logistic model identified FDG-PET "AD" SPM classification (Expβ = 19.35, 95% C.I. 4.8-77.8, p < 0.001) and CSF Aβ42 (Expβ = 6.5, 95% C.I. 1.64-25.43, p < 0.05) as the best predictors of conversion from MCI to AD dementia. The "FTD" SPM pattern significantly predicted conversion to FTD dementias at follow-up (Expβ = 14, 95% C.I. 3.1-63, p < 0.001). Overall, FDG-PET-SPM classification was the most accurate biomarker, able to correctly differentiate either the MCI subjects who converted to AD or FTD dementias, and those who remained stable or reverted to normal cognition (Expβ = 17.9, 95% C.I. 4.55-70.46, p < 0.001). Conclusions Our results support the relevant role of FDG-PET-SPM classification in predicting progression to different dementia conditions in prodromal MCI phase, and in the exclusion of progression, outperforming CSF biomarkers.
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Key Words
- AD, Alzheimer's disease
- AUC, area under curve
- Alzheimer's disease dementia
- CBD, corticobasal degeneration
- CDR, Clinical Dementia Rating
- CSF, cerebrospinal fluid
- Clinical setting
- DLB, dementia with Lewy bodies
- EANM, European Association of Nuclear Medicine
- Erlangen Score
- FDG, fluorodeoxyglucose
- FTD, frontotemporal dementia
- Frontotemporal dementia
- LR+, positive likelihood ratio
- LR-, negative likelihood ratio
- MCI, mild cognitive impairment
- PET, positron emission tomography
- PSP, progressive supranuclear palsy
- Prognosis
- aMCI, single-domain amnestic mild cognitive impairment
- bvFTD, behavioral variant of frontotemporal dementia
- md aMCI, multi-domain amnestic mild cognitive impairment
- md naMCI, multi-domain non-amnestic mild cognitive impairment
- naMCI, single-domain non-amnestic mild cognitive impairment
- p-tau, phosphorylated tau
- t-tau, total tau
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Affiliation(s)
- Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Ballarini
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arianna Sala
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Cerami
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Luca Presotto
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Santangelo
- Department of Neurology and INSPE, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Luigi Gianolli
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology and INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy.
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Meles SK, Pagani M, Arnaldi D, De Carli F, Dessi B, Morbelli S, Sambuceti G, Jonsson C, Leenders KL, Nobili F. The Alzheimer's disease metabolic brain pattern in mild cognitive impairment. J Cereb Blood Flow Metab 2017; 37:3643-3648. [PMID: 28929833 PMCID: PMC5718332 DOI: 10.1177/0271678x17732508] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/13/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022]
Abstract
We investigated the expression of the Alzheimer's disease-related metabolic brain pattern (ADRP) in 18F-FDG-PET scans of 44 controls, 27 patients with mild cognitive impairment (MCI) who did not convert to Alzheimer's disease (AD) after five or more years of clinical follow-up, 95 MCI patients who did develop AD dementia on clinical follow-up, and 55 patients with mild-to-moderate AD. The ADRP showed good sensitivity (84%) and specificity (86%) for MCI-converters when compared to controls, but limited specificity when compared to MCI non-converters (66%). Assessment of 18F-FDG-PET scans on a case-by-case basis using the ADRP may be useful for quantifying disease progression.
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Affiliation(s)
- Sanne K Meles
- Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Marco Pagani
- Institutes of Cognitive Sciences and Technologies, CNR, Rome, Italy
- Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Dario Arnaldi
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Fabrizio De Carli
- Institute of Molecular Bioimaging and Physiology, National Research Council – Genoa Unit, AOU San Martino-IST, Genoa, Italy
| | - Barbara Dessi
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Silvia Morbelli
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Cathrine Jonsson
- Medical Radiation Physics and Nuclear Medicine, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Klaus L Leenders
- Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
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38
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Garibotto V, Herholz K, Boccardi M, Picco A, Varrone A, Nordberg A, Nobili F, Ratib O. Clinical validity of brain fluorodeoxyglucose positron emission tomography as a biomarker for Alzheimer's disease in the context of a structured 5-phase development framework. Neurobiol Aging 2017; 52:183-195. [PMID: 28317648 DOI: 10.1016/j.neurobiolaging.2016.03.033] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/09/2016] [Accepted: 03/22/2016] [Indexed: 10/19/2022]
Abstract
The use of Alzheimer's disease (AD) biomarkers is supported in diagnostic criteria, but their maturity for clinical routine is still debated. Here, we evaluate brain fluorodeoxyglucose positron emission tomography (FDG PET), a measure of cerebral glucose metabolism, as a biomarker to identify clinical and prodromal AD according to the framework suggested for biomarkers in oncology, using homogenous criteria with other biomarkers addressed in parallel reviews. FDG PET has fully achieved phase 1 (rational for use) and most of phase 2 (ability to discriminate AD subjects from healthy controls or other forms of dementia) aims. Phase 3 aims (early detection ability) are partly achieved. Phase 4 studies (routine use in prodromal patients) are ongoing, and only preliminary results can be extrapolated from retrospective observations. Phase 5 studies (quantify impact and costs) have not been performed. The results of this study show that specific efforts are needed to complete phase 3 evidence, in particular comparing and combining FDG PET with other biomarkers, and to properly design phase 4 prospective studies as a basis for phase 5 evaluations.
