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Meyer MR, Kirmess KM, Eastwood S, Wente‐Roth TL, Irvin F, Holubasch MS, Venkatesh V, Fogelman I, Monane M, Hanna L, Rabinovici GD, Siegel BA, Whitmer RA, Apgar C, Bateman RJ, Holtzman DM, Irizarry M, Verbel D, Sachdev P, Ito S, Contois J, Yarasheski KE, Braunstein JB, Verghese PB, West T. Clinical validation of the PrecivityAD2 blood test: A mass spectrometry-based test with algorithm combining %p-tau217 and Aβ42/40 ratio to identify presence of brain amyloid. Alzheimers Dement 2024; 20:3179-3192. [PMID: 38491912 PMCID: PMC11095426 DOI: 10.1002/alz.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND With the availability of disease-modifying therapies for Alzheimer's disease (AD), it is important for clinicians to have tests to aid in AD diagnosis, especially when the presence of amyloid pathology is a criterion for receiving treatment. METHODS High-throughput, mass spectrometry-based assays were used to measure %p-tau217 and amyloid beta (Aβ)42/40 ratio in blood samples from 583 individuals with suspected AD (53% positron emission tomography [PET] positive by Centiloid > 25). An algorithm (PrecivityAD2 test) was developed using these plasma biomarkers to identify brain amyloidosis by PET. RESULTS The area under the receiver operating characteristic curve (AUC-ROC) for %p-tau217 (0.94) was statistically significantly higher than that for p-tau217 concentration (0.91). The AUC-ROC for the PrecivityAD2 test output, the Amyloid Probability Score 2, was 0.94, yielding 88% agreement with amyloid PET. Diagnostic performance of the APS2 was similar by ethnicity, sex, age, and apoE4 status. DISCUSSION The PrecivityAD2 blood test showed strong clinical validity, with excellent agreement with brain amyloidosis by PET.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lucy Hanna
- Center for Statistical SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | | | | | | | - Charles Apgar
- American College of RadiologyPhiladelphiaPennsylvaniaUSA
| | | | | | | | | | | | | | | | | | | | | | - Tim West
- C2N DiagnosticsSt. LouisMissouriUSA
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2
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Pemberton HG, Buckley C, Battle M, Bollack A, Patel V, Tomova P, Cooke D, Balhorn W, Hegedorn K, Lilja J, Brand C, Farrar G. Software compatibility analysis for quantitative measures of [ 18F]flutemetamol amyloid PET burden in mild cognitive impairment. EJNMMI Res 2023; 13:48. [PMID: 37225974 DOI: 10.1186/s13550-023-00994-3] [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: 09/26/2022] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
RATIONALE Amyloid-β (Aβ) pathology is one of the earliest detectable brain changes in Alzheimer's disease pathogenesis. In clinical practice, trained readers will visually categorise positron emission tomography (PET) scans as either Aβ positive or negative. However, adjunct quantitative analysis is becoming more widely available, where regulatory approved software can currently generate metrics such as standardised uptake value ratios (SUVr) and individual Z-scores. Therefore, it is of direct value to the imaging community to assess the compatibility of commercially available software packages. In this collaborative project, the compatibility of amyloid PET quantification was investigated across four regulatory approved software packages. In doing so, the intention is to increase visibility and understanding of clinically relevant quantitative methods. METHODS Composite SUVr using the pons as the reference region was generated from [18F]flutemetamol (GE Healthcare) PET in a retrospective cohort of 80 amnestic mild cognitive impairment (aMCI) patients (40 each male/female; mean age = 73 years, SD = 8.52). Based on previous autopsy validation work, an Aβ positivity threshold of ≥ 0.6 SUVrpons was applied. Quantitative results from MIM Software's MIMneuro, Syntermed's NeuroQ, Hermes Medical Solutions' BRASS and GE Healthcare's CortexID were analysed using intraclass correlation coefficient (ICC), percentage agreement around the Aβ positivity threshold and kappa scores. RESULTS Using an Aβ positivity threshold of ≥ 0.6 SUVrpons, 95% agreement was achieved across the four software packages. Two patients were narrowly classed as Aβ negative by one software package but positive by the others, and two patients vice versa. All kappa scores around the same Aβ positivity threshold, both combined (Fleiss') and individual software pairings (Cohen's), were ≥ 0.9 signifying "almost perfect" inter-rater reliability. Excellent reliability was found between composite SUVr measurements for all four software packages, with an average measure ICC of 0.97 and 95% confidence interval of 0.957-0.979. Correlation coefficient analysis between the two software packages reporting composite z-scores was strong (r2 = 0.98). CONCLUSION Using an optimised cortical mask, regulatory approved software packages provided highly correlated and reliable quantification of [18F]flutemetamol amyloid PET with a ≥ 0.6 SUVrpons positivity threshold. In particular, this work could be of interest to physicians performing routine clinical imaging rather than researchers performing more bespoke image analysis. Similar analysis is encouraged using other reference regions as well as the Centiloid scale, when it has been implemented by more software packages.
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Affiliation(s)
- Hugh G Pemberton
- GE Healthcare, Pollards Wood, Chalfont St Giles, Amersham, HP8 4SP, UK.
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK.
- UCL Queen Square Institute of Neurology, University College London, London, UK.
| | | | - Mark Battle
- GE Healthcare, Pollards Wood, Chalfont St Giles, Amersham, HP8 4SP, UK
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Ariane Bollack
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Vrajesh Patel
- GE Healthcare, Pollards Wood, Chalfont St Giles, Amersham, HP8 4SP, UK
| | - Petya Tomova
- GE Healthcare, Pollards Wood, Chalfont St Giles, Amersham, HP8 4SP, UK
| | | | | | | | | | - Christine Brand
- GE Healthcare, Pollards Wood, Chalfont St Giles, Amersham, HP8 4SP, UK
| | - Gill Farrar
- GE Healthcare, Pollards Wood, Chalfont St Giles, Amersham, HP8 4SP, UK
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Leuzy A, Mattsson-Carlgren N, Cullen NC, Stomrud E, Palmqvist S, La Joie R, Iaccarino L, Zetterberg H, Rabinovici G, Blennow K, Janelidze S, Hansson O. Robustness of CSF Aβ42/40 and Aβ42/P-tau181 measured using fully automated immunoassays to detect AD-related outcomes. Alzheimers Dement 2023. [PMID: 36681387 DOI: 10.1002/alz.12897] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION This study investigated the comparability of cerebrospinal fluid (CSF) cutoffs for Elecsys immunoassays for amyloid beta (Aβ)42/Aβ40 or Aβ42/phosphorylated tau (p-tau)181 and the effects of measurement variability when predicting Alzheimer's disease (AD)-related outcomes (i.e., Aβ-positron emission tomography [PET] visual read and AD neuropathology). METHODS We studied 750 participants (BioFINDER study, Alzheimer's Disease Neuroimaging Initiative [ADNI], and University of California San Francisco [UCSF]). Youden's index was used to identify cutoffs and to calculate accuracy (Aβ-PET visual read as outcome). Using longitudinal variability in Aβ-negative controls, we identified a gray zone around cut-points where the risk of an inconsistent predicted outcome was >5%. RESULTS For Aβ42/Aβ40, cutoffs across cohorts were <0.059 (BioFINDER), <0.057 (ADNI), and <0.058 (UCSF). For Aβ42/p-tau181, cutoffs were <41.90 (BioFINDER), <39.20 (ADNI), and <46.02 (UCSF). Accuracy was ≈90% for both Aβ42/Aβ40 and Aβ42/p-tau181 using these cutoffs. Using Aβ-PET as an outcome, 8.7% of participants fell within a gray zone interval for Aβ42/Aβ40, compared to 4.5% for Aβ42/p-tau181. Similar findings were observed using a measure of overall AD neuropathologic change (7.7% vs. 3.3%). In a subset with CSF and plasma Aβ42/40, the number of individuals within the gray zone was ≈1.5 to 3 times greater when using plasma Aβ42/40. DISCUSSION CSF Aβ42/p-tau181 was more robust to the effects of measurement variability, suggesting that it may be the preferred Elecsys-based measure in clinical practice and trials.
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Affiliation(s)
- Antoine Leuzy
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Nicholas C Cullen
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.,Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, California, USA.,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, California, USA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
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Kim J, Choe YS, Park Y, Kim Y, Kim JP, Jang H, Kim HJ, Na DL, Cho SJ, Moon SH, Seo SW. Clinical outcomes of increased focal amyloid uptake in individuals with subthreshold global amyloid levels. Front Aging Neurosci 2023; 15:1124445. [PMID: 36936497 PMCID: PMC10017468 DOI: 10.3389/fnagi.2023.1124445] [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: 12/15/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Background Although the standardized uptake value ratio (SUVR) method is objective and simple, cut-off optimization using global SUVR values may not reflect focal increased uptake in the cerebrum. The present study investigated clinical and neuroimaging characteristics according to focally increased β-amyloid (Aβ) uptake and global Aβ status. Methods We recruited 968 participants with cognitive continuum. All participants underwent neuropsychological tests and 498 18F-florbetaben (FBB) amyloid positron emission tomography (PET) and 470 18F-flutemetamol (FMM) PET. Each PET scan was assessed in 10 regions (left and right frontal, lateral temporal, parietal, cingulate, and striatum) with focal-quantitative SUVR-based cutoff values for each region by using an iterative outlier approach. Results A total of 62 (6.4%) subjects showed increased focal Aβ uptake with subthreshold global Aβ status [global (-) and focal (+) Aβ group, G(-)F(+) group]. The G(-)F(+) group showed worse performance in memory impairment (p < 0.001), global cognition (p = 0.009), greater hippocampal atrophy (p = 0.045), compared to those in the G(-)F(-). Participants with widespread Aβ involvement in the whole region [G(+)] showed worse neuropsychological (p < 0.001) and neuroimaging features (p < 0.001) than those with focal Aβ involvement G(-)F(+). Conclusion Our findings suggest that individuals show distinctive clinical outcomes according to focally increased Aβ uptake and global Aβ status. Thus, researchers and clinicians should pay more attention to focal increased Aβ uptake in addition to global Aβ status.
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Affiliation(s)
- Jaeho Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Yeong Sim Choe
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Yuhyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
- Samsung Medical Center, Stem Cell and Regenerative Medicine Institute, Seoul, Republic of Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- *Correspondence: Seung Hwan Moon,
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
- Sang Won Seo,
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5
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Fowler CJ, Stoops E, Rainey‐Smith SR, Vanmechelen E, Vanbrabant J, Dewit N, Mauroo K, Maruff P, Rowe CC, Fripp J, Li Q, Bourgeat P, Collins SJ, Martins RN, Masters CL, Doecke JD. Plasma p-tau181/Aβ 1-42 ratio predicts Aβ-PET status and correlates with CSF-p-tau181/Aβ 1-42 and future cognitive decline. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12375. [PMID: 36447478 PMCID: PMC9695763 DOI: 10.1002/dad2.12375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/28/2022] [Indexed: 11/26/2022]
Abstract
Background In Alzheimer's disease (AD), plasma amyloid beta (Aβ)1-42 and phosphorylated tau (p-tau) predict high amyloid status from Aβ positron emission tomography (PET); however, the extent to which combination of these plasma assays can predict remains unknown. Methods Prototype Simoa assays were used to measure plasma samples from participants who were either cognitively normal (CN) or had mild cognitive impairment (MCI)/AD in the Australian Imaging, Biomarkers and Lifestyle (AIBL) study. Results The p-tau181/Aβ1-42 ratio showed the best prediction of Aβ-PET across all participants (area under the curve [AUC] = 0.905, 95% confidence interval [CI]: 0.86-0.95) and in CN (AUC = 0.873; 0.80-0.94), and symptomatic (AUC = 0.908; 0.82-1.00) adults. Plasma p-tau181/Aβ1-42 ratio correlated with cerebrospinal fluid (CSF) p-tau181 (Elecsys, Spearman's ρ = 0.74, P < 0.0001) and predicted abnormal CSF Aβ (AUC = 0.816; 0.74-0.89). The p-tau181/Aβ1-42 ratio also predicted future rates of cognitive decline assessed by AIBL Preclinical Alzheimer Cognitive Composite or Clinical Dementia Rating Sum of Boxes (P < 0.0001). Discussion Plasma p-tau181/Aβ1-42 ratio predicted both Aβ-PET status and cognitive decline, demonstrating potential as both a diagnostic aid and as a screening and prognostic assay for preclinical AD trials.
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Affiliation(s)
| | | | - Stephanie R. Rainey‐Smith
- School of Medical and Health SciencesCentre of Excellence for Alzheimer's Disease Research & CareEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | | | | | | | | | | | - Christopher C. Rowe
- The Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Austin Health, Molecular Imaging Researchand The Florey Department of NeuroscienceUniversity of MelbourneMelbourneVictoriaAustralia
| | - Jurgen Fripp
- Australian E‐Health Research CentreCSIROHerstonQueenslandAustralia
| | - Qiao‐Xin Li
- The Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
| | | | - Steven J. Collins
- Department of Medicine (RMH)The University of MelbourneMelbourneVictoriaAustralia
| | - Ralph N. Martins
- School of Medical and Health SciencesCentre of Excellence for Alzheimer's Disease Research & CareEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Department of Biological SciencesMacquarie UniversityNorth RydeNew South WalesAustralia
| | - Colin L. Masters
- The Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
| | - James D. Doecke
- Australian E‐Health Research CentreCSIROHerstonQueenslandAustralia
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Burkett BJ, Babcock JC, Lowe VJ, Graff-Radford J, Subramaniam RM, Johnson DR. PET Imaging of Dementia: Update 2022. Clin Nucl Med 2022; 47:763-773. [PMID: 35543643 DOI: 10.1097/rlu.0000000000004251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ABSTRACT PET imaging plays an essential role in achieving earlier and more specific diagnoses of dementia syndromes, important for clinical prognostication and optimal medical management. This has become especially vital with the recent development of pathology-specific disease-modifying therapy for Alzheimer disease, which will continue to evolve and require methods to select appropriate treatment candidates. Techniques that began as research tools such as amyloid and tau PET have now entered clinical use, making nuclear medicine physicians and radiologists essential members of the care team. This review discusses recent changes in the understanding of dementia and examines the roles of nuclear medicine imaging in clinical practice. Within this framework, multiple cases will be shown to illustrate a systematic approach of FDG PET interpretation and integration of PET imaging of specific molecular pathology including dopamine transporters, amyloid, and tau. The approach presented here incorporates contemporary understanding of both common and uncommon dementia syndromes, intended as an updated practical guide to assist with the sophisticated interpretation of nuclear medicine examinations in the context of this rapidly and continually developing area of imaging.
