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Kim SJ, Jang H, Yoo H, Na DL, Ham H, Kim HJ, Kim JP, Farrar G, Moon SH, Seo SW. Clinical and Pathological Validation of CT-Based Regional Harmonization Methods of Amyloid PET. Clin Nucl Med 2024; 49:1-8. [PMID: 38048354 DOI: 10.1097/rlu.0000000000004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE The CT-based regional direct comparison Centiloid (dcCL) method was developed to harmonize and quantify regional β-amyloid (Aβ) burden. In the present study, we aimed to investigate correlations between the CT-based regional dcCL scales and Aβ pathological burdens and to validate the clinical utility using thresholds derived from pathological assessment. PATIENTS AND METHODS We included a pathological cohort of 63 cases and a clinical cohort of 4062 participants, and obtained modified Consortium to Establish a Registry for Alzheimer's Disease criteria (mCERAD) scores by assessment of neuritic plaque burdens in multiple areas of each cortical region. PET and CT images were processed using the CT-based regional dcCL method to calculate scales in 6 distinct regions. RESULTS The CT-based regional dcCL scales were correlated with neuritic plaque burdens represented by mCERAD scores, globally and regionally ( r = 0.56~0.76). In addition, striatum dcCL scales reflected Aβ involvement in the striatum ( P < 0.001). The regional dcCL scales could predict significant Aβ deposition in specific brain regions with high accuracy: area under the receiver operating characteristic curve of 0.81-0.97 with an mCERAD cutoff of 1.5 and area under the receiver operating characteristic curve of 0.88-0.93 with an mCERAD cutoff of 0.5. When applying the dcCL thresholds of 1.5 mCERAD scores, the G(-)R(+) group showed lower performances in memory and global cognitive functions and had less hippocampal volume compared with the G(-)R(-) group ( P < 0.001). However, when applying the dcCL thresholds of 0.5 mCERAD scores, there were no differences in the global cognitive functions between the 2 groups. CONCLUSIONS The thresholds of regional dcCL scales derived from pathological assessments might provide clinicians with a better understanding of biomarker-guided diagnosis and distinguishable clinical phenotypes, which are particularly useful when harmonizing different PET ligands with only PET/CT.
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Affiliation(s)
| | | | - Heejin Yoo
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center
| | | | | | | | | | - Gill Farrar
- Pharmaceutical Diagnostics, GE Healthcare, Chalfont St Giles, United Kingdom
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Tian M, Zuo C, Civelek AC, Carrio I, Watanabe Y, Kang KW, Murakami K, Garibotto V, Prior JO, Barthel H, Guan Y, Lu J, Zhou R, Jin C, Wu S, Zhang X, Zhong Y, Zhang H. International Nuclear Medicine Consensus on the Clinical Use of Amyloid Positron Emission Tomography in Alzheimer's Disease. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:375-389. [PMID: 37589025 PMCID: PMC10425321 DOI: 10.1007/s43657-022-00068-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 08/18/2023]
Abstract
Alzheimer's disease (AD) is the main cause of dementia, with its diagnosis and management remaining challenging. Amyloid positron emission tomography (PET) has become increasingly important in medical practice for patients with AD. To integrate and update previous guidelines in the field, a task group of experts of several disciplines from multiple countries was assembled, and they revised and approved the content related to the application of amyloid PET in the medical settings of cognitively impaired individuals, focusing on clinical scenarios, patient preparation, administered activities, as well as image acquisition, processing, interpretation and reporting. In addition, expert opinions, practices, and protocols of prominent research institutions performing research on amyloid PET of dementia are integrated. With the increasing availability of amyloid PET imaging, a complete and standard pipeline for the entire examination process is essential for clinical practice. This international consensus and practice guideline will help to promote proper clinical use of amyloid PET imaging in patients with AD.
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Affiliation(s)
- Mei Tian
- PET Center, Huashan Hospital, Fudan University, Shanghai, 200235 China
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai, 200235 China
- National Center for Neurological Disorders and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Ali Cahid Civelek
- Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins Medicine, Baltimore, 21287 USA
| | - Ignasi Carrio
- Department of Nuclear Medicine, Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, 08025 Spain
| | - Yasuyoshi Watanabe
- Laboratory for Pathophysiological and Health Science, RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo 650-0047 Japan
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, 03080 Korea
| | - Koji Murakami
- Department of Radiology, Juntendo University Hospital, Tokyo, 113-8431 Japan
| | - Valentina Garibotto
- Diagnostic Department, University Hospitals of Geneva and NIMTlab, University of Geneva, Geneva, 1205 Switzerland
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, 1011 Switzerland
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Center, Leipzig, 04103 Germany
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, 200235 China
| | - Jiaying Lu
- PET Center, Huashan Hospital, Fudan University, Shanghai, 200235 China
| | - Rui Zhou
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Chentao Jin
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Shuang Wu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Xiaohui Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Yan Zhong
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Hong Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 China
- The College of Biomedical Engineering and Instrument Science of Zhejiang University, Hangzhou, 310007 China
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, 310007 China
| | - Molecular Imaging-Based Precision Medicine Task Group of A3 (China-Japan-Korea) Foresight Program
- PET Center, Huashan Hospital, Fudan University, Shanghai, 200235 China
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
- National Center for Neurological Disorders and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040 China
- Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins Medicine, Baltimore, 21287 USA
- Department of Nuclear Medicine, Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, 08025 Spain
- Laboratory for Pathophysiological and Health Science, RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo 650-0047 Japan
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, 03080 Korea
- Department of Radiology, Juntendo University Hospital, Tokyo, 113-8431 Japan
- Diagnostic Department, University Hospitals of Geneva and NIMTlab, University of Geneva, Geneva, 1205 Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, 1011 Switzerland
- Department of Nuclear Medicine, Leipzig University Medical Center, Leipzig, 04103 Germany
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 China
- The College of Biomedical Engineering and Instrument Science of Zhejiang University, Hangzhou, 310007 China
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, 310007 China
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3
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Kim BS, Jun S, Kim H. Cognitive Trajectories and Associated Biomarkers in Patients with Mild Cognitive Impairment. J Alzheimers Dis 2023; 92:803-814. [PMID: 36806501 DOI: 10.3233/jad-220326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND To diagnose mild cognitive impairment (MCI) patients at risk of progression to dementia is clinically important but challenging. OBJECTIVE We classified MCI patients based on cognitive trajectories and compared biomarkers among groups. METHODS This study analyzed amnestic MCI patients with at least three Clinical Dementia Rating (CDR) scores available over a minimum of 36 months from the Alzheimer's Disease Neuroimaging Initiative database. Patients were classified based on their progression using trajectory modeling with the CDR-sum of box scores. We compared clinical and neuroimaging biomarkers across groups. RESULTS Of 569 eligible MCI patients (age 72.7±7.4 years, women n = 223), three trajectory groups were identified: stable (58.2%), slow decliners (24.6%), and fast decliners (17.2%). In the fifth year after diagnosis, the CDR-sum of box scores increased by 1.2, 5.4, and 11.8 points for the stable, slow, and fast decliners, respectively. Biomarkers associated with cognitive decline were amyloid-β 42, total tau, and phosphorylated tau protein in cerebrospinal fluid, hippocampal volume, cortical metabolism, and amount of cortical and subcortical amyloid deposits. Cortical metabolism and the amount of amyloid deposits were associated with the rate of cognitive decline. CONCLUSION Data-driven trajectory analysis provides new insights into the various cognitive trajectories of MCI. Baseline brain metabolism, and the amount of cortical and subcortical amyloid burden can provide additional information on the rate of cognitive decline.