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Affiliation(s)
- Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva University, Geneva, Switzerland.
| | - Karl Herholz
- Wolfson Molecular Imaging Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Marina Boccardi
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; LANVIE (Laboratory of Neuroimaging of Aging), Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Agnese Picco
- LANVIE (Laboratory of Neuroimaging of Aging), Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Andrea Varrone
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Nordberg
- Department of Geriatric Medicine, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Flavio Nobili
- Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Osman Ratib
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva University, Geneva, Switzerland
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Abstract
A compelling need in the field of neurodegenerative diseases is the development and validation of biomarkers for early identification and differential diagnosis. The availability of positron emission tomography (PET) neuroimaging tools for the assessment of molecular biology and neuropathology has opened new venues in the diagnostic design and the conduction of new clinical trials. PET techniques, allowing the in vivo assessment of brain function and pathology changes, are increasingly showing great potential in supporting clinical diagnosis also in the early and even preclinical phases of dementia. This review will summarize the most recent evidence on fluorine-18 fluorodeoxyglucose-, amyloid -, tau -, and neuroinflammation - PET tools, highlighting strengths and limitations and possible new perspectives in research and clinical applications. Appropriate use of PET tools is crucial for a prompt diagnosis and target evaluation of new developed drugs aimed at slowing or preventing dementia.
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Affiliation(s)
- Leonardo Iaccarino
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arianna Sala
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
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40
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Morbelli S, Bauckneht M, Arnaldi D, Picco A, Pardini M, Brugnolo A, Buschiazzo A, Pagani M, Girtler N, Nieri A, Chincarini A, De Carli F, Sambuceti G, Nobili F. 18F-FDG PET diagnostic and prognostic patterns do not overlap in Alzheimer's disease (AD) patients at the mild cognitive impairment (MCI) stage. Eur J Nucl Med Mol Imaging 2017; 44:2073-2083. [PMID: 28785843 DOI: 10.1007/s00259-017-3790-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/23/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to identify the cortical regions where hypometabolism can predict the speed of conversion to dementia in mild cognitive impairment due to Alzheimer's disease (MCI-AD). METHODS We selected from the clinical database of our tertiary center memory clinic, eighty-two consecutive MCI-AD that underwent 18F-fluorodeoxyglucose (FDG) PET at baseline during the first diagnostic work-up and were followed up at least until their clinical conversion to AD dementia. The whole group of MCI-AD was compared in SPM8 with a group of age-matched healthy controls (CTR) to verify the presence of AD diagnostic-pattern; then the correlation between conversion time and brain metabolism was assessed to identify the prognostic-pattern. Significance threshold was set at p < 0.05 False-Discovery-Rate (FDR) corrected at peak and at cluster level. Each MCI-AD was then compared with CTR by means of a SPM single-subject analysis and grouped according to presence of AD diagnostic-pattern and prognostic-pattern. Kaplan-Meier-analysis was used to evaluate if diagnostic- and/or prognostic-patterns can predict speed of conversion to dementia. RESULTS Diagnostic-pattern corresponded to typical posterior hypometabolism (BA 7, 18, 19, 30, 31 and 40) and did not correlate with time to conversion, which was instead correlated with metabolic levels in right middle and inferior temporal gyri as well as in the fusiform gyrus (prognostic-pattern, BA 20, 21 and 38). At Kaplan-Meier analysis, patients with hypometabolism in the prognostic pattern converted to AD-dementia significantly earlier than patients not showing significant hypometabolism in the right middle and inferior temporal cortex (9 versus 19 months; Log rank p < 0.02, Breslow test: p < 0.003, Tarone-Ware test: p < 0.007). CONCLUSION The present findings support the role of FDG PET as a robust progression biomarker even in a naturalist population of MCI-AD. However, not the AD-typical diagnostic-pattern in posterior regions but the middle and inferior temporal metabolism captures speed of conversion to dementia in MCI-AD since baseline. The highlighted prognostic pattern is a further, independent source of heterogeneity in MCI-AD and affects a primary-endpoint on interventional clinical trials (time of conversion to dementia).
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Affiliation(s)
- Silvia Morbelli
- Nuclear Medicine Unit, IRCCS AOU San Martino, IST and Department of Health Sciences, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy.