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7
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Kang DW, Wang SM, Um YH, Kim NY, Lee CU, Lim HK. Associations Between Sub-Threshold Amyloid-β Deposition, Cortical Volume, and Cognitive Function Modulated by APOE ɛ4 Carrier Status in Cognitively Normal Older Adults. J Alzheimers Dis 2022; 89:1003-1016. [PMID: 35964194 PMCID: PMC9535581 DOI: 10.3233/jad-220427] [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] [Indexed: 11/21/2022]
Abstract
Background: There has been renewed interest in the deteriorating effects of sub-threshold amyloid-β (Aβ) accumulation in Alzheimer’s disease (AD). Despite evidence suggesting a synergistic interaction between the APOE ɛ4 allele and Aβ deposition in neurodegeneration, few studies have investigated the modulatory role of this allele in sub-threshold Aβ deposition during the preclinical phase. Objective: We aimed to explore the differential effect of the APOE ɛ4 carrier status on the association between sub-threshold Aβ deposition, cortical volume, and cognitive performance in cognitively normal older adults (CN). Methods: A total of 112 CN with sub-threshold Aβ deposition was included in the study. Participants underwent structural magnetic resonance imaging, [18F] flutemetamol PET-CT, and a neuropsychological battery. Potential interactions between APOE ɛ4 carrier status, Aβ accumulation, and cognitive function for cortical volume were assessed with whole-brain voxel-wise analysis. Results: We found that greater cortical volume was observed with higher regional Aβ deposition in the APOE ɛ4 carriers, which could be attributed to an interaction between the APOE ɛ4 carrier status and regional Aβ deposition in the posterior cingulate cortex/precuneus. Finally, the APOE ɛ4 carrier status-neuropsychological test score interaction demonstrated a significant effect on the gray matter volume of the left middle occipital gyrus. Conclusion: There might be a compensatory response to initiating Aβ in APOE ɛ4 carriers during the earliest AD stage. Despite its exploratory nature, this study offers some insight into recent interests concerning probabilistic AD modeling, focusing on the modulating role of the APOE ɛ4 carrier status during the preclinical period.
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Affiliation(s)
- Dong Woo Kang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nak Young Kim
- Department of Psychiatry, Keyo Hospital, Uiwang, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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8
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Focal amyloid and asymmetric tau in an imaging-to-autopsy case of clinical primary progressive aphasia with Alzheimer disease neuropathology. Acta Neuropathol Commun 2022; 10:111. [PMID: 35945628 PMCID: PMC9361632 DOI: 10.1186/s40478-022-01412-w] [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: 05/24/2022] [Accepted: 07/17/2022] [Indexed: 01/21/2023] Open
Abstract
Quantification of in vivo amyloid and tau PET imaging relationships with postmortem measurements are critical for validating the sensitivity and specificity imaging biomarkers across clinical phenotypes with Alzheimer disease neuropathologic change (ADNC). This study examined the quantitative relationship between regional binding of in vivo 18F-florbetapir amyloid PET and 18F-flortaucipir tau PET with postmortem stereological counts of amyloid plaques and neurofibrillary tangles (NFT) in a case of primary progressive aphasia (PPA) with ADNC, where neurodegeneration asymmetrically targets the left hemisphere. Beginning 2 years prior to death, a 63-year-old right-handed man presenting with agrammatic variant PPA underwent a florbetapir and flortaucpir PET scan, and neuropsychological assessments and magnetic resonance imaging sessions every 6 months. Florbetapir and flortaucpir PET standard uptake value ratios (SUVRs) were quantified from 8 left and right hemisphere brain regions with stereological quantification of amyloid plaques and NFTs from corresponding postmortem sections. Pearson's correlations and measures of asymmetry were used to examine relationships between imaging and autopsy measurements. The three visits prior to death revealed decline of language measures, with marked progression of atrophy. Florbetapir PET presented with an atypical focal pattern of uptake and showed a significant positive correlation with postmortem amyloid plaque density across the 8 regions (r = 0.92; p = 0.001). Flortaucipir PET had a left-lateralized distribution and showed a significant positive correlation with NFT density (r = 0.78; p = 0.023). Flortaucipir PET and NFT density indicated a medial temporal lobe sparing presentation of ADNC, demonstrating that AD does not always target the medial temporal lobe. This study adds additional evidence, in a non-amnestic phenotype of ADNC, that there is a strong correlation between AD PET biomarkers, florbetapir and flortaucipir, with quantitative neuropathology. The atypical and focal presentation of plaque density and florbetapir PET uptake suggests not all amyloid pathology presents as diffuse across neocortex.
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9
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Pemberton HG, Collij LE, Heeman F, Bollack A, Shekari M, Salvadó G, Alves IL, Garcia DV, Battle M, Buckley C, Stephens AW, Bullich S, Garibotto V, Barkhof F, Gispert JD, Farrar G. Quantification of amyloid PET for future clinical use: a state-of-the-art review. Eur J Nucl Med Mol Imaging 2022; 49:3508-3528. [PMID: 35389071 PMCID: PMC9308604 DOI: 10.1007/s00259-022-05784-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
Amyloid-β (Aβ) pathology is one of the earliest detectable brain changes in Alzheimer's disease (AD) pathogenesis. The overall load and spatial distribution of brain Aβ can be determined in vivo using positron emission tomography (PET), for which three fluorine-18 labelled radiotracers have been approved for clinical use. In clinical practice, trained readers will categorise scans as either Aβ positive or negative, based on visual inspection. Diagnostic decisions are often based on these reads and patient selection for clinical trials is increasingly guided by amyloid status. However, tracer deposition in the grey matter as a function of amyloid load is an inherently continuous process, which is not sufficiently appreciated through binary cut-offs alone. State-of-the-art methods for amyloid PET quantification can generate tracer-independent measures of Aβ burden. Recent research has shown the ability of these quantitative measures to highlight pathological changes at the earliest stages of the AD continuum and generate more sensitive thresholds, as well as improving diagnostic confidence around established binary cut-offs. With the recent FDA approval of aducanumab and more candidate drugs on the horizon, early identification of amyloid burden using quantitative measures is critical for enrolling appropriate subjects to help establish the optimal window for therapeutic intervention and secondary prevention. In addition, quantitative amyloid measurements are used for treatment response monitoring in clinical trials. In clinical settings, large multi-centre studies have shown that amyloid PET results change both diagnosis and patient management and that quantification can accurately predict rates of cognitive decline. Whether these changes in management reflect an improvement in clinical outcomes is yet to be determined and further validation work is required to establish the utility of quantification for supporting treatment endpoint decisions. In this state-of-the-art review, several tools and measures available for amyloid PET quantification are summarised and discussed. Use of these methods is growing both clinically and in the research domain. Concurrently, there is a duty of care to the wider dementia community to increase visibility and understanding of these methods.
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Affiliation(s)
- Hugh G Pemberton
- GE Healthcare, Amersham, UK.
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK.
- UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fiona Heeman
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ariane Bollack
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Mahnaz Shekari
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Gemma Salvadó
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
| | - David Vallez Garcia
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark Battle
- GE Healthcare, Amersham, UK
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | | | | | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Geneva, Geneva, Switzerland
- NIMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frederik Barkhof
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina, Madrid, Spain
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10
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Newberg AB, Coble R, Khosravi M, Alavi A. Positron Emission Tomography-Based Assessment of Cognitive Impairment and Dementias, Critical Role of Fluorodeoxyglucose in such Settings. PET Clin 2022; 17:479-494. [PMID: 35717103 DOI: 10.1016/j.cpet.2022.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Positron emission tomography (PET) has been a key component in the diagnostic armamentarium for assessing neurodegenerative diseases such as Alzheimer or Parkinson disease. PET imaging has been useful for diagnosing these disorders, identifying their pathophysiology, and following their treatment. Further, PET imaging has been extensively used for both clinical and research purposes, particularly for helping with potential therapeutic approaches for managing neurodegenerative diseases. This article will review the current literature regarding PET imaging in patients with neurodegenerative disorders. This includes an evaluation of the most commonly used tracer fluorodeoxyglucose that measures cerebral glucose metabolism, tracers that assess neurotransmitter systems, and tracers designed to reveal disease-specific pathophysiological processes. With the continuing development of an expanding variety of radiopharmaceuticals, PET imaging will likely play a prominent role in future research and clinical applications for neurodegenerative diseases.
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Affiliation(s)
- Andrew B Newberg
- Marcus Institute of Integrative Health, Thomas Jefferson University, 789 East Lancaster Avenue, Suite 110, Villanova, PA 19085, USA; Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Roger Coble
- Marcus Institute of Integrative Health, Thomas Jefferson University, 789 East Lancaster Avenue, Suite 110, Villanova, PA 19085, USA; University of California Berkeley, Berkeley, CA, USA
| | - Mohsen Khosravi
- Marcus Institute of Integrative Health, Thomas Jefferson University, 789 East Lancaster Avenue, Suite 110, Villanova, PA 19085, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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11
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Abrahamson EE, Kofler JK, Becker CR, Price JC, Newell KL, Ghetti B, Murrell JR, McLean CA, Lopez OL, Mathis CA, Klunk WE, Villemagne VL, Ikonomovic MD. 11C-PiB PET can underestimate brain amyloid-β burden when cotton wool plaques are numerous. Brain 2022; 145:2161-2176. [PMID: 34918018 PMCID: PMC9630719 DOI: 10.1093/brain/awab434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 09/01/2023] Open
Abstract
Individuals with familial Alzheimer's disease due to PSEN1 mutations develop high cortical fibrillar amyloid-β load but often have lower cortical 11C-Pittsburgh compound B (PiB) retention than Individuals with sporadic Alzheimer's disease. We hypothesized this is influenced by limited interactions of Pittsburgh compound B with cotton wool plaques, an amyloid-β plaque type common in familial Alzheimer's disease but rare in sporadic Alzheimer's disease. Histological sections of frontal and temporal cortex, caudate nucleus and cerebellum were obtained from 14 cases with sporadic Alzheimer's disease, 12 cases with familial Alzheimer's disease due to PSEN1 mutations, two relatives of a PSEN1 mutation carrier but without genotype information and three non-Alzheimer's disease cases. Sections were processed immunohistochemically using amyloid-β-targeting antibodies and the fluorescent amyloid stains cyano-PiB and X-34. Plaque load was quantified by percentage area analysis. Frozen homogenates from the same brain regions from five sporadic Alzheimer's disease and three familial Alzheimer's disease cases were analysed for 3H-PiB in vitro binding and concentrations of amyloid-β1-40 and amyloid-β1-42. Nine sporadic Alzheimer's disease, three familial Alzheimer's disease and three non-Alzheimer's disease participants had 11C-PiB PET with standardized uptake value ratios calculated using the cerebellum as the reference region. Cotton wool plaques were present in the neocortex of all familial Alzheimer's disease cases and one sporadic Alzheimer's disease case, in the caudate nucleus from four familial Alzheimer's disease cases, but not in the cerebellum. Cotton wool plaques immunolabelled robustly with 4G8 and amyloid-β42 antibodies but weakly with amyloid-β40 and amyloid-βN3pE antibodies and had only background cyano-PiB fluorescence despite labelling with X-34. Relative to amyloid-β plaque load, cyano-Pittsburgh compound B plaque load was similar in sporadic Alzheimer's disease while in familial Alzheimer's disease it was lower in the neocortex and the caudate nucleus. In both regions, insoluble amyloid-β1-42 and amyloid-β1-40 concentrations were similar in familial Alzheimer's disease and sporadic Alzheimer's disease groups, while 3H-PiB binding was lower in the familial Alzheimer's disease than the sporadic Alzheimer's disease group. Higher amyloid-β1-42 concentration associated with higher 3H-PiB binding in sporadic Alzheimer's disease but not familial Alzheimer's disease. 11C-PiB retention correlated with region-matched post-mortem amyloid-β plaque load; however, familial Alzheimer's disease cases with abundant cotton wool plaques had lower 11C-PiB retention than sporadic Alzheimer's disease cases with similar amyloid-β plaque loads. PiB has limited ability to detect amyloid-β aggregates in cotton wool plaques and may underestimate total amyloid-β plaque burden in brain regions with abundant cotton wool plaques.
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Affiliation(s)
- Eric E Abrahamson
- Department of Neurology, University of Pittsburgh School of Medicine. Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA
| | - Julia K Kofler
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carl R Becker
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Julie C Price
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Cambridge, MA, USA
| | - Kathy L Newell
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Jill R Murrell
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Catriona A McLean
- Victorian Brain Bank, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh School of Medicine. Pittsburgh, PA, USA
| | - Chester A Mathis
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Victor L Villemagne
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh School of Medicine. Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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12
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Kang DW, Wang SM, Um YH, Kim NY, Lee CU, Lim HK. Impact of APOE ε4 Carrier Status on Associations Between Subthreshold, Positive Amyloid-β Deposition, Brain Function, and Cognitive Performance in Cognitively Normal Older Adults: A Prospective Study. Front Aging Neurosci 2022; 14:871323. [PMID: 35677201 PMCID: PMC9168227 DOI: 10.3389/fnagi.2022.871323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022] Open
Abstract
BackgroundA growing body of evidence suggests a deteriorating effect of subthreshold amyloid-beta (Aβ) accumulation on cognition before the onset of clinical symptoms of Alzheimer's disease (AD). Despite the association between the Aβ-dependent pathway and the APOE ε4 allele, the impact of this allele on the progression from the subthreshold Aβ deposits to cognitive function impairment is unclear. Furthermore, the comparative analysis of positive Aβ accumulation in the preclinical phase is lacking.ObjectiveThis study aimed to explore the differential effect of the APOE ε4 carrier status on the association between Aβ deposition, resting-state brain function, and cognitive performance in cognitively normal (CN) older adults, depending on the Aβ burden status.MethodsOne hundred and eighty-two older CN adults underwent resting-state functional magnetic resonance imaging, [18F] flutemetamol (FMM) positron emission tomography, a neuropsychological battery, and APOE genotyping. We evaluated the resting-state brain function by measuring the local and remote functional connectivity (FC) and measured the remote FC in the default-mode network (DMN), central-executive network (CEN), and salience network (SN). In addition, the subjects were dichotomized into those with subthreshold and positive Aβ deposits using a neocortical standardized uptake value ratio with the cut-off value of 0.62, which was calculated with respect to the pons.ResultsThe present result showed that APOE ε4 carrier status moderated the relationship between Aβ deposition, local and remote resting-state brain function, and cognitive performance in each CN subthreshold and positive Aβ group. We observed the following: (i) the APOE ε4 carrier status-Aβ deposition and APOE ε4 carrier status-local FC interaction for the executive and memory function; (ii) the APOE ε4 carrier status-regional Aβ accumulation interaction for the local FC; and (iv) the APOE ε4 carrier status-local FC interaction for the remote inter-network FC between the DMN and CEN, contributing higher cognitive performance in the APOE ε4 carrier with higher inter-network FC. Finally, these results were modulated according to Aβ positivity.ConclusionThis study is the first attempt to thoroughly examine the influence of the APOE ε4 carrier status from the subthreshold to positive Aβ accumulation during the preclinical phase.