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Affiliation(s)
- Bum Soo Kim
- Department of Nuclear Medicine, Kosin University Gospel Hospital, University of Kosin College of Medicine, Busan, Republic of Korea
| | - Sungmin Jun
- Department of Nuclear Medicine, Kosin University Gospel Hospital, University of Kosin College of Medicine, Busan, Republic of Korea
| | - Heeyoung Kim
- Department of Nuclear Medicine, Kosin University Gospel Hospital, University of Kosin College of Medicine, Busan, Republic of Korea
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Hammers DB, Suhrie K, Dixon A, Gradwohl BD, Archibald ZG, King JB, Spencer RJ, Duff K, Hoffman JM. Relationship between a novel learning slope metric and Alzheimer's disease biomarkers. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:799-819. [PMID: 33952156 PMCID: PMC8568738 DOI: 10.1080/13825585.2021.1919984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/18/2021] [Indexed: 01/07/2023]
Abstract
The Learning Ratio (LR) is a novel learning score examining the proportion of information learned over successive learning trials relative to information available to be learned. Validation is warranted to understand LR's sensitivity to Alzheimer's disease (AD) pathology. One-hundred twenty-three participants across the AD continuum underwent memory assessment, quantitative brain imaging, and genetic analysis. LR scores were calculated from the HVLT-R, BVMT-R, RBANS List Learning, and RBANS Story Memory, and compared to total hippocampal volumes,18F-Flutemetamol composite SUVR uptake, and APOE ε4 status. Lower LR scores were consistently associated with smaller total hippocampal volumes, greater cerebral β-amyloid deposition, and APOE ε4 positivity. This LR score outperformed a traditional learning slope calculation in all analyses. LR is sensitive to AD pathology along the AD continuum - more so than a traditional raw learning score - and reducing the competition between the first trial and subsequent trials can better depict learning capacity.
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Affiliation(s)
- Dustin B. Hammers
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Kayla Suhrie
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Ava Dixon
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Brian D. Gradwohl
- Mercy Health Hauenstein Neurosciences, Mercy Health, Muskegon, MI, USA
| | - Zane G. Archibald
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jace B. King
- Utah Center for Advanced Imaging Research, Department of Radiology & Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, USA
| | - Robert J. Spencer
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor MI, USA
- Michigan Medicine, Department of Psychiatry, Neuropsychology Section, Ann Arbor MI, USA
| | - Kevin Duff
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - John M. Hoffman
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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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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Beach TG. A History of Senile Plaques: From Alzheimer to Amyloid Imaging. J Neuropathol Exp Neurol 2022; 81:387-413. [PMID: 35595841 DOI: 10.1093/jnen/nlac030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Senile plaques have been studied in postmortem brains for more than 120 years and the resultant knowledge has not only helped us understand the etiology and pathogenesis of Alzheimer disease (AD), but has also pointed to possible modes of prevention and treatment. Within the last 15 years, it has become possible to image plaques in living subjects. This is arguably the single greatest advance in AD research since the identification of the Aβ peptide as the major plaque constituent. The limitations and potentialities of amyloid imaging are still not completely clear but are perhaps best glimpsed through the perspective gained from the accumulated postmortem histological studies. The basic morphological classification of plaques into neuritic, cored and diffuse has been supplemented by sophisticated immunohistochemical and biochemical analyses and increasingly detailed mapping of plaque brain distribution. Changes in plaque classification and staging have in turn contributed to changes in the definition and diagnostic criteria for AD. All of this information continues to be tested by clinicopathological correlations and it is through the insights thereby gained that we will best be able to employ the powerful tool of amyloid imaging.
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Affiliation(s)
- Thomas G Beach
- From the Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
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7
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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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Kim JP, Chun MY, Kim SJ, Jang H, Kim HJ, Jeong JH, Na DL, Seo SW. Distinctive Temporal Trajectories of Alzheimer’s Disease Biomarkers According to Sex and APOE Genotype: Importance of Striatal Amyloid. Front Aging Neurosci 2022; 14:829202. [PMID: 35197846 PMCID: PMC8859452 DOI: 10.3389/fnagi.2022.829202] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/14/2022] [Indexed: 01/09/2023] Open
Abstract
PurposePreviously, sex and apolipoprotein E (APOE) genotype had distinct effects on the cognitive trajectory across the Alzheimer’s disease (AD) continuum. We therefore aimed to investigate whether these trajectory curves including β-amyloid (Aβ) accumulation in the cortex and striatum, and tau accumulation would differ according to sex and APOE genotype.MethodsWe obtained 534 subjects for 18F-florbetapir (AV45) PET analysis and 163 subjects for 18F-flortaucipir (AV1451) PET analysis from the Alzheimer’s Disease Neuroimaging Initiative database. For cortical Aβ, striatal Aβ, and tau SUVR, we fitted penalized splines to model the slopes of SUVR value as a non-linear function of baseline SUVR value. By integrating the fitted splines, we obtained the predicted SUVR curves as a function of time.ResultsThe time from initial SUVR to the cutoff values were 14.9 years for cortical Aβ, 18.2 years for striatal Aβ, and 22.7 years for tau. Although there was no difference in cortical Aβ accumulation rate between women and men, striatal Aβ accumulation was found to be faster in women than in men, and this temporal difference according to sex was more pronounced in tau accumulation. However, APOE ε4 carriers showed faster progression than non-carriers regardless of kinds of AD biomarkers’ trajectories.ConclusionOur temporal trajectory models illustrate that there is a distinct progression pattern of AD biomarkers depending on sex and APOE genotype. In this regard, our models will be able to contribute to designing personalized treatment and prevention strategies for AD in clinical practice.