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS AOU San Martino, IST and Department of Health Sciences, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Dario Arnaldi
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Agnese Picco
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Matteo Pardini
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Andrea Brugnolo
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Ambra Buschiazzo
- Nuclear Medicine Unit, IRCCS AOU San Martino, IST and Department of Health Sciences, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Marco Pagani
- Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy
- Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Nicola Girtler
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Alberto Nieri
- Nuclear Medicine Unit, IRCCS AOU San Martino, IST and Department of Health Sciences, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Andrea Chincarini
- Istituto Nazionale di Fisica Nucleare, Sezione di Genova, Genoa, Italy
| | - Fabrizio De Carli
- Institute of Bioimaging and Molecular Physiology, National Research Council, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, IRCCS AOU San Martino, IST and Department of Health Sciences, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
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Cerebral PET glucose hypometabolism in subjects with mild cognitive impairment and higher EEG high-alpha/low-alpha frequency power ratio. Neurobiol Aging 2017; 58:213-224. [PMID: 28755648 DOI: 10.1016/j.neurobiolaging.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/29/2017] [Accepted: 06/18/2017] [Indexed: 01/18/2023]
Abstract
In Alzheimer's disease (AD) research, both 2-deoxy-2-(18F)fluoro-D-glucose (FDG) positron emission tomography (PET) and electroencephalography (EEG) are reliable investigational modalities. The aim of this study was to investigate the associations between EEG High-alpha/Low-alpha (H-alpha/L-alpha) power ratio and cortical glucose metabolism. A total of 23 subjects with mild cognitive impairment (MCI) underwent FDG-PET and EEG examinations. H-alpha/L-alpha power ratio was computed for each subject and 2 groups were obtained based on the increase of the power ratio. The subjects with higher H-alpha/L-alpha power ratio showed a decrease in glucose metabolism in the hub brain areas previously identified as typically affected by AD pathology. In subjects with higher H-alpha/L-alpha ratio and lower metabolism, a "double alpha peak" was identified in the EEG spectrum and a U-shaped correlation between glucose metabolism and increase of H-alpha/L-alpha power ratio has been found. Moreover, in this group, a conversion rate of 62.5% at 24 months was detected, significantly different from the chance percentage expected. The neurophysiological meaning of the interplay between alpha oscillations and glucose metabolism and the possible interest of the H-alpha/L-alpha power ratio as a clinical biomarker in AD have been discussed.
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42
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Presotto L, Ballarini T, Caminiti SP, Bettinardi V, Gianolli L, Perani D. Validation of 18F–FDG-PET Single-Subject Optimized SPM Procedure with Different PET Scanners. Neuroinformatics 2017; 15:151-163. [DOI: 10.1007/s12021-016-9322-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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43
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The need of standardization and of large clinical studies in an emerging indication of [18F]FDG PET: the autoimmune encephalitis. Eur J Nucl Med Mol Imaging 2016; 44:353-357. [DOI: 10.1007/s00259-016-3589-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/24/2016] [Indexed: 01/20/2023]
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44
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Dual-phase amyloid PET: hitting two birds with one stone. Eur J Nucl Med Mol Imaging 2016; 43:1300-3. [DOI: 10.1007/s00259-016-3393-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
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Teipel S, Grothe MJ. Does posterior cingulate hypometabolism result from disconnection or local pathology across preclinical and clinical stages of Alzheimer's disease? Eur J Nucl Med Mol Imaging 2016; 43:526-36. [PMID: 26555082 PMCID: PMC6166099 DOI: 10.1007/s00259-015-3222-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Posterior cingulate cortex (PCC) hypometabolism as measured by FDG PET is an indicator of Alzheimer's disease (AD) in prodromal stages, such as in mild cognitive impairment (MCI), and has been found to be closely associated with hippocampus atrophy in AD dementia. We studied the effects of local and remote atrophy and of local amyloid load on the PCC metabolic signal in patients with different preclinical and clinical stages of AD. METHODS We determined the volume of the hippocampus and PCC grey matter based on volumetric MRI scans, PCC amyloid load based on AV45 PET, and PCC metabolism based on FDG PET in 667 subjects participating in the Alzheimer's Disease Neuroimaging Initiative spanning the range from cognitively normal ageing through prodromal AD to AD dementia. RESULTS In cognitively normal individuals and those with early MCI, PCC hypometabolism was exclusively associated with hippocampus atrophy, whereas in subjects with late MCI it was associated with both local and remote effects of atrophy as well as local amyloid load. In subjects with AD dementia, PCC hypometabolism was exclusively related to local atrophy. CONCLUSION Our findings suggest that the effects of remote pathology on PCC hypometabolism decrease and the effects of local pathology increase from preclinical to clinical stages of AD, consistent with a progressive disconnection of the PCC from downstream cortical and subcortical brain regions.
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Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.
- DZNE, German Center for Neurodegenerative Diseases, Gehlsheimer Str. 20, 18147, Rostock, Germany.
| | - Michel J Grothe
- DZNE, German Center for Neurodegenerative Diseases, Gehlsheimer Str. 20, 18147, Rostock, Germany
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