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Affiliation(s)
- Dong Woo Kang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Nak-Young Kim
- Department of Psychiatry, Keyo Hospital, Uiwang, South Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- *Correspondence: Hyun Kook Lim
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13
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Reinartz M, Luckett ES, Schaeverbeke J, De Meyer S, Adamczuk K, Thal DR, Van Laere K, Dupont P, Vandenberghe R. Classification of 18F-Flutemetamol scans in cognitively normal older adults using machine learning trained with neuropathology as ground truth. Eur J Nucl Med Mol Imaging 2022; 49:3772-3786. [PMID: 35522322 PMCID: PMC9399207 DOI: 10.1007/s00259-022-05808-7] [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: 12/20/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
Purpose End-of-life studies have validated the binary visual reads of 18F-labeled amyloid PET tracers as an accurate tool for the presence or absence of increased neuritic amyloid plaque density. In this study, the performance of a support vector machine (SVM)-based classifier will be tested against pathological ground truths and its performance determined in cognitively healthy older adults. Methods We applied SVM with a linear kernel to an 18F-Flutemetamol end-of-life dataset to determine the regions with the highest feature weights in a data-driven manner and to compare between two different pathological ground truths: based on neuritic amyloid plaque density or on amyloid phases, respectively. We also trained and tested classifiers based on the 10% voxels with the highest amplitudes of feature weights for each of the two neuropathological ground truths. Next, we tested the classifiers’ diagnostic performance in the asymptomatic Alzheimer’s disease (AD) phase, a phase of interest for future drug development, in an independent dataset of cognitively intact older adults, the Flemish Prevent AD Cohort-KU Leuven (F-PACK). A regression analysis was conducted between the Centiloid (CL) value in a composite volume of interest (VOI), as index for amyloid load, and the distance to the hyperplane for each of the two classifiers, based on the two pathological ground truths. A receiver operating characteristic analysis was also performed to determine the CL threshold that optimally discriminates between neuritic amyloid plaque positivity versus negativity, or amyloid phase positivity versus negativity, within F-PACK. Results The classifiers yielded adequate specificity and sensitivity within the end-of-life dataset (neuritic amyloid plaque density classifier: specificity of 90.2% and sensitivity of 83.7%; amyloid phase classifier: specificity of 98.4% and sensitivity of 84.0%). The regions with the highest feature weights corresponded to precuneus, caudate, anteromedial prefrontal, and also posterior inferior temporal and inferior parietal cortex. In the cognitively normal cohort, the correlation coefficient between CL and distance to the hyperplane was −0.66 for the classifier trained with neuritic amyloid plaque density, and −0.88 for the classifier trained with amyloid phases. This difference was significant. The optimal CL cut-off for discriminating positive versus negative scans was CL = 48–51 for the different classifiers (area under the curve (AUC) = 99.9%), except for the classifier trained with amyloid phases and based on the 10% voxels with highest feature weights. There the cut-off was CL = 26 (AUC = 99.5%), which closely matched the CL threshold for discriminating phases 0–2 from 3–5 based on the end-of-life dataset and the neuropathological ground truth. Discussion Among a set of neuropathologically validated classifiers trained with end-of-life cases, transfer to a cognitively normal population works best for a classifier trained with amyloid phases and using only voxels with the highest amplitudes of feature weights. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05808-7.
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Affiliation(s)
- Mariska Reinartz
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | - Emma Susanne Luckett
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | - Steffi De Meyer
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | | | - Dietmar Rudolf Thal
- Department of Pathology, UZ Leuven, Leuven, Belgium.,Laboratory of Neuropathology, KU Leuven, Leuven, Belgium
| | - Koen Van Laere
- Division of Nuclear Medicine, UZ Leuven, Leuven, Belgium.,Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium. .,Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium. .,Neurology Department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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14
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Ushizima D, Chen Y, Alegro M, Ovando D, Eser R, Lee W, Poon K, Shankar A, Kantamneni N, Satrawada S, Junior EA, Heinsen H, Tosun D, Grinberg LT. Deep learning for Alzheimer's disease: Mapping large-scale histological tau protein for neuroimaging biomarker validation. Neuroimage 2022; 248:118790. [PMID: 34933123 PMCID: PMC8983026 DOI: 10.1016/j.neuroimage.2021.118790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 01/16/2023] Open
Abstract
Abnormal tau inclusions are hallmarks of Alzheimer's disease and predictors of clinical decline. Several tau PET tracers are available for neurodegenerative disease research, opening avenues for molecular diagnosis in vivo. However, few have been approved for clinical use. Understanding the neurobiological basis of PET signal validation remains problematic because it requires a large-scale, voxel-to-voxel correlation between PET and (immuno) histological signals. Large dimensionality of whole human brains, tissue deformation impacting co-registration, and computing requirements to process terabytes of information preclude proper validation. We developed a computational pipeline to identify and segment particles of interest in billion-pixel digital pathology images to generate quantitative, 3D density maps. The proposed convolutional neural network for immunohistochemistry samples, IHCNet, is at the pipeline's core. We have successfully processed and immunostained over 500 slides from two whole human brains with three phospho-tau antibodies (AT100, AT8, and MC1), spanning several terabytes of images. Our artificial neural network estimated tau inclusion from brain images, which performs with ROC AUC of 0.87, 0.85, and 0.91 for AT100, AT8, and MC1, respectively. Introspection studies further assessed the ability of our trained model to learn tau-related features. We present an end-to-end pipeline to create terabytes-large 3D tau inclusion density maps co-registered to MRI as a means to facilitate validation of PET tracers.
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Affiliation(s)
- Daniela Ushizima
- Bakar Institute for Computational Health Sciences, University of California San Francisco, CA, USA; Berkeley Institute for Data Science, University of California Berkeley, CA, USA; Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Yuheng Chen
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Maryana Alegro
- Bakar Institute for Computational Health Sciences, University of California San Francisco, CA, USA; Berkeley Institute for Data Science, University of California Berkeley, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Dulce Ovando
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Rana Eser
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - WingHung Lee
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Kinson Poon
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Anubhav Shankar
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Namrata Kantamneni
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Shruti Satrawada
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Helmut Heinsen
- University of Sao Paulo Medical School, Sao Paulo, Brazil; Julius-Maximilians University Würzburg, Würzburg, Germany
| | - Duygu Tosun
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA; Veterans Affairs San Francisco, CA, USA
| | - Lea T Grinberg
- Bakar Institute for Computational Health Sciences, University of California San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA; University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
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15
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Bridel C, Somers C, Sieben A, Rozemuller A, Niemantsverdriet E, Struyfs H, Vermeiren Y, Van Broeckhoven C, De Deyn PP, Bjerke M, Nagels G, Teunissen CE, Engelborghs S. Associating Alzheimer’s disease pathology with its cerebrospinal fluid biomarkers. Brain 2022; 145:4056-4064. [DOI: 10.1093/brain/awac013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/02/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
Alzheimer’s disease cerebrospinal fluid (CSF) biomarkers 42 amino acid long amyloid-β peptide (Aβ1-42), total tau protein (T-tau), and tau protein phosphorylated at threonine 181 (P-tau181) are considered surrogate biomarkers of Alzheimer’s disease pathology, and significantly improve diagnostic accuracy. Their ability to reflect neuropathological changes later in the disease course is not well characterized. This study aimed to assess the potential of CSF biomarkers measured in mid- to late-stage Alzheimer’s disease to reflect post mortem neuropathological changes. Individuals were selected from 2 autopsy cohorts of Alzheimer’s disease patients in Antwerp and Amsterdam. Neuropathological diagnosis was performed according to the updated consensus National Institute on Aging-Alzheimer’s Association guidelines by Montine et al, which includes quantification of amyloid beta plaque, neurofibrillary tangle, and neuritic plaque load. CSF samples were analyzed for Aβ1-42, T-tau, and P-tau181 by ELISA. 114 cases of pure definite Alzheimer’s disease were included in the study (mean age 74 years, disease duration 6 years at CSF sampling, 50% females). Median interval between CSF sampling and death was one year. We found no association between Aβ1-42 and Alzheimer’s disease neuropathological change profile. In contrast, an association of P-tau181 and T-tau with Alzheimer’s disease neuropathological change profile was observed. P-tau181 was associated with all three individual Montine scores, and the associations became stronger and more significant as the interval between lumbar puncture and death increased. T-tau was also associated with all three Montine scores, but in individuals with longer intervals from lumbar puncture to death only. Stratification of the cohort according to APOE ε4 carrier status revealed that the associations applied mostly to APOE ε4 non-carriers. Our data suggest that similarly to what has been reported for Aβ1-42, plateau levels of P-tau181 and T-tau are reached during the disease course, albeit at later disease stages, reducing the potential of tau biomarkers to monitor Alzheimer’s disease pathology as the disease progresses. As a consequence, CSF biomarkers, which are performant for clinical diagnosis of early Alzheimer’s disease, may not be well suited for staging or monitoring Alzheimer’s disease pathology as it progresses through later stages.
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Affiliation(s)
- Claire Bridel
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Charisse Somers
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Anne Sieben
- Biobank, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Annemieke Rozemuller
- Department of Pathology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Yannick Vermeiren
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Chair Group of Nutritional Biology, Division of Human Nutrition and Health, Wageningen University and Research (WUR), Wageningen, The Netherlands
| | - Christine Van Broeckhoven
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB, Antwerp, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Peter P. De Deyn
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Biobank, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Maria Bjerke
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Vrije Universiteit Brussel, Center for Neurosciences (C4N), Brussels, Belgium
- Universitair Ziekenhuis Brussel, Laboratory of Neurochemistry, Brussels, Belgium
| | - Guy Nagels
- Vrije Universiteit Brussel, Center for Neurosciences (C4N), Brussels, Belgium
- Universitair Ziekenhuis Brussel, Department of Neurology, Brussels, Belgium
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Vrije Universiteit Brussel, Center for Neurosciences (C4N), Brussels, Belgium
- Universitair Ziekenhuis Brussel, Department of Neurology, Brussels, Belgium
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16
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Nadebaum DP, Krishnadas N, Poon AMT, Kalff V, Lichtenstein M, Villemagne VL, Jones G, Rowe CC. Head-to-head comparison of cerebral blood flow single-photon emission computed tomography and 18 F-fluoro-2-deoxyglucose positron emission tomography in the diagnosis of Alzheimer disease. Intern Med J 2021; 51:1243-1250. [PMID: 32388925 PMCID: PMC8457212 DOI: 10.1111/imj.14890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical diagnosis of Alzheimer disease (AD) is only 70% accurate. Reduced cerebral blood flow (CBF) and metabolism in parieto-temporal and posterior cingulate cortex may assist diagnosis. While widely accepted that 18 F-fluoro-2-deoxyglucose positron emission tomography (18 F-FDG PET) has superior accuracy to CBF-SPECT for AD, there are very limited head-to-head data from clinically relevant populations and these studies relied on clinical diagnosis as the reference standard. AIMS To compare directly the accuracy of CBF-SPECT and 18 F-FDG PET in patients referred for diagnostic studies in detecting β-amyloid PET confirmed AD. METHODS A total of 126 patients, 56% with mild cognitive impairment and 44% with dementia, completed both CBF-SPECT and 18 F-FDG PET as part of their diagnostic assessment, and subsequently underwent β-amyloid PET for research purposes. Transaxial slices and Neurostat 3D-SSP analyses of 18 F-FDG PET and CBF-SPECT scans were independently reviewed by five nuclear medicine clinicians blinded to all other data. Operators selected the most likely diagnosis and their diagnostic confidence. Accuracy analysis used final diagnosis incorporating β-amyloid PET as the reference standard. RESULTS Clinicians reported high diagnostic confidence in 83% of 18 F-FDG PET compared to 67% for CBF-SPECT (P = 0.001). All reviewers showed individually higher accuracy using 18 F-FDG PET. Based on majority read, the combined area under the receiver operating characteristic curve in diagnosing AD was 0.71 for 18 F-FDG PET and 0.61 for CBF-SPECT (P = 0.02). The sensitivity of 18 F-FDG PET and CBF-SPECT was 76% versus 43% (P < 0.001), while specificity was 74% versus 83% (P = 0.45). CONCLUSIONS 18 F-FDG PET is superior to CBF-SPECT in detecting AD among patients referred for the assessment of cognitive impairment.
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Affiliation(s)
- David P Nadebaum
- Department of Molecular Imaging and Therapy, Austin Hospital, Melbourne, Victoria, Australia.,Department of Nuclear Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - Natasha Krishnadas
- Department of Molecular Imaging and Therapy, Austin Hospital, Melbourne, Victoria, Australia
| | - Aurora M T Poon
- Department of Molecular Imaging and Therapy, Austin Hospital, Melbourne, Victoria, Australia
| | - Victor Kalff
- Department of Nuclear Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - Meir Lichtenstein
- Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Victor L Villemagne
- Department of Molecular Imaging and Therapy, Austin Hospital, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gareth Jones
- Department of Molecular Imaging and Therapy, Austin Hospital, Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Hospital, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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17
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Kim HR, Jung SH, Kim J, Jang H, Kang SH, Hwangbo S, Kim JP, Kim SY, Kim B, Kim S, Jeong JH, Yoon SJ, Park KW, Kim EJ, Yoon B, Jang JW, Hong JY, Choi SH, Noh Y, Kim KW, Kim SE, Lee JS, Jung NY, Lee J, Kim BC, Son SJ, Hong CH, Na DL, Seo SW, Won HH, Kim HJ. Identifying novel genetic variants for brain amyloid deposition: a genome-wide association study in the Korean population. Alzheimers Res Ther 2021; 13:117. [PMID: 34154648 PMCID: PMC8215820 DOI: 10.1186/s13195-021-00854-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Genome-wide association studies (GWAS) have identified a number of genetic variants for Alzheimer's disease (AD). However, most GWAS were conducted in individuals of European ancestry, and non-European populations are still underrepresented in genetic discovery efforts. Here, we performed GWAS to identify single nucleotide polymorphisms (SNPs) associated with amyloid β (Aβ) positivity using a large sample of Korean population. METHODS One thousand four hundred seventy-four participants of Korean ancestry were recruited from multicenters in South Korea. Discovery dataset consisted of 1190 participants (383 with cognitively unimpaired [CU], 330 with amnestic mild cognitive impairment [aMCI], and 477 with AD dementia [ADD]) and replication dataset consisted of 284 participants (46 with CU, 167 with aMCI, and 71 with ADD). GWAS was conducted to identify SNPs associated with Aβ positivity (measured by amyloid positron emission tomography). Aβ prediction models were developed using the identified SNPs. Furthermore, bioinformatics analysis was conducted for the identified SNPs. RESULTS In addition to APOE, we identified nine SNPs on chromosome 7, which were associated with a decreased risk of Aβ positivity at a genome-wide suggestive level. Of these nine SNPs, four novel SNPs (rs73375428, rs2903923, rs3828947, and rs11983537) were associated with a decreased risk of Aβ positivity (p < 0.05) in the replication dataset. In a meta-analysis, two SNPs (rs7337542 and rs2903923) reached a genome-wide significant level (p < 5.0 × 10-8). Prediction performance for Aβ positivity increased when rs73375428 were incorporated (area under curve = 0.75; 95% CI = 0.74-0.76) in addition to clinical factors and APOE genotype. Cis-eQTL analysis demonstrated that the rs73375428 was associated with decreased expression levels of FGL2 in the brain. CONCLUSION The novel genetic variants associated with FGL2 decreased risk of Aβ positivity in the Korean population. This finding may provide a candidate therapeutic target for AD, highlighting the importance of genetic studies in diverse populations.