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Affiliation(s)
- Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Center for Neuroimaging, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Min Young Chun
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo-Jong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Jee Hyang Jeong
- Departments of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
- Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, South Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
- *Correspondence: Sang Won Seo,
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Müller EG, Stokke C, Stokmo HL, Edwin TH, Knapskog AB, Revheim ME. Evaluation of semi-quantitative measures of 18F-flutemetamol PET for the clinical diagnosis of Alzheimer's disease. Quant Imaging Med Surg 2022; 12:493-509. [PMID: 34993096 DOI: 10.21037/qims-21-188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND 18F-flutemetamol positron emission tomography (PET) is used to assess cortical amyloid-β burden in patients with cognitive impairment to support a clinical diagnosis. Visual classification is the most widely used method in clinical practice although semi-quantification is beneficial to obtain an objective and continuous measure of the Aβ burden. The aims were: first to evaluate the correspondence between standardized uptake value ratios (SUVRs) from three different software, Centiloids and visual classification, second to estimate thresholds for supporting visual classification and last to assess differences in semi-quantitative measures between clinical diagnoses. METHODS This observational study included 195 patients with cognitive impairment who underwent 18F-flutemetamol PET. PET images were semi-quantified with SyngoVia, CortexID suite, and PMOD. Receiver operating characteristics curves were used to compare visual classification with composite SUVR normalized to pons (SUVRpons) and cerebellar cortex (SUVRcer), and Centiloids. We explored correlations and differences between semi-quantitative measures as well as differences in SUVR between two clinical diagnosis groups: Alzheimer's disease-group and non-Alzheimer's disease-group. RESULTS PET images from 191 patients were semi-quantified with SyngoVia and CortexID and 86 PET-magnetic resonance imaging pairs with PMOD. All receiver operating characteristics curves showed a high area under the curve (>0.98). Thresholds for a visually positive PET was for SUVRcer: 1.87 (SyngoVia) and 1.64 (CortexID) and for SUVRpons: 0.54 (SyngoVia) and 0.55 (CortexID). The threshold on the Centiloid scale was 39.6 Centiloids. All semi-quantitative measures showed a very high correlation between different software and normalization methods. Composite SUVRcer was significantly different between SyngoVia and PMOD, SyngoVia and CortexID but not between PMOD and CortexID. Composite SUVRpons were significantly different between all three software. There were significant differences in the mean rank of SUVRpons, SUVRcer, and Centiloid between Alzheimer's disease-group and non-Alzheimer's disease-group. CONCLUSIONS SUVR from different software performed equally well in discriminating visually positive and negative 18F-Flutemetamol PET images. Thresholds should be considered software-specific and cautiously be applied across software without preceding validation to categorize scans as positive or negative. SUVR and Centiloid may be used alongside a thorough clinical evaluation to support a clinical diagnosis.
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Affiliation(s)
- Ebba Gløersen Müller
- Division of Radiology and Nuclear Medicine, Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Caroline Stokke
- Division of Radiology and Nuclear Medicine, Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| | - Henning Langen Stokmo
- Division of Radiology and Nuclear Medicine, Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trine Holt Edwin
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, The memory clinic, Oslo University Hospital, Oslo, Norway
| | - Anne-Brita Knapskog
- Department of Geriatric Medicine, The memory clinic, Oslo University Hospital, Oslo, Norway
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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10
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Suhrie KR, Hammers DB, Porter SM, Dixon AM, King JB, Anderson JS, Duff K, Hoffman JM. Predicting biomarkers in intact older adults and those with amnestic Mild Cognitive Impairment, and mild Alzheimer's Disease using the Repeatable Battery for the Assessment of Neuropsychological Status. J Clin Exp Neuropsychol 2021; 43:861-878. [PMID: 35019815 DOI: 10.1080/13803395.2021.2023476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated, to varying degrees, with commonly used biomarkers of Alzheimer's disease (AD). Given the ease of RBANS administration as a screening tool for clinical trials and other applications, a better understanding of how RBANS performance is associated with presence of APOE ε4 allele[s], cerebral amyloid burden, and hippocampal volume is warranted. METHOD One hundred twenty-one older adults who were classified as intact, amnestic Mild Cognitive Impairment, or mild AD underwent cognitive assessment with the RBANS, genetic analysis, and quantitative brain imaging. APOE ε4 carrier status, 18F-Flutemetamol composite standardized uptake value ratio (SUVR), and hippocampal volume were each regressed on demographic variables and RBANS Total Scale score, Index scores, and subtest scores. RESULTS Lower RBANS Total Scale score or Delayed Memory Index (DMI) predicted the presence of APOE ε4 allele[s], higher cerebral amyloid burden, and lower hippocampal volumes. DMI was a slightly better predictor than Total Scale score for most AD biomarkers. No demographic variables consistently contributed to these models. CONCLUSIONS The RBANS - DMI in particular - is sensitive to AD pathology. As such, it could be used as a predictive tool, particularly in clinical drug trials to enrich samples prior to less accessible AD biomarker investigation.
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Affiliation(s)
- Kayla R Suhrie
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Dustin B Hammers
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Sariah M Porter
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Ava M Dixon
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Jace B King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jeffrey S Anderson
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Kevin Duff
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - John M Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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11
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Cook XAF, Pantaine LRE, Blakemore DC, Moses IB, Sach NW, Shavnya A, Willis MC. Base‐Activated Latent Heteroaromatic Sulfinates as Nucleophilic Coupling Partners in Palladium‐Catalyzed Cross‐Coupling Reactions. Angew Chem Int Ed Engl 2021. [DOI: 10.1002/ange.202109146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Xinlan A. F. Cook
- Department of Chemistry University of Oxford Chemistry Research Laboratory Mansfield Road Oxford OX1 3TA UK
| | - Loïc R. E. Pantaine
- Department of Chemistry University of Oxford Chemistry Research Laboratory Mansfield Road Oxford OX1 3TA UK
| | | | - Ian B. Moses
- Pharmaceutical sciences Pfizer Inc. Discovery Park, Ramsgate Road CT13 9ND UK
| | - Neal W. Sach
- Medicine Design, La Jolla Laboratories Pfizer Inc. 10777 Science Center Drive San Diego CA 92121 USA
| | - Andre Shavnya
- Medicine Design Pfizer Inc. Eastern Point Road Groton CT 06340 USA
| | - Michael C. Willis
- Department of Chemistry University of Oxford Chemistry Research Laboratory Mansfield Road Oxford OX1 3TA UK
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12
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Cook XAF, Pantaine LRE, Blakemore DC, Moses IB, Sach NW, Shavnya A, Willis MC. Base-Activated Latent Heteroaromatic Sulfinates as Nucleophilic Coupling Partners in Palladium-Catalyzed Cross-Coupling Reactions. Angew Chem Int Ed Engl 2021; 60:22461-22468. [PMID: 34342107 PMCID: PMC8518705 DOI: 10.1002/anie.202109146] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Indexed: 01/10/2023]
Abstract
Heteroaromatic sulfinates are effective nucleophilic reagents in Pd0 -catalyzed cross-coupling reactions with aryl halides. However, metal sulfinate salts can be challenging to purify, solubilize in reaction media, and are not tolerant to multi-step transformations. Here we introduce base-activated, latent sulfinate reagents: β-nitrile and β-ester sulfones. We show that under the cross-coupling conditions, these species generate the sulfinate salt in situ, which then undergo efficient palladium-catalyzed desulfinative cross-coupling with (hetero)aryl bromides to deliver a broad range of biaryls. These latent sulfinate reagents have proven to be stable through multi-step substrate elaboration, and amenable to scale-up.
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Affiliation(s)
- Xinlan A. F. Cook
- Department of ChemistryUniversity of OxfordChemistry Research LaboratoryMansfield RoadOxfordOX1 3TAUK
| | - Loïc R. E. Pantaine
- Department of ChemistryUniversity of OxfordChemistry Research LaboratoryMansfield RoadOxfordOX1 3TAUK
| | | | - Ian B. Moses
- Pharmaceutical sciencesPfizer Inc.Discovery Park, Ramsgate RoadCT13 9NDUK
| | - Neal W. Sach
- Medicine Design, La Jolla LaboratoriesPfizer Inc.10777 Science Center DriveSan DiegoCA92121USA
| | - Andre Shavnya
- Medicine DesignPfizer Inc.Eastern Point RoadGrotonCT06340USA
| | - Michael C. Willis
- Department of ChemistryUniversity of OxfordChemistry Research LaboratoryMansfield RoadOxfordOX1 3TAUK
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13
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Peira E, Grazzini M, Bauckneht M, Sensi F, Bosco P, Arnaldi D, Morbelli S, Chincarini A, Pardini M, Nobili F. Probing the Role of a Regional Quantitative Assessment of Amyloid PET. J Alzheimers Dis 2021; 80:383-396. [PMID: 33554908 DOI: 10.3233/jad-201156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In clinical practice, the amy-PET is globally inspected to provide a binary outcome, but the role of a regional assessment has not been fully investigated yet. OBJECTIVE To deepen the role of regional amyloid burden and its implication on clinical-neuropsychological features. MATERIALS Amy-PET and a complete neuropsychological assessment (Trail Making Test, Rey Auditory Verbal Learning Test, semantic verbal fluency, Symbol Digit, Stroop, visuoconstruction) were available in 109 patients with clinical suspicion of Alzheimer's disease. By averaging the standardized uptake value ratio and ELBA, a regional quantification was calculated for each scan. Patients were grouped according to their overall amyloid load: correlation maps, based on regional quantification, were calculated and compared. A regression analysis between neuropsychological assessment and the regional amyloid-β (Aβ) load was carried out. RESULTS Significant differences were observed between the correlation maps of patients at increasing levels of Aβ and the overall dataset. The Aβ uptake of the subcortical gray matter resulted not related to other brain regions independently of the global Aβ level. A significant association of semantic verbal fluency was observed with ratios of cortical and subcortical distribution of Aβ which represent a coarse measure of differences in regional distribution of Aβ. CONCLUSION Our observations confirmed the different susceptibility to Aβ accumulation among brain regions. The association between cognition and Aβ distribution deserves further investigations: it is possibly due to a direct local effect or it represents a proxy marker of a more aggressive disease subtype. Regional Aβ assessment represents an available resource on amy-PET scan with possibly clinical and prognostic implications.
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Affiliation(s)
- Enrico Peira
- INFN, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Grazzini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Dept. of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | | | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy.,Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Dept. of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy.,Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy.,Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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14
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Cho SH, Choe YS, Kim YJ, Kim HJ, Jang H, Kim Y, Kim SE, Kim SJ, Kim JP, Jung YH, Kim BC, Lockhart SN, Farrar G, Na DL, Moon SH, Seo SW. Head-to-Head Comparison of 18F-Florbetaben and 18F-Flutemetamol in the Cortical and Striatal Regions. J Alzheimers Dis 2021; 76:281-290. [PMID: 32474468 DOI: 10.3233/jad-200079] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND 18F-florbetaben (FBB) and 18F-flutemetamol (FMM) amyloid PET have been developed and approved for clinical use. It is important to understand the distinct features of these ligands to compare and correctly interpret the results of different amyloid PET studies. OBJECTIVE We performed a head-to-head comparison of FBB and FMM to compare with regard to imaging characteristics, including dynamic range of retention, and differences in quantitative measurements between the two ligands in cortical, striatal, and white matter (WM) regions. METHODS Paired FBB and FMM PET images were acquired in 107 participants. Correlations of FBB and FMM amyloid deposition in the cortex, striatum, and WM were investigated and compared in different reference regions (cerebellar gray matter (CG), whole cerebellum (WC), WC with brainstem (WC + B), and pons). RESULTS The cortical SUVR (R2 = 0.97) and striatal SUVR (R2 = 0.95) demonstrated an excellent linear correlation between FBB and FMM using a WC as reference region. There was no difference in the cortical SUVR ratio between the two ligands (p = 0.90), but the striatal SUVR ratio was higher in FMM than in FBB (p < 0.001). Also, the effect size of differences in striatal SUVR seemed to be higher with FMM (2.61) than with FBB (2.34). These trends were similarly observed according to four different reference regions (CG, WC, WC + B, and pons). CONCLUSION Our findings suggest that FMM might be better than FBB to detect amyloid burden in the striatum, although both ligands are comparable for imaging AD pathology in vivo.
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Affiliation(s)
- Soo Hyun Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 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, 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, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Si Eun Kim
- Departments of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Seung Joo Kim
- Department of Neurology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Young Hee Jung
- Department of Neurology, Myoungji Hospital, Hanyang University, Goyangsi, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Samuel N Lockhart
- Internal Medicine - Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - 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, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
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15
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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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16
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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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17
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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: 27] [Impact Index Per Article: 6.8] [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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18
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Hammers DB, Kucera A, Spencer RJ, Abildskov TJ, Archibald ZG, Hoffman JM, Wilde EA. Examining the Relationship between a Verbal Incidental Learning Measure from the WAIS-IV and Neuroimaging Biomarkers for Alzheimer's Pathology. Dev Neuropsychol 2020; 45:95-109. [PMID: 32374196 DOI: 10.1080/87565641.2020.1762602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Convergent validation of a verbal incidental learning (IL) task from the WAIS-IV using neuroimaging biomarkers is warranted to understand its sensitivity to Alzheimer's disease (AD) pathology. Fifty-five memory clinic patients aged 59 to 87 years received neuropsychological assessment, and measures of IL and quantitative brain imaging. Worse IL-Total Score and IL-Similarities performances were significantly associated with smaller hemispheric hippocampal volumes. IL measures were not significantly correlated with cerebral β-amyloid burden, though a trend was present and effect sizes were mild. These hippocampal volume results suggest that this IL task may be sensitive to AD pathology along the AD continuum.
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Affiliation(s)
- Dustin B Hammers
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Amanda Kucera
- University of Utah Health Care , Salt Lake City, UT, USA
| | - Robert J Spencer
- Mental Health Service, VA Ann Arbor Healthcare System , Ann Arbor, MI, USA
| | - Tracy J Abildskov
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Zane G Archibald
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah , Salt Lake City, UT, USA
| | - John M Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah , Salt Lake City, UT, USA
| | - Elizabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah , Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Medical Center , Salt Lake City, UT, USA
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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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20
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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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21
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Bădan MI, Bonci EA, Piciu D. A review on immunohistochemical and histopathologic validation in PET-CT findings with consideration to microRNAs. Med Pharm Rep 2019; 92:337-345. [PMID: 31750432 PMCID: PMC6853049 DOI: 10.15386/mpr-1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/20/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose This review provides an overview of some of the most recent clinical trials which investigated various types of cancer and other diseases, through the use of PET-CT imaging, highlighting the use of immunohistochemical stains or conventional histopathology for the validation or contradiction of their hypothesis. Furthermore, we investigate a potential new direction of research by analyzing the upcoming role of microRNAs in disease confirmation. Methods An extensive search of MEDLINE/PubMed and SCOPUS electronic databases was made, using the MeSH terms "positron emission tomography computed tomography" and "immunohistochemistry" as well as "SUV" and "immunohistochemistry", restricting the search by clinical trials and time period. Further searches were made for articles regarding Ki-67 and microRNAs in correlation with metabolic PET-CT uptake. Results Out of all 389 initial search results, 27 original articles were found relevant to the topic. Their contents were synthesized and discussed regarding the matter at hand. No relevant clinical trials involving microRNAs were found. Conclusions Immunohistochemical and histopathologic results remain widely used and indispensable in modern research, concerning PET-CT validation. Possible candidates for diagnosis confirmation, in future research, may reside in the further development of microRNAs.