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Affiliation(s)
- Hang-Rai Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang-Hyuk Jung
- Department of Digital Health, SAIHST, Sungkyunkwan University, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Jaeho Kim
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Hoon Kang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Song Hwangbo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jun Pyo Kim
- Center for Neuroimaging, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - So Yeon Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Samsung Genome Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Beomsu Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Soyeon Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A University College of Medicine, Department of Translational Biomedical Sciences, Graduate School of Dong-A University, Busan, Republic of Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Young Noh
- Department of Neurology, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
| | - Ko Woon Kim
- Department of Neurology, School of Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Si Eun Kim
- Department of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Na-Yeon Jung
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Juyoun Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Byeong C Kim
- Departmet of Neurology, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hong-Hee Won
- Department of Digital Health, SAIHST, Sungkyunkwan University, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
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18
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Bucci M, Savitcheva I, Farrar G, Salvadó G, Collij L, Doré V, Gispert JD, Gunn R, Hanseeuw B, Hansson O, Shekari M, Lhommel R, Molinuevo JL, Rowe C, Sur C, Whittington A, Buckley C, Nordberg A. A multisite analysis of the concordance between visual image interpretation and quantitative analysis of [ 18F]flutemetamol amyloid PET images. Eur J Nucl Med Mol Imaging 2021; 48:2183-2199. [PMID: 33844055 PMCID: PMC8175298 DOI: 10.1007/s00259-021-05311-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/09/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND [18F]flutemetamol PET scanning provides information on brain amyloid load and has been approved for routine clinical use based upon visual interpretation as either negative (equating to none or sparse amyloid plaques) or amyloid positive (equating to moderate or frequent plaques). Quantitation is however fundamental to the practice of nuclear medicine and hence can be used to supplement amyloid reading methodology especially in unclear cases. METHODS A total of 2770 [18F]flutemetamol images were collected from 3 clinical studies and 6 research cohorts with available visual reading of [18F]flutemetamol and quantitative analysis of images. These were assessed further to examine both the discordance and concordance between visual and quantitative imaging primarily using thresholds robustly established using pathology as the standard of truth. Scans covered a wide range of cases (i.e. from cognitively unimpaired subjects to patients attending the memory clinics). Methods of quantifying amyloid ranged from using CE/510K cleared marked software (e.g. CortexID, Brass), to other research-based methods (e.g. PMOD, CapAIBL). Additionally, the clinical follow-up of two types of discordance between visual and quantitation (V+Q- and V-Q+) was examined with competing risk regression analysis to assess possible differences in prediction for progression to Alzheimer's disease (AD) and other diagnoses (OD). RESULTS Weighted mean concordance between visual and quantitation using the autopsy-derived threshold was 94% using pons as the reference region. Concordance from a sensitivity analysis which assessed the maximum agreement for each cohort using a range of cut-off values was also estimated at approximately 96% (weighted mean). Agreement was generally higher in clinical cases compared to research cases. V-Q+ discordant cases were 11% more likely to progress to AD than V+Q- for the SUVr with pons as reference region. CONCLUSIONS Quantitation of amyloid PET shows a high agreement vs binary visual reading and also allows for a continuous measure that, in conjunction with possible discordant analysis, could be used in the future to identify possible earlier pathological deposition as well as monitor disease progression and treatment effectiveness.
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Affiliation(s)
- Marco Bucci
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Irina Savitcheva
- Medical Radiation Physics and Nuclear Medicine, Section for Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Gill Farrar
- Pharmaceutical Diagnostics, GE Healthcare, Amersham, UK
| | - Gemma Salvadó
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lyduine Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Vincent Doré
- Austin Health, University of Melbourne, Melbourne, Australia.,Health and Biosecurity, CSIRO, Parkville, Australia
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Centro de Investigación Biomédica en Red Bioingenieriá, Biomateriales y Nanomedicina, (CIBER-BBN), Barcelona, Spain
| | - Roger Gunn
- Invicro, London, UK.,Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
| | - Bernard Hanseeuw
- Neurology and Nuclear Medicine Departments, Saint-Luc University Hospital, Av. Hippocrate, 10, 1200, Brussels, Belgium.,Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmo, Lund University, Lund, Sweden
| | - Mahnaz Shekari
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Renaud Lhommel
- Neurology and Nuclear Medicine Departments, Saint-Luc University Hospital, Av. Hippocrate, 10, 1200, Brussels, Belgium
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Christopher Rowe
- Austin Health, University of Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | | | | | | | - Agneta Nordberg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,Department of Aging, Karolinska University Hospital, Stockholm, Sweden.
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19
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Schwarz AJ. The Use, Standardization, and Interpretation of Brain Imaging Data in Clinical Trials of Neurodegenerative Disorders. Neurotherapeutics 2021; 18:686-708. [PMID: 33846962 PMCID: PMC8423963 DOI: 10.1007/s13311-021-01027-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
Imaging biomarkers play a wide-ranging role in clinical trials for neurological disorders. This includes selecting the appropriate trial participants, establishing target engagement and mechanism-related pharmacodynamic effect, monitoring safety, and providing evidence of disease modification. In the early stages of clinical drug development, evidence of target engagement and/or downstream pharmacodynamic effect-especially with a clear relationship to dose-can provide confidence that the therapeutic candidate should be advanced to larger and more expensive trials, and can inform the selection of the dose(s) to be further tested, i.e., to "de-risk" the drug development program. In these later-phase trials, evidence that the therapeutic candidate is altering disease-related biomarkers can provide important evidence that the clinical benefit of the compound (if observed) is grounded in meaningful biological changes. The interpretation of disease-related imaging markers, and comparability across different trials and imaging tools, is greatly improved when standardized outcome measures are defined. This standardization should not impinge on scientific advances in the imaging tools per se but provides a common language in which the results generated by these tools are expressed. PET markers of pathological protein aggregates and structural imaging of brain atrophy are common disease-related elements across many neurological disorders. However, PET tracers for pathologies beyond amyloid β and tau are needed, and the interpretability of structural imaging can be enhanced by some simple considerations to guard against the possible confound of pseudo-atrophy. Learnings from much-studied conditions such as Alzheimer's disease and multiple sclerosis will be beneficial as the field embraces rarer diseases.
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Affiliation(s)
- Adam J Schwarz
- Takeda Pharmaceuticals Ltd., 40 Landsdowne Street, Cambridge, MA, 02139, USA.
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20
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Collij LE, Salvadó G, Shekari M, Lopes Alves I, Reimand J, Wink AM, Zwan M, Niñerola-Baizán A, Perissinotti A, Scheltens P, Ikonomovic MD, Smith APL, Farrar G, Molinuevo JL, Barkhof F, Buckley CJ, van Berckel BNM, Gispert JD. Visual assessment of [ 18F]flutemetamol PET images can detect early amyloid pathology and grade its extent. Eur J Nucl Med Mol Imaging 2021; 48:2169-2182. [PMID: 33615397 PMCID: PMC8175297 DOI: 10.1007/s00259-020-05174-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/20/2020] [Indexed: 11/08/2022]
Abstract
Purpose To investigate the sensitivity of visual read (VR) to detect early amyloid pathology and the overall utility of regional VR. Methods [18F]Flutemetamol PET images of 497 subjects (ALFA+ N = 352; ADC N = 145) were included. Scans were visually assessed according to product guidelines, recording the number of positive regions (0–5) and a final negative/positive classification. Scans were quantified using the standard and regional Centiloid (CL) method. The agreement between VR-based classification and published CL-based cut-offs for early (CL = 12) and established (CL = 30) pathology was determined. An optimal CL cut-off maximizing Youden’s index was derived. Global and regional CL quantification was compared to VR. Finally, 28 post-mortem cases from the [18F]flutemetamol phase III trial were included to assess the percentage agreement between VR and neuropathological classification of neuritic plaque density. Results VR showed excellent agreement against CL = 12 (κ = .89, 95.2%) and CL = 30 (κ = .88, 95.4%) cut-offs. ROC analysis resulted in an optimal CL = 17 cut-off against VR (sensitivity = 97.9%, specificity = 97.8%). Each additional positive VR region corresponded to a clear increase in global CL. Regional VR was also associated with regional CL quantification. Compared to mCERADSOT-based classification (i.e., any region mCERADSOT > 1.5), VR was in agreement in 89.3% of cases, with 13 true negatives, 12 true positives, and 3 false positives (FP). Regional sparse-to-moderate neuritic and substantial diffuse Aβ plaque was observed in all FP cases. Regional VR was also associated with regional plaque density. Conclusion VR is an appropriate method for assessing early amyloid pathology and that grading the extent of visual amyloid positivity could present clinical value. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05174-2.
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Affiliation(s)
- Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Gemma Salvadó
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mahnaz Shekari
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Juhan Reimand
- Alzheimer Center and department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia.,Radiology Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Alle Meije Wink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Marissa Zwan
- Alzheimer Center and department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Aida Niñerola-Baizán
- Nuclear Medicine Department, Hospital Clínic Barcelona & Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Andrés Perissinotti
- Nuclear Medicine Department, Hospital Clínic Barcelona & Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Philip Scheltens
- Alzheimer Center and department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Geriatric Research Education and Clinical Center, VA Pittsburgh HS, Pittsburgh, PA, USA
| | | | | | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.,Centre for Medical Image Computing, and Queen Square Institute of Neurology, UCL, London, UK
| | | | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands. .,Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1108 HV, Amsterdam, The Netherlands.
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain. .,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. .,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain. .,Alzheimer Prevention Program, BarcelonaBeta Brain Research Center (BBRC), C/ Wellington, 30, 08005, Barcelona, Spain.
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21
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Teipel SJ, Temp AGM, Levin F, Dyrba M, Grothe MJ. Association of TDP-43 Pathology with Global and Regional 18F-Florbetapir PET Signal in the Alzheimer's Disease Spectrum. J Alzheimers Dis 2021; 79:663-670. [PMID: 33337372 DOI: 10.3233/jad-201032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND TAR DNA-binding protein 43 (TDP-43) has been recognized as a frequent co-pathology of Alzheimer's disease (AD). The effect of the presence of TDP-43 pathology on in vivo measures of AD-related amyloid pathology using amyloid sensitive PET is still unresolved. OBJECTIVE To study the association of TDP-43 pathology with antemortem amyloid PET signal. METHODS We studied 30 cases from the ADNI autopsy sample with available ratings of presence of TDP-43 and antemortem amyloid sensitive 18F-FlorbetapirPET. We used Bayesian regression to determine the effect of TDP-43 on global and regional amyloid PET signal. In a post-hoc analysis, we assessed the association of TDP-43 pathology with antemortem memory performance. RESULTS We found substantial to strong evidence for a negative effect of TDP-43 (Bayes factor against the null model (BF10) = 9.0) and hippocampal sclerosis (BF10 = 6.4) on partial volume corrected hippocampal 18F-Florbetapir uptake. This effect was only partly mediated by the negative effect of TDP-43 on hippocampal volume. In contrast, Bayesian regression supported that there is no effect of TDP-43 on global cortical PET-signal (BF10 = 0.65). We found an anecdotal level of evidence for a negative effect of TDP-43 pathology on antemortem memory performance after accounting for global amyloid PET signal (BF10 = 1.6). CONCLUSION Presence of TDP-43 pathology does not confound the global amyloid PET-signal but has a selective effect on hippocampal PET-signal that appears only partially dependent on TDP-43 mediated atrophy.
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Affiliation(s)
- Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | | | - Fedor Levin
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Martin Dyrba
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Michel J Grothe
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
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22
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Teipel SJ, Temp AGM, Levin F, Dyrba M, Grothe MJ. Association of PET-based stages of amyloid deposition with neuropathological markers of Aβ pathology. Ann Clin Transl Neurol 2021; 8:29-42. [PMID: 33137247 PMCID: PMC7818279 DOI: 10.1002/acn3.51238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/22/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine if PET-based stages of regional amyloid deposition are associated with neuropathological phases of Aβ pathology. METHODS We applied data-driven regional frequency-based and a-priori striatum-based PET staging approaches to ante-mortem 18F-Florbetapir-PET scans of 30 cases from the Alzheimer's Disease Neuroimaging Initiative autopsy cohort, and used Bayesian regression analysis to study the associations of these in vivo amyloid stages with neuropathological Thal phases of regional Aβ plaque distribution and with semi-quantitative ratings of neocortical and striatal plaque densities. RESULTS Bayesian regression revealed extreme evidence for an association of both PET-based staging approaches with Thal phases, and these associations were about 44 times more likely for frequency-based stages and 89 times more likely for striatum-based stages than for global cortical 18F-Florbetapir-PET signal. Early (i.e., neocortical-only) PET-based amyloid stages also predicted the absence of striatal/diencephalic cored plaques. Receiver operating characteristics curves revealed highly accurate discrimination between low/high Thal phases and the presence/absence of regional plaques. The median areas under the curve were 0.99 for frequency-based staging (95% credibility interval 0.97-1.00), 0.93 for striatum-based staging (0.83-1.00), and 0.87 for global 18F-Florbetapir-PET signal (0.72-0.98). INTERPRETATION Our data indicate that both regional frequency- and striatum-based amyloid-PET staging approaches were superior to standard global amyloid-PET signal for differentiating between low and high degrees of regional amyloid pathology spread. Despite this, we found no evidence for the ability of either staging scheme to differentiate between low and moderate degrees of amyloid pathology which may be particularly relevant for early, preclinical stages of Alzheimer's disease.
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Affiliation(s)
- Stefan J. Teipel
- German Center for Neurodegenerative Diseases (DZNE)RostockGermany
- Department of Psychosomatic MedicineUniversity Medicine RostockRostockGermany
| | - Anna G. M. Temp
- German Center for Neurodegenerative Diseases (DZNE)RostockGermany
| | - Fedor Levin
- German Center for Neurodegenerative Diseases (DZNE)RostockGermany
| | - Martin Dyrba
- German Center for Neurodegenerative Diseases (DZNE)RostockGermany
| | - Michel J. Grothe
- German Center for Neurodegenerative Diseases (DZNE)RostockGermany
- Servicio de Neurología y Neurofisiología ClínicaUnidad de Trastornos del MovimientoInstituto de Biomedicina de SevillaHospital Universitario Virgen del Rocío/CSICUniversidad de SevillaSevilleSpain
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23
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Cho SH, Choe YS, Kim YJ, Lee B, Kim HJ, Jang H, Kim JP, Jung YH, Kim SJ, Kim BC, Farrar G, Na DL, Moon SH, Seo SW. Concordance in detecting amyloid positivity between 18F-florbetaben and 18F-flutemetamol amyloid PET using quantitative and qualitative assessments. Sci Rep 2020; 10:19576. [PMID: 33177593 PMCID: PMC7658982 DOI: 10.1038/s41598-020-76102-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/20/2020] [Indexed: 01/19/2023] Open
Abstract
We aimed to quantitatively and qualitatively assess whether there is a discrepancy in detecting amyloid beta (Aβ) positivity between 18F-florbetaben (FBB) and 18F-flutemetamol (FMM) positron emission tomography (PET). We obtained paired FBB and FMM PET images from 107 participants. Three experts visually quantified the Aβ deposition as positive or negative. Quantitative assessment was performed using global cortical standardized uptake value ratio (SUVR) with the whole cerebellum as the reference region. Inter-rater agreement was excellent for FBB and FMM. The concordance rates between FBB and FMM were 94.4% (101/107) for visual assessment and 98.1% (105/107) for SUVR cut-off categorization. Both FBB and FMM showed high agreement rates between visual assessment and SUVR positive or negative categorization (93.5% in FBB and 91.2% in FMM). When the two ligands were compared based on SUVR cut-off categorization as standard of truth, although not statistically significant, the false-positive rate was higher in FMM (9.1%) than in FBB (1.8%) (p = 0.13). Our findings suggested that both FBB and FMM had excellent agreement when used to quantitatively and qualitatively evaluate Aβ deposits, thus, combining amyloid PET data associated with the use of different ligands from multi-centers is feasible.