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Affiliation(s)
- Marius-Ioan Bădan
- Department of Morphological Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Eduard-Alexandru Bonci
- Department of Morphological Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Piciu
- Department of Morphological Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Endocrinology and Nuclear Medicine, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
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22
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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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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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24
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Camacho V, Gómez-Grande A, Sopena P, García-Solís D, Gómez Río M, Lorenzo C, Rubí S, Arbizu J. Amyloid PET in neurodegenerative diseases with dementia. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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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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Cho SH, Shin JH, Jang H, Park S, Kim HJ, Kim SE, Kim SJ, Kim Y, Lee JS, Na DL, Lockhart SN, Rabinovici GD, Seong JK, Seo SW. Amyloid involvement in subcortical regions predicts cognitive decline. Eur J Nucl Med Mol Imaging 2018; 45:2368-2376. [PMID: 29980831 DOI: 10.1007/s00259-018-4081-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/25/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE We estimated whether amyloid involvement in subcortical regions may predict cognitive impairment, and established an amyloid staging scheme based on degree of subcortical amyloid involvement. METHODS Data from 240 cognitively normal older individuals, 393 participants with mild cognitive impairment, and 126 participants with Alzheimer disease were acquired at Alzheimer's Disease Neuroimaging Initiative sites. To assess subcortical involvement, we analyzed amyloid deposition in amygdala, putamen, and caudate nucleus. We staged participants into a 3-stage model based on cortical and subcortical amyloid involvement: 382 with no cortical or subcortical involvement as stage 0, 165 with cortical but no subcortical involvement as stage 1, and 203 with both cortical and subcortical involvement as stage 2. RESULTS Amyloid accumulation was first observed in cortical regions and spread down to the putamen, caudate nucleus, and amygdala. In longitudinal analysis, changes in MMSE, ADAS-cog 13, FDG PET SUVR, and hippocampal volumes were steepest in stage 2 followed by stage 1 then stage 0 (p value <0.001). Stage 2 showed steeper changes in MMSE score (β [SE] = -0.02 [0.004], p < 0.001), ADAS-cog 13 (0.05 [0.01], p < 0.001), FDG PET SUVR (-0.0008 [0.0003], p = 0.004), and hippocampal volumes (-4.46 [0.65], p < 0.001) compared to stage 1. CONCLUSIONS We demonstrated a downward spreading pattern of amyloid, suggesting that amyloid accumulates first in neocortex followed by subcortical structures. Furthermore, our new finding suggested that an amyloid staging scheme based on subcortical involvement might reveal how differential regional accumulation of amyloid affects cognitive decline through functional and structural changes of the brain.
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Affiliation(s)
- Soo Hyun Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Jeong-Hyeon Shin
- School of Biomedical Engineering, Korea University, Seoul, 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.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Seongbeom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South 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.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Si Eun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Seung Joo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Yeshin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Seoul, South 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.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Samuel N Lockhart
- Internal Medicine - Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea 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. .,Neuroscience Center, Samsung Medical Center, Seoul, South Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea. .,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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27
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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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28
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PET staging of amyloidosis using striatum. Alzheimers Dement 2018; 14:1281-1292. [PMID: 29792874 PMCID: PMC6219621 DOI: 10.1016/j.jalz.2018.04.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/06/2018] [Accepted: 04/09/2018] [Indexed: 01/13/2023]
Abstract
Introduction: Amyloid positron emission tomography (PET) data are commonly expressed as binary measures of cortical deposition. However, not all individuals with high cortical amyloid will experience rapid cognitive decline. Motivated by postmortem data, we evaluated a three-stage PET classification: low cortical; high cortical, low striatal; and high cortical, high striatal amyloid; hypothesizing this model could better reflect Alzheimer’s dementia progression than a model based only on cortical measures. Methods: We classified PET data from 1433 participants (646 normal, 574 mild cognitive impairment, and 213 AD), explored the successive involvement of cortex and striatum using 3-year follow-up PET data, and evaluated the associations between PET stages, hippocampal volumes, and cognition. Results: Follow-up data indicated that PET detects amyloid first in cortex and then in striatum. Our three-category staging including striatum better predicted hippocampal volumes and subsequent cognition than a three-category staging including only cortical amyloid. Discussion: PET can evaluate amyloid expansion from cortex to subcortex. Using striatal signal as a marker of advanced amyloidosis may increase predictive power in Alzheimer’s dementia research.
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29
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Camacho V, Gómez-Grande A, Sopena P, García-Solís D, Gómez Río M, Lorenzo C, Rubí S, Arbizu J. Amyloid PET in neurodegenerative diseases with dementia. Rev Esp Med Nucl Imagen Mol 2018; 37:397-406. [PMID: 29776894 DOI: 10.1016/j.remn.2018.03.004] [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: 02/21/2018] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative condition characterized by progressive cognitive decline and memory loss, and is the most common form of dementia. Amyloid plaques with neurofibrillary tangles are a neuropathological hallmark of AD that produces synaptic dysfunction and culminates later in neuronal loss. Amyloid PET is a useful, available and non-invasive technique that provides in vivo information about the cortical amyloid burden. In the latest revised criteria for the diagnosis of AD biomarkers were defined and integrated: pathological and diagnostic biomarkers (increased retention on fibrillar amyloid PET or decreased Aβ1-42 and increased T-Tau or P-Tau in CSF) and neurodegeneration or topographical biomarkers (temporoparietal hypometabolism on 18F-FDG PET and temporal atrophy on MRI). Recently specific recommendations have been created as a consensus statement on the appropriate use of the imaging biomarkers, including amyloid PET: early-onset cognitive impairment/dementia, atypical forms of AD, mild cognitive impairment with early age of onset, and to differentiate between AD and other neurodegenerative diseases that occur with dementia. Amyloid PET is also contributing to the development of new therapies for AD, as well as in research studies for the study of other neurodegenerative diseases that occur with dementia where the deposition of Aβ amyloid is involved in its pathogenesis. In this paper, we review some general concepts and study the use of amyloid PET in depth and its relationship with neurodegenerative diseases and other diagnostic techniques.