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Affiliation(s)
- Soo Hyun Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yeong Sim Choe
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Young Ju Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Byungju Lee
- Department of Neurology, Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Young Hee Jung
- Department of Neurology, Myoungji Hospital, Hanyang University, Goyangsi, Korea
| | - Soo-Jong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Gill Farrar
- Pharmaceutical Diagnostics, GE Healthcare, Chalfont St Giles, UK
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, Korea. .,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea. .,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University School of Medicine, Suwon, Korea.
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24
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Abstract
Aβ plaques are one of the two lesions in the brain that define the neuropathological diagnosis of Alzheimer's disease. Plaques are highly diverse structures; many of them include massed, fibrillar polymers of the Aβ protein referred to as Aβ-amyloid, but some lack the defining features of amyloid. Cellular elements in 'classical' plaques include abnormal neuronal processes and reactive glial cells, but these are not present in all plaques. Plaques have been given various names since their discovery in 1892, including senile plaques, amyloid plaques, and neuritic plaques. However, with the identification in the 1980s of Aβ as the obligatory and universal component of plaques, the term 'Aβ plaques' has become a unifying term for these heterogeneous formations. Tauopathy, the second essential lesion of the Alzheimer's disease diagnostic dyad, is downstream of Aβ-proteopathy, but it is critically important for the manifestation of dementia. The etiologic link between Aβ-proteopathy and tauopathy in Alzheimer's disease remains largely undefined. Aβ plaques develop and propagate via the misfolding, self-assembly and spread of Aβ by the prion-like mechanism of seeded protein aggregation. Partially overlapping sets of risk factors and sequelae, including inflammation, genetic variations, and various environmental triggers have been linked to plaque development and idiopathic Alzheimer's disease, but no single factor has emerged as a requisite cause. The value of Aβ plaques per se as therapeutic targets is uncertain; although some plaques are sites of focal gliosis and inflammation, the complexity of inflammatory biology presents challenges to glia-directed intervention. Small, soluble, oligomeric assemblies of Aβ are enriched in the vicinity of plaques, and these probably contribute to the toxic impact of Aβ aggregation on the brain. Measures designed to reduce the production or seeded self-assembly of Aβ can impede the formation of Aβ plaques and oligomers, along with their accompanying abnormalities; given the apparent long timecourse of the emergence, maturation and proliferation of Aβ plaques in humans, such therapies are likely to be most effective when begun early in the pathogenic process, before significant damage has been done to the brain. Since their discovery in the late 19th century, Aβ plaques have, time and again, illuminated fundamental mechanisms driving neurodegeneration, and they should remain at the forefront of efforts to understand, and therefore treat, Alzheimer's disease.
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Affiliation(s)
- Lary C. Walker
- Department of Neurology and Yerkes National Primate Research Center, Emory University
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25
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Leuzy A, Lilja J, Buckley CJ, Ossenkoppele R, Palmqvist S, Battle M, Farrar G, Thal DR, Janelidze S, Stomrud E, Strandberg O, Smith R, Hansson O. Derivation and utility of an Aβ-PET pathology accumulation index to estimate Aβ load. Neurology 2020; 95:e2834-e2844. [PMID: 33077542 PMCID: PMC7734735 DOI: 10.1212/wnl.0000000000011031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate a novel β-amyloid (Aβ)-PET-based quantitative measure (Aβ accumulation index [Aβ index]), including the assessment of its ability to discriminate between participants based on Aβ status using visual read, CSF Aβ42/Aβ40, and post-mortem neuritic plaque burden as standards of truth. METHODS One thousand one hundred twenty-one participants (with and without cognitive impairment) were scanned with Aβ-PET: Swedish BioFINDER, n = 392, [18F]flutemetamol; Alzheimer's Disease Neuroimaging Initiative (ADNI), n = 692, [18F]florbetapir; and a phase 3 end-of-life study, n = 100, [18F]flutemetamol. The relationships between Aβ index and standardized uptake values ratios (SUVR) from Aβ-PET were assessed. The diagnostic performances of Aβ index and SUVR were compared with visual reads, CSF Aβ42/Aβ40, and Aβ histopathology used as reference standards. RESULTS Strong associations were observed between Aβ index and SUVR (R 2: BioFINDER 0.951, ADNI 0.943, end-of-life, 0.916). Both measures performed equally well in differentiating Aβ-positive from Aβ-negative participants, with areas under the curve (AUCs) of 0.979 to 0.991 to detect abnormal visual reads, AUCs of 0.961 to 0.966 to detect abnormal CSF Aβ42/Aβ40, and AUCs of 0.820 to 0.823 to detect abnormal Aβ histopathology. Both measures also showed a similar distribution across postmortem-based Aβ phases (based on anti-Aβ 4G8 antibodies). Compared to models using visual read alone, the addition of the Aβ index resulted in a significant increase in AUC and a decrease in Akaike information criterion to detect abnormal Aβ histopathology. CONCLUSION The proposed Aβ index showed a tight association to SUVR and carries an advantage over the latter in that it does not require the definition of regions of interest or the use of MRI. Aβ index may thus prove simpler to implement in clinical settings and may also facilitate the comparison of findings using different Aβ-PET tracers. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that the Aβ accumulation index accurately differentiates Aβ-positive from Aβ-negative participants compared to Aβ-PET visual reads, CSF Aβ42/Aβ40, and Aβ histopathology.
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Affiliation(s)
- Antoine Leuzy
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium.
| | - Johan Lilja
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Christopher J Buckley
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Rik Ossenkoppele
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Sebastian Palmqvist
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Mark Battle
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Gill Farrar
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Dietmar R Thal
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Shorena Janelidze
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Erik Stomrud
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Olof Strandberg
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Ruben Smith
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
| | - Oskar Hansson
- From the Clinical Memory Research Unit (A.L., J.L., R.O., S.P., S.J., E.S., O.S., R.S., O.H.), Department of Clinical Sciences, Lund University, Malmö; Department of Surgical Sciences, Nuclear Medicine and PET (J.L.), Uppsala University; Hermes Medical Solutions (J.L.), Stockholm, Sweden; GE Healthcare Life Sciences (C.J.B., M.B., G.F.), Amersham, UK; VU University Medical Center (R.O.), Neuroscience Campus Amsterdam, the Netherlands; Department of Neurology (S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden; Department of Imaging and Pathology (D.R.T.), Laboratory of Neuropathology, and Leuven Brain Institute (D.R.T.), Campus Gasthuisberg; and Department of Pathology (D.R.T.), UZ-Leuven, Belgium
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26
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Ikonomovic MD, Buckley CJ, Abrahamson EE, Kofler JK, Mathis CA, Klunk WE, Farrar G. Post-mortem analyses of PiB and flutemetamol in diffuse and cored amyloid-β plaques in Alzheimer's disease. Acta Neuropathol 2020; 140:463-476. [PMID: 32772265 PMCID: PMC7498488 DOI: 10.1007/s00401-020-02175-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 01/22/2023]
Abstract
Specificity and sensitivity of positron emission tomography (PET) radiopharmaceuticals targeting fibrillar amyloid-β (Aβ) deposits is high for detection of neuritic Aβ plaques, a mature form of Aβ deposits which often have dense Aβ core (i.e., cored plaques). However, imaging-to-autopsy validation studies of amyloid PET radioligands have identified several false positive cases all of which had mainly diffuse Aβ plaques (i.e., plaques without neuritic pathology or dense amyloid core), and high amyloid PET signal was reported in the striatum where diffuse plaques predominate in Alzheimer's disease (AD). Relative contributions of different plaque types to amyloid PET signal is unclear, particularly in neocortical areas where they are intermixed in AD. In vitro binding assay and autoradiography were performed using [3H]flutemetamol and [3H]Pittsburgh Compound-B (PiB) in frozen brain homogenates from 30 autopsy cases including sporadic AD and non-AD controls with a range of brain Aβ burden and plaque density. Fixed tissue sections of frontal cortex and caudate from 10 of the AD cases were processed for microscopy using fluorescent derivatives of flutemetamol (cyano-flutemetamol) and PiB (cyano-PiB) and compared to Aβ immunohistochemistry and pan-amyloid (X-34) histology. Using epifluorescence microscopy, percent area coverage and fluorescence output values of cyano-PiB- and cyano-flutemetamol-labeled plaques in two-dimensional microscopic fields were then calculated and combined to obtain integrated density measurements. Using confocal microscopy, we analysed total fluorescence output of the entire three-dimensional volume of individual cored plaques and diffuse plaques labeled with cyano-flutemetamol or cyano-PiB. [3H]Flutemetamol and [3H]PiB binding values in tissue homogenates correlated strongly and their binding pattern in tissue sections, as seen on autoradiograms, overlapped the pattern of Aβ-immunoreactive plaques on directly adjacent sections. Cyano-flutemetamol and cyano-PiB fluorescence was prominent in cored plaques and less so in diffuse plaques. Across brain regions and cases, percent area coverage of cyano-flutemetamol-labeled plaques correlated strongly with cyano-PiB-labeled and Aβ-immunoreactive plaques. For both ligands, plaque burden, calculated as percent area coverage of all Aβ plaque types, was similar in frontal cortex and caudate regions, while integrated density values were significantly greater in frontal cortex, which contained both cored plaques and diffuse plaques, compared to the caudate, which contained only diffuse plaques. Three-dimensional analysis of individual plaques labeled with either ligand showed that total fluorescence output of a single cored plaque was equivalent to total fluorescence output of approximately three diffuse plaques of similar volume. Our results indicate that [18F]flutemetamol and [11C]PiB PET signal is influenced by both diffuse plaques and cored plaques, and therefore is likely a function of plaque size and density of Aβ fibrils in plaques. Brain areas with large volumes/frequencies of diffuse plaques could yield [18F]flutemetamol and [11C]PiB PET retention levels comparable to brain regions with a lower volume/frequency of cored plaques.
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Affiliation(s)
- Milos D Ikonomovic
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- University of Pittsburgh School of Medicine, Thomas Detre Hall of the WPIC, Room 1421, 3811 O'Hara Street, Pittsburgh, 15213-2593, PA, USA.
| | | | - Eric E Abrahamson
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia K Kofler
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chester A Mathis
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William E Klunk
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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27
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Hattori N, Sherwin P, Farrar G. Initial Physician Experience with [ 18F]Flutemetamol Amyloid PET Imaging Following Availability for Routine Clinical Use in Japan. J Alzheimers Dis Rep 2020; 4:165-174. [PMID: 32715277 PMCID: PMC7369136 DOI: 10.3233/adr-190150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Brain amyloid is a neuropathological hallmark of Alzheimer’s disease (AD). By visualizing brain amyloid, positron emission tomography (PET) may influence the diagnostic assessment and management of patients with cognitive impairment. Objective: As part of a Japanese post-approval study to measure the safety of [18F]flutemetamol PET, the association of amyloid PET results with changes in diagnosis and diagnostic confidence was assessed. Methods: Fifty-seven subjects were imaged for amyloid PET using [18F]flutemetamol at a single Japanese memory clinic. The cognitive diagnosis and referring physician’s confidence in the diagnosis were recorded before and after availability of PET results. Imaging started approximately 90 minutes after [18F]flutemetamol administration with approximately 185 MBq injected. PET images were acquired for 30 minutes. Results: Amyloid PET imaging led to change in diagnosis in 15/44 clinical subjects (34%). Mean diagnostic confidence increased by approximately 20%, from 73% pre-scan to 93% post-scan, and this rise was fairly consistent across the main patient subgroups (mild cognitive impairment, AD, and non-AD) irrespective of the pre-scan diagnosis and scan result. Conclusion: The study examined the utility of amyloid PET imaging in a Japanese clinical cohort and highlighted the use of an etiological diagnosis in the presence of the amyloid scan. [18F]Flutemetamol PET led to a change in diagnosis in over 30% of cases and to an increase in diagnostic confidence by approximately 20% consistent with other reports.
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28
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Parizkova M, Lerch O, Andel R, Kalinova J, Markova H, Vyhnalek M, Hort J, Laczó J. Spatial Pattern Separation in Early Alzheimer's Disease. J Alzheimers Dis 2020; 76:121-138. [PMID: 32444544 DOI: 10.3233/jad-200093] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The hippocampus, entorhinal cortex, and basal forebrain are among the first brain structures affected by Alzheimer's disease (AD). They play an essential role in spatial pattern separation, a process critical for accurate encoding of similar spatial information. OBJECTIVE Our aim was to examine spatial pattern separation and its association with volumetric changes of the hippocampus, entorhinal cortex, and basal forebrain nuclei projecting to the hippocampus (the medial septal nuclei and vertical limb of the diagonal band of Broca - Ch1-2 nuclei) in the biomarker-defined early clinical stages of AD. METHODS A total of 98 older adults were recruited from the Czech Brain Aging Study cohort. The participants with amnestic mild cognitive impairment (aMCI) due to AD (n = 44), mild AD dementia (n = 31), and cognitively normal older adults (CN; n = 23) underwent spatial pattern separation testing, comprehensive cognitive assessment, and MRI brain volumetry. RESULTS Spatial pattern separation accuracy was lower in the early clinical stages of AD compared to the CN group (p < 0.001) and decreased with disease severity (CN > aMCI due to AD > AD dementia). Controlling for general memory and cognitive performance, demographic characteristics and psychological factors did not change the results. Hippocampal and Ch1-2 volumes were directly associated with spatial pattern separation performance while the entorhinal cortex operated on pattern separation indirectly through the hippocampus. CONCLUSION Smaller volumes of the hippocampus, entorhinal cortex, and basal forebrain Ch1-2 nuclei are linked to spatial pattern separation impairment in biomarker-defined early clinical AD and may contribute to AD-related spatial memory deficits.
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Affiliation(s)
- Martina Parizkova
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ondrej Lerch
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ross Andel
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jana Kalinova
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Hana Markova
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Martin Vyhnalek
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jakub Hort
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Laczó
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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Fink HA, Linskens EJ, Silverman PC, McCarten JR, Hemmy LS, Ouellette JM, Greer NL, Wilt TJ, Butler M. Accuracy of Biomarker Testing for Neuropathologically Defined Alzheimer Disease in Older Adults With Dementia. Ann Intern Med 2020; 172:669-677. [PMID: 32340038 DOI: 10.7326/m19-3888] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Biomarker accuracy for Alzheimer disease (AD) is uncertain. PURPOSE To summarize evidence on biomarker accuracy for classifying AD in older adults with dementia. DATA SOURCES Electronic bibliographic databases (searched from January 2012 to November 2019 for brain imaging and cerebrospinal fluid [CSF] tests and from inception to November 2019 for blood tests), ClinicalTrials.gov (to November 2019), and systematic review bibliographies. STUDY SELECTION English-language studies evaluating the accuracy of brain imaging, CSF testing, or blood tests for distinguishing neuropathologically defined AD from non-AD among older adults with dementia. Studies with low or medium risk of bias were analyzed. DATA EXTRACTION Two reviewers rated risk of bias. One extracted data; the other verified accuracy. DATA SYNTHESIS Fifteen brain imaging studies and 9 CSF studies met analysis criteria. Median sensitivity and specificity, respectively, were 0.91 and 0.92 for amyloid positron emission tomography (PET), 0.89 and 0.74 for 18F-labeled fluorodeoxyglucose (18F-FDG) PET, 0.64 and 0.83 for single-photon emission computed tomography, and 0.91 and 0.89 for medial temporal lobe atrophy on magnetic resonance imaging (MRI). Individual CSF biomarkers and ratios had moderate sensitivity (range, 0.62 to 0.83) and specificity (range, 0.53 to 0.69); in the few direct comparisons, β-amyloid 42 (Aβ42)/phosphorylated tau (p-tau) ratio, total tau (t-tau)/Aβ42 ratio, and p-tau appeared more accurate than Aβ42 and t-tau alone. Single studies suggested that amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. LIMITATIONS Studies were small, biomarker cut points and neuropathologic AD were inconsistently defined, and methods with uncertain applicability to typical clinical settings were used. Few studies directly compared biomarkers, assessed test combinations, evaluated whether biomarkers improved classification accuracy when added to clinical evaluation, or reported harms. CONCLUSION In methodologically heterogeneous studies of uncertain applicability to typical clinical settings, amyloid PET, 18F-FDG PET, and MRI were highly sensitive for neuropathologic AD. Amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897).