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Affiliation(s)
- V Camacho
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
| | - A Gómez-Grande
- Servicio de Medicina Nuclear, Hospital 12 de Octubre, Madrid, España
| | - P Sopena
- Servicio de Medicina Nuclear, Hospital Vithas-Nisa 9 de Octubre, Valencia, España; Servicio de Medicina Nuclear, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - D García-Solís
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Gómez Río
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (IBS), Granada, España
| | - C Lorenzo
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - S Rubí
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, España
| | - J Arbizu
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Grothe MJ, Barthel H, Sepulcre J, Dyrba M, Sabri O, Teipel SJ. In vivo staging of regional amyloid deposition. Neurology 2017; 89:2031-2038. [PMID: 29046362 PMCID: PMC5711511 DOI: 10.1212/wnl.0000000000004643] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/14/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To estimate a regional progression pattern of amyloid deposition from cross-sectional amyloid-sensitive PET data and evaluate its potential for in vivo staging of an individual's amyloid pathology. METHODS Multiregional analysis of florbetapir (18F-AV45)-PET data was used to determine individual amyloid distribution profiles in a sample of 667 participants from the Alzheimer's Disease Neuroimaging Initiative cohort, including cognitively normal older individuals (CN) as well as patients with mild cognitive impairment and Alzheimer disease (AD) dementia. The frequency of regional amyloid positivity across CN individuals was used to construct a 4-stage model of progressing amyloid pathology, and individual distribution profiles were used to evaluate the consistency of this hierarchical stage model across the full cohort. RESULTS According to a 4-stage model, amyloid deposition begins in temporobasal and frontomedial areas, and successively affects the remaining associative neocortex, primary sensory-motor areas and the medial temporal lobe, and finally the striatum. Amyloid deposition in these brain regions showed a highly consistent hierarchical nesting across participants, where only 2% exhibited distribution profiles that deviated from the staging scheme. The earliest in vivo amyloid stages were mostly missed by conventional dichotomous classification approaches based on global florbetapir-PET signal, but were associated with significantly reduced CSF Aβ42 levels. Advanced in vivo amyloid stages were most frequent in patients with AD and correlated with cognitive impairment in individuals without dementia. CONCLUSIONS The highly consistent regional hierarchy of PET-evidenced amyloid deposition across participants resembles neuropathologic observations and suggests a predictable regional sequence that may be used to stage an individual's progress of amyloid pathology in vivo.
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Affiliation(s)
- Michel J Grothe
- From the German Center for Neurodegenerative Diseases (DZNE) (M.J.G., M.D., S.J.T.), Rostock; Department of Nuclear Medicine (H.B., O.S.), University of Leipzig, Germany; Gordon Center for Medical Imaging (J.S.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (J.S.), Charlestown, MA; and Department of Psychosomatic Medicine (S.J.T.), University of Rostock, Germany.
| | - Henryk Barthel
- From the German Center for Neurodegenerative Diseases (DZNE) (M.J.G., M.D., S.J.T.), Rostock; Department of Nuclear Medicine (H.B., O.S.), University of Leipzig, Germany; Gordon Center for Medical Imaging (J.S.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (J.S.), Charlestown, MA; and Department of Psychosomatic Medicine (S.J.T.), University of Rostock, Germany
| | - Jorge Sepulcre
- From the German Center for Neurodegenerative Diseases (DZNE) (M.J.G., M.D., S.J.T.), Rostock; Department of Nuclear Medicine (H.B., O.S.), University of Leipzig, Germany; Gordon Center for Medical Imaging (J.S.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (J.S.), Charlestown, MA; and Department of Psychosomatic Medicine (S.J.T.), University of Rostock, Germany
| | - Martin Dyrba
- From the German Center for Neurodegenerative Diseases (DZNE) (M.J.G., M.D., S.J.T.), Rostock; Department of Nuclear Medicine (H.B., O.S.), University of Leipzig, Germany; Gordon Center for Medical Imaging (J.S.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (J.S.), Charlestown, MA; and Department of Psychosomatic Medicine (S.J.T.), University of Rostock, Germany
| | - Osama Sabri
- From the German Center for Neurodegenerative Diseases (DZNE) (M.J.G., M.D., S.J.T.), Rostock; Department of Nuclear Medicine (H.B., O.S.), University of Leipzig, Germany; Gordon Center for Medical Imaging (J.S.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (J.S.), Charlestown, MA; and Department of Psychosomatic Medicine (S.J.T.), University of Rostock, Germany
| | - Stefan J Teipel
- From the German Center for Neurodegenerative Diseases (DZNE) (M.J.G., M.D., S.J.T.), Rostock; Department of Nuclear Medicine (H.B., O.S.), University of Leipzig, Germany; Gordon Center for Medical Imaging (J.S.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (J.S.), Charlestown, MA; and Department of Psychosomatic Medicine (S.J.T.), University of Rostock, Germany
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31
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Abstract
Measures of the severity of cognitive impairment or parkinsonism are the usual endpoints in clinical trials for Alzheimer’s disease (AD) and Parkinson’s disease (PD), but are critically hampered by their lack of disease sensitivity and specificity. Due to the high failure rate of clinical trials, the rate of regulatory approval for efficacious new drugs has stagnated in the past few decades, with the gap between basic science discovery and clinical application metaphorically termed the “Valley of Death”. While the causes for this are probably multiple and complex, the usage of biomarkers as surrogate endpoints, particularly when they are molecularly-specific for the disease, has achieved some success in cancer trials, and it is likely that neurodegenerative disease trials would benefit from the same approach. As dementia and parkinsonism are not disease-specific clinical syndromes, both AD and PD trials have been flawed by reliance on clinical diagnosis and clinical endpoints. Clinical improvement has been a requirement for regulatory approval, but molecularly-specific biomarkers should improve both diagnostic accuracy and tracking of disease progression, allowing quicker screening of drug candidates. However, even when a molecularly-specific biomarker is found, such as amyloid imaging for AD, it may not reflect the entire extant molecular disease repertoire and may not serve equally well in the different roles of preclinical detection, diagnostic confirmation and surrogate endpoint, necessitating the usage of two, three or more biomarkers, deployed in series or in parallel.
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32
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Salloway S, Gamez JE, Singh U, Sadowsky CH, Villena T, Sabbagh MN, Beach TG, Duara R, Fleisher AS, Frey KA, Walker Z, Hunjan A, Escovar YM, Agronin ME, Ross J, Bozoki A, Akinola M, Shi J, Vandenberghe R, Ikonomovic MD, Sherwin PF, Farrar G, Smith APL, Buckley CJ, Thal DR, Zanette M, Curtis C. Performance of [ 18F]flutemetamol amyloid imaging against the neuritic plaque component of CERAD and the current (2012) NIA-AA recommendations for the neuropathologic diagnosis of Alzheimer's disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 9:25-34. [PMID: 28795133 PMCID: PMC5536824 DOI: 10.1016/j.dadm.2017.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Performance of the amyloid tracer [18F]flutemetamol was evaluated against three pathology standard of truth (SoT) measures including neuritic plaques (CERAD “original” and “modified” and the amyloid component of the 2012 NIA-AA guidelines). Methods After [18F]flutemetamol imaging, 106 end-of-life patients who died underwent postmortem brain examination for amyloid plaque load. Blinded positron emission tomography scan interpretations by five independent electronically trained readers were compared with pathology measures. Results By SoT, sensitivity and specificity of majority image interpretations were, respectively, 91.9% and 87.5% with “original CERAD,” 90.8% and 90.0% with “modified CERAD,” and 85.7% and 100% with the 2012 NIA-AA criteria. Discussion The high accuracy of either CERAD criteria suggests that [18F]flutemetamol predominantly reflects neuritic amyloid plaque density. However, the use of CERAD criteria as the SoT can result in some false-positive results because of the presence of diffuse plaques, which are accounted for when the positron emission tomography read is compared with the 2012 NIA-AA criteria. Determination of the accuracy of [18F]flutemetamol image read against Aβ at autopsy. High sensitivity and specificity to 3 neuropathologic criteria as Standards of Truth. Images are 100% specific when the SoT reflects both neuritic and diffuse plaques. This study has the largest autopsy validation cohort for Aβ PET tracers to date.