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Affiliation(s)
- Howard A Fink
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | - Eric J Linskens
- Minneapolis VA Health Care System, Minneapolis, Minnesota (E.J.L., N.L.G.)
| | | | - J Riley McCarten
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | - Laura S Hemmy
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | | | - Nancy L Greer
- Minneapolis VA Health Care System, Minneapolis, Minnesota (E.J.L., N.L.G.)
| | - Timothy J Wilt
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | - Mary Butler
- University of Minnesota, Minneapolis, Minnesota (J.M.O., M.B.)
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Curiel Cid RE, Crocco EA, Duara R, Garcia JM, Rosselli M, DeKosky ST, Smith G, Bauer R, Chirinos CL, Adjouadi M, Barker W, Loewenstein DA. A novel method of evaluating semantic intrusion errors to distinguish between amyloid positive and negative groups on the Alzheimer's disease continuum. J Psychiatr Res 2020; 124:131-136. [PMID: 32146222 PMCID: PMC10026350 DOI: 10.1016/j.jpsychires.2020.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The development and validation of clinical outcome measures to detect early cognitive decline associated with Alzheimer's disease (AD) biomarkers is imperative. Semantic intrusions on the Loewenstein Acevedo Scales of Semantic Interference and Learning (LASSI-L) has outperformed widely used cognitive measures as an early correlate of elevated brain amyloid in prodromal AD and has distinguished those with amnestic mild cognitive impairment (aMCI) and high amyloid load from aMCI attributable to other non-AD conditions. METHODS Since intrusion errors on memory tasks vary widely, we employed a novel method that accounts for the percentage of intrusion errors (PIE) in relation to total responses. Individuals with either high or low amyloid load across the spectrum of aMCI and dementia and amyloid negative cognitively normal older adults (CN) were studied. RESULTS Mean PIE on indices sensitive to proactive semantic interference (PSI) and failure to recover from proactive semantic interference (frPSI) could distinguish amyloid positive from amyloid negative aMCI and dementia groups. Number of correct responses alone, while able to differentiate the different diagnostic groups, did not differentiate amyloid positive aMCI from their counterparts without amyloid pathology. CONCLUSIONS PIE, a novel and sensitive index of early memory dysfunction, demonstrated high levels of sensitivity and specificity in differentiating CN from amyloid positive persons with preclinical AD. Mean levels of PIE are higher for amyloid positive aMCI and dementia participants relative to their amyloid negative counterparts.
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Affiliation(s)
- Rosie E Curiel Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Avenue, Miami, FL, 33136, USA.
| | - Elizabeth A Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Avenue, Miami, FL, 33136, USA
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, 33140, USA
| | - Jessica M Garcia
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Avenue, Miami, FL, 33136, USA
| | - Monica Rosselli
- Department of Psychology, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Steven T DeKosky
- Department of Neurology and McKnight Brain Institute, University of Florida, 1149 Newell Drive Bldg. 59, Rm L5-101, Gainesville, FL, 32611, USA
| | - Glenn Smith
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., RM 3154, Gainesville, FL, 32606, USA
| | - Russell Bauer
- Department of Neurology and McKnight Brain Institute, University of Florida, 1149 Newell Drive Bldg. 59, Rm L5-101, Gainesville, FL, 32611, USA
| | - Cesar L Chirinos
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, 33140, USA
| | - Malek Adjouadi
- Center for Advanced Technology and Education, Florida International University, 10555 West Flagler Street, EC 2220, Miami, FL, 33174, USA
| | - Warren Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, 33140, USA
| | - David A Loewenstein
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Avenue, Miami, FL, 33136, USA
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Amadoru S, Doré V, McLean CA, Hinton F, Shepherd CE, Halliday GM, Leyton CE, Yates PA, Hodges JR, Masters CL, Villemagne VL, Rowe CC. Comparison of amyloid PET measured in Centiloid units with neuropathological findings in Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2020; 12:22. [PMID: 32131891 PMCID: PMC7057642 DOI: 10.1186/s13195-020-00587-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/13/2020] [Indexed: 12/14/2022]
Abstract
Background The Centiloid scale was developed to standardise the results of beta-amyloid (Aβ) PET. We aimed to determine the Centiloid unit (CL) thresholds for CERAD sparse and moderate-density neuritic plaques, Alzheimer’s disease neuropathologic change (ADNC) score of intermediate or high probability of Alzheimer’s Disease (AD), final clinicopathological diagnosis of AD, and expert visual read of a positive Aβ PET scan. Methods Aβ PET results in CL for 49 subjects were compared with post-mortem findings, visual read, and final clinicopathological diagnosis. The Youden Index was used to determine the optimal CL thresholds from receiver operator characteristic (ROC) curves. Results A threshold of 20.1 CL (21.3 CL when corrected for time to death, AUC 0.97) yielded highest accuracy in detecting moderate or frequent plaque density while < 10 CL was optimal for excluding neuritic plaque. The threshold for ADNC intermediate or high likelihood AD was 49.4 CL (AUC 0.98). Those cases with a final clinicopathological diagnosis of AD yielded a median CL result of 87.7 (IQR ± 42.2) with 94% > 45 CL. Positive visual read agreed highly with results > 26 CL. Conclusions Centiloid values < 10 accurately reflected the absence of any neuritic plaque and > 20 CL indicated the presence of at least moderate plaque density, but approximately 50 CL or more best confirmed both neuropathological and clinicopathological diagnosis of Alzheimer’s disease. Supplementary information Supplementary information accompanies this paper at 10.1186/s13195-020-00587-5.
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Affiliation(s)
- Sanka Amadoru
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia.
| | - Vincent Doré
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia.,CSIRO Health and Biosecurity, Parkville, Victoria, 3052, Australia
| | - Catriona A McLean
- Victorian Brain Bank, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Fairlie Hinton
- Victorian Brain Bank, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Claire E Shepherd
- Sydney Brain Bank, Neuroscience Research Australia and Faculty of Medicine, University of NSW, Sydney, Australia
| | - Glenda M Halliday
- Sydney Brain Bank, Neuroscience Research Australia and Faculty of Medicine, University of NSW, Sydney, Australia.,The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Cristian E Leyton
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Paul A Yates
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia
| | - John R Hodges
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Colin L Masters
- Victorian Brain Bank, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Victor L Villemagne
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia
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Shaw LM, Korecka M, Figurski M, Toledo J, Irwin D, Kang JH, Trojanowski JQ. Detection of Alzheimer Disease Pathology in Patients Using Biochemical Biomarkers: Prospects and Challenges for Use in Clinical Practice. J Appl Lab Med 2020; 5:183-193. [PMID: 31848218 PMCID: PMC7246169 DOI: 10.1373/jalm.2019.029587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thirty-four years ago, amyloid-β 1-42 peptide was identified in amyloid plaques from brain tissue obtained from patients with Alzheimer disease (AD) and Down syndrome. This finding led to development of immunoassays for this marker of amyloid plaque burden in cerebrospinal fluid (CSF) approximately 10 years later. Subsequently, research immunoassays were developed for total τ protein and τ phosphorylated at the threonine 181 position. Subsequent studies documented the clinical utility of these biomarkers of amyloid plaque burden or τ tangle pathology in cohorts of living patients. CONTENT We describe the following: (a) clinical utility of AD biomarkers; (b) measurement challenges, including development of mass spectrometry-based reference methods and automated immunoassays; (c) development of "appropriate use criteria" (AUC) guidelines for safe/appropriate use of CSF testing for diagnosis of AD developed by neurologists, a neuroethicist, and laboratorians; (d) a framework, sponsored by the National Institute of Aging-Alzheimer's Association (NIA-AA), that defines AD on the basis of CSF and imaging methods for detecting amyloid plaque burden, τ tangle pathology, and neurodegeneration. This framework's purpose was investigative but has important implications for future clinical practice; (e) recognition of copathologies in AD patients and challenges for developing methods to detect these in living patients. SUMMARY The field can expect availability of validated research tools for detection of AD pathology that support clinical treatment trials of disease-modifying agents and, ultimately, use in clinical practice. Validated methods are becoming available for CSF testing; emergence of validated methods for AD biomarkers in plasma can be expected in the next few years.
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Affiliation(s)
- Leslie M Shaw
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
| | - Magdalena Korecka
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
| | - Michal Figurski
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
| | - Jon Toledo
- Department of Neurology, Houston Methodist Hospital,
Houston, TX
| | - David Irwin
- Department of Neurology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA 19104
| | - Ju Hee Kang
- Department of Pharmacology and Clinical Pharmacology,
College of Medicine, Inha University, Incheon, 22212, Republic of Korea
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
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Kaplow J, Vandijck M, Gray J, Kanekiyo M, Huyck E, Traynham CJ, Esquivel R, Fagan AM, Luthman J. Concordance of Lumipulse cerebrospinal fluid t-tau/Aβ42 ratio with amyloid PET status. Alzheimers Dement 2020; 16:144-152. [PMID: 31914216 PMCID: PMC7061432 DOI: 10.1002/alz.12000] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cerebrospinal fluid (CSF) biomarkers can identify individuals with Alzheimer's disease (AD) pathology (eg, amyloid plaques, neurofibrillary tangles), but defined analyte cut-points using high-throughput automated assays are necessary for general clinical use. METHODS CSF amyloid β42 peptide (Aβ42), t-tau, and t-tau/Aβ42 were quantified by the Lumipulse platform in two test cohorts (A/B: Eisai BAN2401-201/MISSION AD E2609-301/302, n = 138; C: Knight Alzheimer's Disease Research Center (ADRC), n = 198), and receiver operating characteristic (ROC) curve analyses defined cut-points corresponding best to amyloid determinations using positron emission tomography (PET) imaging. The best-performing cut-point was then validated as a predictor of amyloid status in an independent cohort (D: MISSION AD E2609-301/302, n = 240). RESULTS Virtually identical t-tau/Aβ42 cut-points (∼0.54) performed best in both test cohorts and with similar accuracy (areas under ROC curve [AUCs] [A/B: 0.95; C: 0.94]). The cut-point yielded an overall percent agreement with amyloid PET of 85.0% in validation cohort D. DISCUSSION Lumipulse CSF biomarker measures with validated cut-points have clinical utility in identifying AD pathology.
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Affiliation(s)
| | | | - Julia Gray
- Department of Neurology, Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO, 63110, USA
| | | | - Els Huyck
- Fujirebio Europe, Ghent, 9052 Belgium
| | - CJ Traynham
- Fujirebio Diagnostics Inc., Malvern, PA, 19355, USA
| | | | - Anne M. Fagan
- Department of Neurology, Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO, 63110, USA
- Corresponding author: Anne M. Fagan, PhD, Dept. of Neurology, Washington University in St. Louis, 660 S. Euclid Ave., Campus Box 8111, St. Louis, MO 63110, Tel: (314) 362-3453, Fax: (314) 362-2244,
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Fantoni E, Collij L, Lopes Alves I, Buckley C, Farrar G. The Spatial-Temporal Ordering of Amyloid Pathology and Opportunities for PET Imaging. J Nucl Med 2019; 61:166-171. [PMID: 31836683 DOI: 10.2967/jnumed.119.235879] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022] Open
Abstract
Although clinical routine focuses on dichotomous and visual interpretation of amyloid PET, regional image assessment in research settings may yield additional opportunities. Understanding the regional-temporal evolution of amyloid pathology may enable earlier identification of subjects in the Alzheimer Disease pathologic continuum, as well as a finer-grained assessment of pathology beyond traditional dichotomous measures. This review summarizes current research in the detection of regional amyloid deposition patterns and its potential for staging amyloid pathology. Pathology studies, cross-sectional and longitudinal PET-only studies, and comparative PET and autopsy studies are included. Despite certain differences, cortical deposition generally precedes striatal pathology, and in PET-only studies, medial cortical regions are seen to accumulate amyloid earlier than lateral regions. Based on regional amyloid PET, multiple studies have developed and implemented models for staging amyloid pathology that could improve subject selection into secondary prevention trials and visual assessment in clinical routine.
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Affiliation(s)
- Enrico Fantoni
- Pharmaceutical Diagnostics, GE Healthcare, Chalfont St. Giles, Buckinghamshire, United Kingdom; and
| | - Lyduine Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Christopher Buckley
- Pharmaceutical Diagnostics, GE Healthcare, Chalfont St. Giles, Buckinghamshire, United Kingdom; and
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Thal DR, Ronisz A, Tousseyn T, Rijal Upadhaya A, Balakrishnan K, Vandenberghe R, Vandenbulcke M, von Arnim CAF, Otto M, Beach TG, Lilja J, Heurling K, Chakrabarty A, Ismail A, Buckley C, Smith APL, Kumar S, Farrar G, Walter J. Different aspects of Alzheimer's disease-related amyloid β-peptide pathology and their relationship to amyloid positron emission tomography imaging and dementia. Acta Neuropathol Commun 2019; 7:178. [PMID: 31727169 PMCID: PMC6854805 DOI: 10.1186/s40478-019-0837-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022] Open
Abstract
Alzheimer’s disease (AD)-related amyloid β-peptide (Aβ) pathology in the form of amyloid plaques and cerebral amyloid angiopathy (CAA) spreads in its topographical distribution, increases in quantity, and undergoes qualitative changes in its composition of modified Aβ species throughout the pathogenesis of AD. It is not clear which of these aspects of Aβ pathology contribute to AD progression and to what extent amyloid positron emission tomography (PET) reflects each of these aspects. To address these questions three cohorts of human autopsy cases (in total n = 271) were neuropathologically and biochemically examined for the topographical distribution of Aβ pathology (plaques and CAA), its quantity and its composition. These parameters were compared with neurofibrillary tangle (NFT) and neuritic plaque pathology, the degree of dementia and the results from [18F]flutemetamol amyloid PET imaging in cohort 3. All three aspects of Aβ pathology correlated with one another, the estimation of Aβ pathology by [18F]flutemetamol PET, AD-related NFT pathology, neuritic plaques, and with the degree of dementia. These results show that one aspect of Aβ pathology can be used to predict the other two, and correlates well with the development of dementia, advancing NFT and neuritic plaque pathology. Moreover, amyloid PET estimates all three aspects of Aβ pathology in-vivo. Accordingly, amyloid PET-based estimates for staging of amyloid pathology indicate the progression status of amyloid pathology in general and, in doing so, also of AD pathology. Only 7.75% of our cases deviated from this general association.