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Affiliation(s)
- Stephen Salloway
- Neurology and the Memory and Aging Program, Butler Hospital, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Neurology and Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - Carl H Sadowsky
- Division of Neurology, Nova SE University, Fort Lauderdale, FL, USA
| | | | - Marwan N Sabbagh
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Ranjan Duara
- Mount Sinai Medical Center, Wien Center for Alzheimer's Disease and Memory Disorders, Miami Beach, FL, USA
| | | | - Kirk A Frey
- Department of Radiology (Nuclear Medicine), University of Michigan, Ann Arbor, MI, USA
| | - Zuzana Walker
- Division of Psychiatry, University College London and North Essex Partnership University NHS Foundation Trust, London, UK
| | - Arvinder Hunjan
- Hertfordshire Partnership University NHS Foundation Trust, Essex, UK
| | | | - Marc E Agronin
- Mental Health and Clinical Research, Miami Jewish Health Systems, Miami, FL, USA.,University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joel Ross
- Memory Enhancement Center, Eatontown, NJ, USA
| | - Andrea Bozoki
- Department of Neurology, Cognitive and Geriatric Neurology Team, Michigan State University, East Lansing, MI, USA
| | | | - Jiong Shi
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Rik Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Gill Farrar
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, UK
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33
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Pereira JB, Westman E, Hansson O. Association between cerebrospinal fluid and plasma neurodegeneration biomarkers with brain atrophy in Alzheimer's disease. Neurobiol Aging 2017; 58:14-29. [PMID: 28692877 DOI: 10.1016/j.neurobiolaging.2017.06.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/20/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
The aggregation and deposition of amyloid-β (Aβ) peptides into plaques is an early event in Alzheimer's disease (AD), which is followed by different aspects of neurodegeneration that can be measured in the cerebrospinal fluid (CSF) or plasma using neurofilament light (NFL), neurogranin (Ng), total Tau (T-Tau), and phosphorylated tau (P-Tau) levels. The relationship between these biomarkers and regional brain atrophy across the different stages of AD remains largely unexplored. In this study, we assessed whether NFL, Ng, T-Tau, and P-Tau levels in CSF and NFL in plasma are associated with cortical thinning and subcortical volume loss in cognitively normal, mild cognitive impairment, and AD subjects with and without Aβ pathology. Our main findings showed that CSF NFL levels were associated with brain atrophy in all groups, but plasma NFL only correlated with atrophy in symptomatic cases. In contrast, Ng was associated with regional brain atrophy only in individuals with Aβ pathology. Altogether, our main findings suggest that Ng is strongly associated with Aβ pathology, whereas NFL is more unspecific.
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Affiliation(s)
- Joana B Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
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34
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Bao W, Jia H, Finnema S, Cai Z, Carson RE, Huang YH. PET Imaging for Early Detection of Alzheimer's Disease: From Pathologic to Physiologic Biomarkers. PET Clin 2017; 12:329-350. [PMID: 28576171 DOI: 10.1016/j.cpet.2017.03.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article describes the application of various PET imaging agents in the investigation and diagnosis of Alzheimer's disease (AD), including radiotracers for pathologic biomarkers of AD such as β-amyloid deposits and tau protein aggregates, and the neuroinflammation biomarker 18 kDa translocator protein, as well as physiologic biomarkers, such as cholinergic receptors, glucose metabolism, and the synaptic density biomarker synaptic vesicle glycoprotein 2A. Potential of these biomarkers for early AD diagnosis is also assessed.
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Affiliation(s)
- Weiqi Bao
- PET Center, Huanshan Hospital, Fudan University, No. 518, East Wuzhong Road, Xuhui District, Shanghai 200235, China
| | - Hongmei Jia
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, No. 19, Xinjiekouwai Street, Beijing 10075, China
| | - Sjoerd Finnema
- Department of Radiology and Biomedical Imaging, PET Center, Yale University School of Medicine, PO Box 208048, New Haven, CT 06520-8048, USA
| | - Zhengxin Cai
- Department of Radiology and Biomedical Imaging, PET Center, Yale University School of Medicine, PO Box 208048, New Haven, CT 06520-8048, USA
| | - Richard E Carson
- Department of Radiology and Biomedical Imaging, PET Center, Yale University School of Medicine, PO Box 208048, New Haven, CT 06520-8048, USA
| | - Yiyun Henry Huang
- Department of Radiology and Biomedical Imaging, PET Center, Yale University School of Medicine, PO Box 208048, New Haven, CT 06520-8048, USA.
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35
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Hammers DB, Atkinson TJ, Dalley BCA, Suhrie KR, Horn KP, Rasmussen KM, Beardmore BE, Burrell LD, Duff K, Hoffman JM. Amyloid Positivity Using [18F]Flutemetamol-PET and Cognitive Deficits in Nondemented Community-Dwelling Older Adults. Am J Alzheimers Dis Other Demen 2017; 32:320-328. [PMID: 28403622 DOI: 10.1177/1533317517698795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little research exists examining the relationship between beta-amyloid neuritic plaque density via [18F]flutemetamol binding and cognition; consequently, the purpose of the current study was to compare cognitive performances among individuals having either increased amyloid deposition (Flute+) or minimal amyloid deposition (Flute-). Twenty-seven nondemented community-dwelling adults over the age of 65 underwent [18F]flutemetamol amyloid-positron emission tomography imaging, along with cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and select behavioral measures. Analysis of variance was used to identify the differences among the cognitive and behavioral measures between Flute+/Flute- groups. Flute+ participants performed significantly worse than Flute- participants on RBANS indexes of immediate memory, language, delayed memory, and total scale score, but no significant group differences in the endorsed level of depression or subjective report of cognitive difficulties were observed. Although these results are preliminary, [18F]flutemetamol accurately tracks cognition in a nondemented elderly sample, which may allow for better prediction of cognitive decline in late life.