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Müller EG, Edwin TH, Stokke C, Navelsaker SS, Babovic A, Bogdanovic N, Knapskog AB, Revheim ME. Amyloid-β PET-Correlation with cerebrospinal fluid biomarkers and prediction of Alzheimer´s disease diagnosis in a memory clinic. PLoS One 2019; 14:e0221365. [PMID: 31430334 PMCID: PMC6701762 DOI: 10.1371/journal.pone.0221365] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/05/2019] [Indexed: 01/11/2023] Open
Abstract
Background Alzheimer’s disease (AD) remains a clinical diagnosis but biomarkers from cerebrospinal fluid (CSF) and more lately amyloid imaging with positron emission tomography (PET), are important to support a diagnosis of AD. Objective To compare amyloid-β (Aβ) PET imaging with biomarkers in CSF and evaluate the prediction of Aβ PET on diagnosis in a memory clinic setting. Methods We included 64 patients who had lumbar puncture and Aβ PET with 18F-Flutemetamol performed within 190 days. PET was binary classified (Flut+ or Flut-) and logistic regression analyses for correlation to each CSF biomarker; Aβ 42 (Aβ42), total tau (T-tau) and phosphorylated tau (P-tau), were performed. Cut-off values were assessed by receiver operating characteristic (ROC) curves. Logistic regression was performed for prediction of clinical AD diagnosis. We assessed the interrater agreement of PET classification as well as for diagnoses, which were made both with and without knowledge of PET results. Results Thirty-two of the 34 patients (94%) in the Flut+ group and nine of the 30 patients (30%) in the Flut- group had a clinical AD diagnosis. There were significant differences in all CSF biomarkers in the Flut+ and Flut- groups. Aβ42 showed the highest correlation with 18F-Flutemetamol PET with a cut-off value of 706.5 pg/mL, corresponding to sensitivity of 88% and specificity of 87%. 18F-Flutemetamol PET was the best predictor of a clinical AD diagnosis. We found a very high interrater agreement for both PET classification and diagnosis. Conclusions The present study showed an excellent correlation of Aβ42 in CSF and 18F-Flutemetamol PET and the presented cut-off value for Aβ42 yields high sensitivity and specificity for 18F-Flutemetamol PET. 18F-Flutemetamol PET was the best predictor of clinical AD diagnosis.
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Affiliation(s)
- Ebba Gløersen Müller
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Trine Holt Edwin
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
- Department of Life Science and Health, Oslo Metropolitan University, Oslo, Norway
| | | | - Almira Babovic
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Nenad Bogdanovic
- Department for Neurobiology, Caring Science and Society, Division of Clinical Geriatrics, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anne Brita Knapskog
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
| | - Mona Elisabeth Revheim
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abrahamson EE, Head E, Lott IT, Handen BL, Mufson EJ, Christian BT, Klunk WE, Ikonomovic MD. Neuropathological correlates of amyloid PET imaging in Down syndrome. Dev Neurobiol 2019; 79:750-766. [PMID: 31379087 DOI: 10.1002/dneu.22713] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/07/2022]
Abstract
Down syndrome (DS) results in an overproduction of amyloid-β (Aβ) peptide associated with early onset of Alzheimer's disease (AD). DS cases have Aβ deposits detectable histologically as young as 12-30 years of age, primarily in the form of diffuse plaques, the type of early amyloid pathology also seen at pre-clinical (i.e., pathological aging) and prodromal stages of sporadic late onset AD. In DS subjects aged >40 years, levels of cortical Aβ deposition are similar to those observed in late onset AD and in addition to diffuse plaques involve cored plaques associated with dystrophic neurites (neuritic plaques), which are of neuropathological diagnostic significance in AD. The purpose of this review is to summarize and discuss findings from amyloid PET imaging studies of DS in reference to postmortem amyloid-based neuropathology. PET neuroimaging applied to subjects with DS has the potential to (a) track the natural progression of brain pathology, including the earliest stages of amyloid accumulation, and (b) determine whether amyloid PET biomarkers predict the onset of dementia. In addition, the question that is still incompletely understood and relevant to both applications is the ability of amyloid PET to detect Aβ deposits in their earliest form.
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Affiliation(s)
- Eric E Abrahamson
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, UC Irvine School of Medicine, Orange, California
| | - Ira T Lott
- Department of Neurology, UC Irvine School of Medicine, Orange, California
| | - Benjamin L Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elliott J Mufson
- Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona
| | - Bradley T Christian
- Departments of Medical Physics and Psychiatry, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - William E Klunk
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Milos D Ikonomovic
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
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Suppiah S, Didier MA, Vinjamuri S. The Who, When, Why, and How of PET Amyloid Imaging in Management of Alzheimer's Disease-Review of Literature and Interesting Images. Diagnostics (Basel) 2019; 9:diagnostics9020065. [PMID: 31242587 PMCID: PMC6627350 DOI: 10.3390/diagnostics9020065] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/10/2023] Open
Abstract
Amyloid imaging using positron emission tomography (PET) has an emerging role in the management of Alzheimer’s disease (AD). The basis of this imaging is grounded on the fact that the hallmark of AD is the histological detection of beta amyloid plaques (Aβ) at post mortem autopsy. Currently, there are three FDA approved amyloid radiotracers used in clinical practice. This review aims to take the readers through the array of various indications for performing amyloid PET imaging in the management of AD, particularly using 18F-labelled radiopharmaceuticals. We elaborate on PET amyloid scan interpretation techniques, their limitations and potential improved specificity provided by interpretation done in tandem with genetic data such as apolipiprotein E (APO) 4 carrier status in sporadic cases and molecular information (e.g., cerebral spinal fluid (CSF) amyloid levels). We also describe the quantification methods such as the standard uptake value ratio (SUVr) method that utilizes various cutoff points for improved accuracy of diagnosing AD, such as a threshold of 1.122 (area under the curve 0.894), which has a sensitivity of 92.3% and specificity of 90.5%, whereas the cutoff points may be higher in APOE ε4 carriers (1.489) compared to non-carriers (1.313). Additionally, recommendations for future developments in this field are also provided.
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Affiliation(s)
- Subapriya Suppiah
- Centre for Diagnostic Nuclear Imaging, University Putra Malaysia, Serdang 43400, Selangor, Malaysia.
- Department of Imaging, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Mellanie-Anne Didier
- The Royal Liverpool and Broadgreen University Hospitals NHS Trusts, Prescot St, Liverpool L7 8XP, UK.
- Section of Nuclear Medicine, Department of Surgery, Radiology, Anaesthesia & Intensive Care, The University Hospital of The West Indies, The University of The West Indies, Mona Campus, Kingston 7, Jamaica.
| | - Sobhan Vinjamuri
- The Royal Liverpool and Broadgreen University Hospitals NHS Trusts, Prescot St, Liverpool L7 8XP, UK.
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Farrar G, Molinuevo JL, Zanette M. Is there a difference in regional read [ 18F]flutemetamol amyloid patterns between end-of-life subjects and those with amnestic mild cognitive impairment? Eur J Nucl Med Mol Imaging 2019; 46:1299-1308. [PMID: 30863934 PMCID: PMC6486895 DOI: 10.1007/s00259-019-04282-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/04/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Visual interpretation of PET [18F]flutemetamol images relies on systematic review of five brain regions and is considered positive when an elevated signal is observed in at least one region. Amnestic mild cognitive impairment (aMCI) is an early clinical presentation of Alzheimer's disease (AD); hence it is of interest to determine if the pattern of visually read regional positivity between end-of-life (EoL) patients with and without dementia and aMCI patients is different. METHODS A total of 180 EoL patients with and without dementia (mean age 81 years, range 59 to 95 years) and 232 aMCI patients (mean age 71 years, range 53 to 91 years) were scanned following intravenous administration of 185-370 MBq [18F]flutemetamol. Images from both studies were read by two groups of five blinded readers who independently classified each of the five regions as either positive or negative. The majority interpretation made by at least three of the five readers was used as the imaging endpoint and compared with a composite standardized uptake value ratio (SUVR) analysis using a predetermined threshold. RESULTS Amyloid-positive images from 71 of 106 EoL patients coming to autopsy and from 97 aMCI patients were included. In the images from the EoL patients widespread deposition of amyloid was observed, with 76% of the images positive in all five regions and a further 20% positive in four regions. In the images from the aMCI patients, similar results were observed with 87% of the images positive in five regions and a further 5% positive in four regions. The mean SUVR of these positively read images was 2.24 (range 1.48 to 3.14) and 2.08 (range 1.28 to 3.04) in the autopsy and aMCI groups, respectively. There was 95.3% agreement between the visual reading and SUVR quantitation in the aMCI group and 90.4% agreement in the autopsy group. CONCLUSION Patients with aMCI showed a similar distribution of amyloid deposition determined by both visual reading and SUVR to that observed in patients with and without dementia coming to autopsy. Most of the aMCI patients, who are already within the AD continuum, had widespread amyloid deposition in terms of amount and topographical progression. Attempts to observe potential initial signs of amyloid deposition should focus on populations earlier in the dementia spectrum such as patients with subjective cognitive decline or even at-risk subjects with earlier stages of disease.
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Affiliation(s)
| | - José Luis Molinuevo
- Barcelona Beta Brain Research Center, Pasqual Maragall Foundation and Hospital Clinic I Universitari, IDIBAPS, Barcelona, Spain
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Höfling C, Shehabi E, Kuhn PH, Lichtenthaler SF, Hartlage-Rübsamen M, Roßner S. Cell Type-Specific Human APP Transgene Expression by Hippocampal Interneurons in the Tg2576 Mouse Model of Alzheimer's Disease. Front Neurosci 2019; 13:137. [PMID: 30853883 PMCID: PMC6395433 DOI: 10.3389/fnins.2019.00137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/06/2019] [Indexed: 01/21/2023] Open
Abstract
Amyloid precursor protein (APP) transgenic animal models of Alzheimer’s disease have become versatile tools for basic and translational research. However, there is great heterogeneity of histological, biochemical, and functional data between transgenic mouse lines, which might be due to different transgene expression patterns. Here, the expression of human APP (hAPP) by GABAergic hippocampal interneurons immunoreactive for the calcium binding proteins parvalbumin, calbindin, calretinin, and for the peptide hormone somatostatin was analyzed in Tg2576 mice by double immunofluorescent microscopy. Overall, there was no GABAergic interneuron subpopulation that did not express the transgene. On the other hand, in no case all neurons of such a subpopulation expressed hAPP. In dentate gyrus molecular layer and in stratum lacunosum moleculare less than 10% of hAPP-positive interneurons co-express any of these interneuron markers, whereas in stratum oriens hAPP-expressing neurons frequently co-express these interneuron markers to different proportions. We conclude that these neurons differentially contribute to deficits in young Tg2576 mice before the onset of Abeta plaque pathology. The detailed analysis of distinct brain region and neuron type-specific APP transgene expression patterns is indispensable to understand particular pathological features and mouse line-specific differences in neuronal and systemic functions.
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Affiliation(s)
- Corinna Höfling
- Paul-Flechsig-Institute for Brain Research, Leipzig University, Leipzig, Germany
| | - Emira Shehabi
- Paul-Flechsig-Institute for Brain Research, Leipzig University, Leipzig, Germany
| | - Peer-Hendrik Kuhn
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Stefan F Lichtenthaler
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Neuroproteomics, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | | | - Steffen Roßner
- Paul-Flechsig-Institute for Brain Research, Leipzig University, Leipzig, Germany
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La Joie R, Ayakta N, Seeley WW, Borys E, Boxer AL, DeCarli C, Doré V, Grinberg LT, Huang E, Hwang JH, Ikonomovic MD, Jack C, Jagust WJ, Jin LW, Klunk WE, Kofler J, Lesman-Segev OH, Lockhart SN, Lowe VJ, Masters CL, Mathis CA, McLean CL, Miller BL, Mungas D, O'Neil JP, Olichney JM, Parisi JE, Petersen RC, Rosen HJ, Rowe CC, Spina S, Vemuri P, Villemagne VL, Murray ME, Rabinovici GD. Multisite study of the relationships between antemortem [ 11C]PIB-PET Centiloid values and postmortem measures of Alzheimer's disease neuropathology. Alzheimers Dement 2019; 15:205-216. [PMID: 30347188 PMCID: PMC6368897 DOI: 10.1016/j.jalz.2018.09.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/08/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION We sought to establish the relationships between standard postmortem measures of AD neuropathology and antemortem [11C]PIB-positron emission tomography ([11C]PIB-PET) analyzed with the Centiloid (CL) method, a standardized scale for Aβ-PET quantification. METHODS Four centers contributed 179 participants encompassing a broad range of clinical diagnoses, PET data, and autopsy findings. RESULTS CL values increased with each CERAD neuritic plaque score increment (median -3 CL for no plaques and 92 CL for frequent plaques) and nonlinearly with Thal Aβ phases (increases were detected starting at phase 2) with overlap between scores/phases. PET-pathology associations were comparable across sites and unchanged when restricting the analyses to the 56 patients who died within 2 years of PET. A threshold of 12.2 CL detected CERAD moderate-to-frequent neuritic plaques (area under the curve = 0.910, sensitivity = 89.2%, specificity = 86.4%), whereas 24.4 CL identified intermediate-to-high AD neuropathological changes (area under the curve = 0.894, sensitivity = 84.1%, specificity = 87.9%). DISCUSSION Our study demonstrated the robustness of a multisite Centiloid [11C]PIB-PET study and established a range of pathology-based CL thresholds.
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Affiliation(s)
- Renaud La Joie
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
| | - Nagehan Ayakta
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Helen Wills Neuroscience Institute, University of California Berkeley, CA, USA
| | - William W Seeley
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Ewa Borys
- Department of Pathology, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Adam L Boxer
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA
| | - Vincent Doré
- Department of Molecular Imaging & Therapy, Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Lea T Grinberg
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Eric Huang
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Ji-Hye Hwang
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, PA, USA
| | - Clifford Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, CA, USA
| | - Lee-Way Jin
- Alzheimer's Disease Center, Department of Pathology, University of California Davis, CA, USA
| | - William E Klunk
- Department of Neurology, University of Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, PA, USA; Alzheimer's Disease Research Center, University of Pittsburgh, PA, USA
| | - Julia Kofler
- Department of Pathology, University of Pittsburgh, Pennsylvania, USA
| | - Orit H Lesman-Segev
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Samuel N Lockhart
- Helen Wills Neuroscience Institute, University of California Berkeley, CA, USA; Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Val J Lowe
- Department of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Colin L Masters
- The Florey Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Catriona L McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Australia
| | - Bruce L Miller
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Daniel Mungas
- Department of Neurology, University of California, Davis, CA, USA
| | - James P O'Neil
- Helen Wills Neuroscience Institute, University of California Berkeley, CA, USA; Biomedical Isotope Facility, MBIB Division, Lawrence Berkeley National Laboratory, CA, USA
| | - John M Olichney
- Department of Neurology, University of California, Davis, CA, USA
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Howard J Rosen
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christopher C Rowe
- Department of Molecular Imaging & Therapy, Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Salvatore Spina
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Victor L Villemagne
- Department of Molecular Imaging & Therapy, Centre for PET, Austin Health, Heidelberg, Victoria, Australia; The Florey Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Gil D Rabinovici
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Helen Wills Neuroscience Institute, University of California Berkeley, CA, USA
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Sakr FA, Grothe MJ, Cavedo E, Jelistratova I, Habert MO, Dyrba M, Gonzalez-Escamilla G, Bertin H, Locatelli M, Lehericy S, Teipel S, Dubois B, Hampel H. Applicability of in vivo staging of regional amyloid burden in a cognitively normal cohort with subjective memory complaints: the INSIGHT-preAD study. ALZHEIMERS RESEARCH & THERAPY 2019; 11:15. [PMID: 30704537 PMCID: PMC6357385 DOI: 10.1186/s13195-019-0466-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 01/07/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Current methods of amyloid PET interpretation based on the binary classification of global amyloid signal fail to identify early phases of amyloid deposition. A recent analysis of 18F-florbetapir PET data from the Alzheimer's disease Neuroimaging Initiative cohort suggested a hierarchical four-stage model of regional amyloid deposition that resembles neuropathologic estimates and can be used to stage an individual's amyloid burden in vivo. Here, we evaluated the validity of this in vivo amyloid staging model in an independent cohort of older people with subjective memory complaints (SMC). We further examined its potential association with subtle cognitive impairments in this population at elevated risk for Alzheimer's disease (AD). METHODS The monocentric INSIGHT-preAD cohort includes 318 cognitively intact older individuals with SMC. All individuals underwent 18F-florbetapir PET scanning and extensive neuropsychological testing. We projected the regional amyloid uptake signal into the previously proposed hierarchical staging model of in vivo amyloid progression. We determined the adherence to this model across all cases and tested the association between increasing in vivo amyloid stage and cognitive performance using ANCOVA models. RESULTS In total, 156 participants (49%) showed evidence of regional amyloid deposition, and all but 2 of these (99%) adhered to the hierarchical regional pattern implied by the in vivo amyloid progression model. According to a conventional binary classification based on global signal (SUVRCereb = 1.10), individuals in stages III and IV were classified as amyloid-positive (except one in stage III), but 99% of individuals in stage I and even 28% of individuals in stage II were classified as amyloid-negative. Neither in vivo amyloid stage nor conventional binary amyloid status was significantly associated with cognitive performance in this preclinical cohort. CONCLUSIONS The proposed hierarchical staging scheme of PET-evidenced amyloid deposition generalizes well to data from an independent cohort of older people at elevated risk for AD. Future studies will determine the prognostic value of the staging approach for predicting longitudinal cognitive decline in older individuals at increased risk for AD.
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Affiliation(s)
- Fatemah A Sakr
- Department of Psychosomatic Medicine, Clinical Dementia Research, Faculty of Medicine, Rostock University, Rostock, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.
| | - Michel J Grothe
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Enrica Cavedo
- AXA Research Fund and Sorbonne University Chair, Paris, France.,Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital, F-75013, Paris, France.,Brain and Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, F-75013, Paris, France.,Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, F-75013, Paris, France.,Qynapse, Paris, France
| | | | - Marie-Odile Habert
- Sorbonne University, UPMC University Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75013, Paris, France.,Multi-center Neuroimaging Platform.,Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, AP-HP, F-75013, Paris, France
| | - Martin Dyrba
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, University Medical Center of the Johannes-Gutenberg-University Mainz, Langenbeck str, 155131, Mainz, Germany
| | | | - Maxime Locatelli
- Sorbonne University, UPMC University Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75013, Paris, France.,Multi-center Neuroimaging Platform.,Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, AP-HP, F-75013, Paris, France
| | - Stephane Lehericy
- Brain and Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, F-75013, Paris, France.,Multi-center Neuroimaging Platform.,Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle Epiniere (ICM), Paris, France.,Department of Neuroradiology, Salpêtriere Hospital, Paris, France
| | - Stefan Teipel
- Department of Psychosomatic Medicine, Clinical Dementia Research, Faculty of Medicine, Rostock University, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Bruno Dubois
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital, F-75013, Paris, France.,Brain and Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, F-75013, Paris, France.,Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, F-75013, Paris, France
| | - Harald Hampel
- AXA Research Fund and Sorbonne University Chair, Paris, France.,Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital, F-75013, Paris, France.,Brain and Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, F-75013, Paris, France.,Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, F-75013, Paris, France
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Abstract
PURPOSE Longitudinal studies into the variability of F-Flutemetamol uptake are lacking. METHODS/PATIENTS Therefore, the current study examined change in F-Flutemetamol uptake in 19 nondemented older adults (65 to 82 y old) who were either cognitively intact or had Mild Cognitive Impairment (MCI) who were scanned twice across 3.6 years. RESULTS Baseline and follow-up composite SUVRs were significantly correlated (0.96, P<0.001). Significant increases in the composite SUVR from baseline to follow-up were observed (P=0.002). For the total sample, the average difference over this time period when using the composite SUVR was 6.8%. Similar results were seen in subsets of the total sample (MCI vs. cognitively intact, amyloid positive vs. negative). Finally, a Reliable Change Index that exceeded ±0.046 SUVR units would indicate a significant change of F-Flutemetamol. CONCLUSIONS The current results extend the limited literature on longitudinal variability of F-Flutemetamol uptake across 3.6 years, which should give clinicians and researchers more confidence in the stability of this amyloid imaging agent in longer therapeutic and prevention trials in cognitive decline in MCI and Alzheimer disease.
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Shaw LM, Arias J, Blennow K, Galasko D, Molinuevo JL, Salloway S, Schindler S, Carrillo MC, Hendrix JA, Ross A, Illes J, Ramus C, Fifer S. Appropriate use criteria for lumbar puncture and cerebrospinal fluid testing in the diagnosis of Alzheimer's disease. Alzheimers Dement 2018; 14:1505-1521. [PMID: 30316776 PMCID: PMC10013957 DOI: 10.1016/j.jalz.2018.07.220] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 07/31/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The Alzheimer's Association convened a multidisciplinary workgroup to develop appropriate use criteria to guide the safe and optimal use of the lumbar puncture procedure and cerebrospinal fluid (CSF) testing for Alzheimer's disease pathology detection in the diagnostic process. METHODS The workgroup, experienced in the ethical use of lumbar puncture and CSF analysis, developed key research questions to guide the systematic review of the evidence and developed clinical indications commonly encountered in clinical practice based on key patient groups in whom the use of lumbar puncture and CSF may be considered as part of the diagnostic process. Based on their expertise and interpretation of the evidence from systematic review, members rated each indication as appropriate or inappropriate. RESULTS The workgroup finalized 14 indications, rating 6 appropriate and 8 inappropriate. DISCUSSION In anticipation of the emergence of more reliable CSF analysis platforms, the manuscript offers important guidance to health-care practitioners and suggestions for implementation and future research.
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Affiliation(s)
- Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Jalayne Arias
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, University of Gothenberg, Molndal, Sweden
| | - Douglas Galasko
- Department of Neuroscience, University of California, San Diego, CA, USA
| | | | - Stephen Salloway
- Butler Hospital Memory and Aging Program, The Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA
| | | | | | | | - April Ross
- Alzheimer's Association, Chicago, IL, USA
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Lundeen TF, Seibyl JP, Covington MF, Eshghi N, Kuo PH. Signs and Artifacts in Amyloid PET. Radiographics 2018; 38:2123-2133. [DOI: 10.1148/rg.2018180160] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Tamara F. Lundeen
- From the Department of Medical Imaging, University of Arizona/Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5128 (T.F.L., N.E., P.H.K.); Institute for Neurodegenerative Disorders, New Haven, Conn (J.P.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.F.C.); and Departments of Medicine and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - John P. Seibyl
- From the Department of Medical Imaging, University of Arizona/Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5128 (T.F.L., N.E., P.H.K.); Institute for Neurodegenerative Disorders, New Haven, Conn (J.P.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.F.C.); and Departments of Medicine and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Matthew F. Covington
- From the Department of Medical Imaging, University of Arizona/Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5128 (T.F.L., N.E., P.H.K.); Institute for Neurodegenerative Disorders, New Haven, Conn (J.P.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.F.C.); and Departments of Medicine and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Naghmehossadat Eshghi
- From the Department of Medical Imaging, University of Arizona/Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5128 (T.F.L., N.E., P.H.K.); Institute for Neurodegenerative Disorders, New Haven, Conn (J.P.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.F.C.); and Departments of Medicine and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Phillip H. Kuo
- From the Department of Medical Imaging, University of Arizona/Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5128 (T.F.L., N.E., P.H.K.); Institute for Neurodegenerative Disorders, New Haven, Conn (J.P.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.F.C.); and Departments of Medicine and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
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Collij LE, Konijnenberg E, Reimand J, Kate MT, Braber AD, Lopes Alves I, Zwan M, Yaqub M, van Assema DME, Wink AM, Lammertsma AA, Scheltens P, Visser PJ, Barkhof F, van Berckel BNM. Assessing Amyloid Pathology in Cognitively Normal Subjects Using 18F-Flutemetamol PET: Comparing Visual Reads and Quantitative Methods. J Nucl Med 2018; 60:541-547. [PMID: 30315145 PMCID: PMC6448465 DOI: 10.2967/jnumed.118.211532] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/28/2018] [Indexed: 01/30/2023] Open
Abstract
Our objective was to determine the optimal approach for assessing amyloid disease in a cognitively normal elderly population. Methods: Dynamic 18F-flutemetamol PET scans were acquired using a coffee-break protocol (a 0- to 30-min scan and a 90- to 110-min scan) on 190 cognitively normal elderly individuals (mean age, 70.4 y; 60% female). Parametric images were generated from SUV ratio (SUVr) and nondisplaceable binding potential (BPND) methods, with cerebellar gray matter as a reference region, and were visually assessed by 3 trained readers. Interreader agreement was calculated using κ-statistics, and semiquantitative values were obtained. Global cutoffs were calculated for both SUVr and BPND using a receiver-operating-characteristic analysis and the Youden index. Visual assessment was related to semiquantitative classifications. Results: Interreader agreement in visual assessment was moderate for SUVr (κ = 0.57) and good for BPND images (κ = 0.77). There was discordance between readers for 35 cases (18%) using SUVr and for 15 cases (8%) using BPND, with 9 overlapping cases. For the total cohort, the mean (±SD) SUVr and BPND were 1.33 (±0.21) and 0.16 (±0.12), respectively. Most of the 35 cases (91%) for which SUVr image assessment was discordant between readers were classified as negative based on semiquantitative measurements. Conclusion: The use of parametric BPND images for visual assessment of 18F-flutemetamol in a population with low amyloid burden improves interreader agreement. Implementing semiquantification in addition to visual assessment of SUVr images can reduce false-positive classification in this population.
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Affiliation(s)
- Lyduine E Collij
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - Elles Konijnenberg
- Alzheimer Center and Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Juhan Reimand
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands.,Centre of Radiology, North Estonia Medical Centre, Tallinn, Estonia.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Mara Ten Kate
- Alzheimer Center and Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Anouk den Braber
- Alzheimer Center and Department of Neurology, VU Medical Center, Amsterdam, The Netherlands.,Department of Biological Psychology, VU Amsterdam, The Netherlands
| | - Isadora Lopes Alves
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - Marissa Zwan
- Alzheimer Center and Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - Daniëlle M E van Assema
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; and
| | - Alle Meije Wink
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center and Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands.,Institute of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Bart N M van Berckel
- Deptartment of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
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Thal DR, Beach TG, Zanette M, Lilja J, Heurling K, Chakrabarty A, Ismail A, Farrar G, Buckley C, Smith APL. Estimation of amyloid distribution by [ 18F]flutemetamol PET predicts the neuropathological phase of amyloid β-protein deposition. Acta Neuropathol 2018; 136:557-567. [PMID: 30123935 PMCID: PMC6132944 DOI: 10.1007/s00401-018-1897-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
The deposition of the amyloid β-protein (Aβ) in senile plaques is one of the histopathological hallmarks of Alzheimer's disease (AD). Aβ-plaques arise first in neocortical areas and, then, expand into further brain regions in a process described by 5 phases. Since it is possible to identify amyloid pathology with radioactive-labeled tracers by positron emission tomography (PET) the question arises whether it is possible to distinguish the neuropathological Aβ-phases with amyloid PET imaging. To address this question we reassessed 97 cases of the end-of-life study cohort of the phase 3 [18F]flutemetamol trial (ClinicalTrials.gov identifiers NCT01165554, and NCT02090855) by combining the standardized uptake value ratios (SUVRs) with pons as reference region for cortical and caudate nucleus-related [18F]flutemetamol-retention. We tested them for their prediction of the neuropathological pattern found at autopsy. By defining threshold levels for cortical and caudate nucleus SUVRs we could distinguish different levels of [18F]flutemetamol uptake termed PET-Aβ phase estimates. When comparing these PET-Aβ phase estimates with the neuropathological Aβ-phases we found that PET-Aβ phase estimate 0 corresponded with Aβ-phases 0-2, 1 with Aβ-phase 3, 2 with Aβ-phase 4, and 3 with Aβ-phase 5. Classification using the PET-Aβ phase estimates predicted the correct Aβ-phase in 72.16% of the cases studied here. Bootstrap analysis was used to confirm the robustness of the estimates around this association. When allowing a range of ± 1 phase for a given Aβ-phase correct classification was given in 96.91% of the cases. In doing so, we provide a novel method to convert SUVR-levels into PET-Aβ phase estimates that can be easily translated into neuropathological phases of Aβ-deposition. This method allows direct conclusions about the pathological distribution of amyloid plaques (Aβ-phases) in vivo. Accordingly, this method may be ideally suited to detect early preclinical AD-patients, to follow them with disease progression, and to provide a more precise prognosis for them based on the knowledge about the underlying pathological phase of the disease.
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49
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Ikonomovic MD, Fantoni ER, Farrar G, Salloway S. Infrequent false positive [ 18F]flutemetamol PET signal is resolved by combined histological assessment of neuritic and diffuse plaques. ALZHEIMERS RESEARCH & THERAPY 2018; 10:60. [PMID: 29935545 PMCID: PMC6015459 DOI: 10.1186/s13195-018-0387-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The performance of [18F]flutemetamol amyloid PET against histopathological standards of truth was the subject of our recent article in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring (2017;9:25–34). Main body This viewpoint article addresses infrequently observed discordance between visual [18F]flutemetamol PET image readings and histopathology based solely on neuritic plaque assessment by CERAD criteria, which is resolved by assessing both neuritic and diffuse plaques and/or brain atrophy. Conclusion [18F]flutemetamol PET signal corresponds predominantly to neuritic plaque pathology but is also influenced by the presence of diffuse plaques. This could allow for detection of diffuse amyloid deposits in the early stages of AD dementia, particularly in the striatum where diffuse amyloid is most commonly observed.
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Affiliation(s)
- Milos D Ikonomovic
- Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. .,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | | | - Stephen Salloway
- Director of Neurology and the Memory and Aging Program at Butler Hospital in Providence, Providence, RI, USA
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50
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Fantoni ER, Chalkidou A, O’ Brien JT, Farrar G, Hammers A. A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease. J Alzheimers Dis 2018; 63:783-796. [PMID: 29689725 PMCID: PMC5929301 DOI: 10.3233/jad-171093] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. OBJECTIVE To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. METHODS Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. RESULTS For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. CONCLUSIONS Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans.
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Affiliation(s)
| | - Anastasia Chalkidou
- King’s Technology Evaluation Centre (KiTEC), London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | | | | | - Alexander Hammers
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
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