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Affiliation(s)
- Dustin B Hammers
- 1 Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - Taylor J Atkinson
- 1 Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - Bonnie C A Dalley
- 1 Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - Kayla R Suhrie
- 1 Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - Kevin P Horn
- 2 Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Kelli M Rasmussen
- 2 Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Britney E Beardmore
- 2 Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lance D Burrell
- 2 Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Kevin Duff
- 1 Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - John M Hoffman
- 2 Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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36
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Hammers DB, Kucera AM, Card SJ, Tolle KA, Atkinson TJ, Duff K, Spencer RJ. Validity of a verbal incidental learning measure from the WAIS-IV in older adults. APPLIED NEUROPSYCHOLOGY-ADULT 2017. [DOI: 10.1080/23279095.2017.1295968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | | | | | - Kevin Duff
- Neurology, University of Utah, Salt Lake City, Utah, USA
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Hammers DB, Atkinson TJ, Dalley BCA, Suhrie KR, Beardmore BE, Burrell LD, Horn KP, Rasmussen KM, Foster NL, Duff K, Hoffman JM. Relationship between 18F-Flutemetamol uptake and RBANS performance in non-demented community-dwelling older adults. Clin Neuropsychol 2017; 31:531-543. [PMID: 28077020 DOI: 10.1080/13854046.2016.1278039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been used extensively for clinical care and in research for patients with mild cognitive impairment and Alzheimer's disease (AD); however, relatively few studies have evaluated the relationship between RBANS performance and AD imaging biomarkers. The purpose of the current study was to evaluate the association between a relatively new amyloid positron emission tomography imaging biomarker and performance on the RBANS. METHODS Twenty-seven nondemented community-dwelling adults over the age of 65 underwent 18F-Flutemetamol amyloid- positron emission tomography imaging, along with cognitive testing using the RBANS and select behavioral measures. Partial correlation coefficients were used to identify relationships between the imaging and behavioral markers. RESULTS After controlling for age and education, amyloid deposition and RBANS Indexes of Immediate Memory, Delayed Memory, and Total Scale score were significantly correlated (p's < .001, r's = -.73 to -.77, d's = 2.13-2.39), with greater amyloid burden being associated with lower RBANS scores. The Delayed Memory Index was particularly highly associated with 18F-Flutemetamol binding (r2 = .59, p < .001, d = 2.39). Neither 18F-Flutemetamol binding nor RBANS performance was significantly correlated with levels of depression, subjective cognitive difficulties, or premorbid intellect. CONCLUSIONS Because of the limited use of amyloid imaging in clinical settings due to high cost and lack of reimbursement, these findings suggest that in particular RBANS Delayed Memory Index may be a cost-efficient tool to identify early signs of AD pathology, and its use may enlighten clinical decision-making regarding potential progression to dementia due to AD.
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Affiliation(s)
- Dustin B Hammers
- a Department of Neurology, Center for Alzheimer's Care, Imaging, and Research , University of Utah , Salt Lake City , UT , USA
| | - Taylor J Atkinson
- a Department of Neurology, Center for Alzheimer's Care, Imaging, and Research , University of Utah , Salt Lake City , UT , USA
| | - Bonnie C A Dalley
- a Department of Neurology, Center for Alzheimer's Care, Imaging, and Research , University of Utah , Salt Lake City , UT , USA
| | - Kayla R Suhrie
- a Department of Neurology, Center for Alzheimer's Care, Imaging, and Research , University of Utah , Salt Lake City , UT , USA
| | - Britney E Beardmore
- b Center for Quantitative Cancer Imaging, Huntsman Cancer Institute , University of Utah , Salt Lake City , UT , USA
| | - Lance D Burrell
- b Center for Quantitative Cancer Imaging, Huntsman Cancer Institute , University of Utah , Salt Lake City , UT , USA
| | - Kevin P Horn
- b Center for Quantitative Cancer Imaging, Huntsman Cancer Institute , University of Utah , Salt Lake City , UT , USA
| | - Kelli M Rasmussen
- b Center for Quantitative Cancer Imaging, Huntsman Cancer Institute , University of Utah , Salt Lake City , UT , USA
| | - Norman L Foster
- a Department of Neurology, Center for Alzheimer's Care, Imaging, and Research , University of Utah , Salt Lake City , UT , USA
| | - Kevin Duff
- a Department of Neurology, Center for Alzheimer's Care, Imaging, and Research , University of Utah , Salt Lake City , UT , USA
| | - John M Hoffman
- b Center for Quantitative Cancer Imaging, Huntsman Cancer Institute , University of Utah , Salt Lake City , UT , USA
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Ikonomovic MD, Buckley CJ, Heurling K, Sherwin P, Jones PA, Zanette M, Mathis CA, Klunk WE, Chakrabarty A, Ironside J, Ismail A, Smith C, Thal DR, Beach TG, Farrar G, Smith APL. Post-mortem histopathology underlying β-amyloid PET imaging following flutemetamol F 18 injection. Acta Neuropathol Commun 2016; 4:130. [PMID: 27955679 PMCID: PMC5154022 DOI: 10.1186/s40478-016-0399-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/29/2016] [Indexed: 01/19/2023] Open
Abstract
In vivo imaging of fibrillar β-amyloid deposits may assist clinical diagnosis of Alzheimer's disease (AD), aid treatment selection for patients, assist clinical trials of therapeutic drugs through subject selection, and be used as an outcome measure. A recent phase III trial of [18F]flutemetamol positron emission tomography (PET) imaging in 106 end-of-life subjects demonstrated the ability to identify fibrillar β-amyloid by comparing in vivo PET to post-mortem histopathology. Post-mortem analyses demonstrated a broad and continuous spectrum of β-amyloid pathology in AD and other dementing and non-dementing disease groups. The GE067-026 trial demonstrated 91% sensitivity and 90% specificity of [18F]flutemetamol PET by majority read for the presence of moderate or frequent plaques. The probability of an abnormal [18F]flutemetamol scan increased with neocortical plaque density and AD diagnosis. All dementia cases with non-AD neurodegenerative diseases and those without histopathological features of β-amyloid deposits were [18F]flutemetamol negative. Majority PET assessments accurately reflected the amyloid plaque burden in 90% of cases. However, ten cases demonstrated a mismatch between PET image interpretations and post-mortem findings. Although tracer retention was best associated with amyloid in neuritic plaques, amyloid in diffuse plaques and cerebral amyloid angiopathy best explain three [18F]flutemetamol positive cases with mismatched (sparse) neuritic plaque burden. Advanced cortical atrophy was associated with the seven false negative [18F]flutemetamol images. The interpretation of images from pathologically equivocal cases was associated with low reader confidence and inter-reader agreement. Our results support that amyloid in neuritic plaque burden is the primary form of β-amyloid pathology detectable with [18F]flutemetamol PET imaging. ClinicalTrials.gov NCT01165554. Registered June 21, 2010; NCT02090855. Registered March 11, 2014.
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Patterns of Cortical and Subcortical Amyloid Burden across Stages of Preclinical Alzheimer's Disease. J Int Neuropsychol Soc 2016; 22:978-990. [PMID: 27903335 PMCID: PMC5240733 DOI: 10.1017/s1355617716000928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We examined florbetapir positron emission tomography (PET) amyloid scans across stages of preclinical Alzheimer's disease (AD) in cortical, allocortical, and subcortical regions. Stages were characterized using empirically defined methods. METHODS A total of 312 cognitively normal Alzheimer's Disease Neuroimaging Initiative participants completed a neuropsychological assessment and florbetapir PET scan. Participants were classified into stages of preclinical AD using (1) a novel approach based on the number of abnormal biomarkers/cognitive markers each individual possessed, and (2) National Institute on Aging and the Alzheimer's Association (NIA-AA) criteria. Preclinical AD groups were compared to one another and to a mild cognitive impairment (MCI) sample on florbetapir standardized uptake value ratios (SUVRs) in cortical and allocortical/subcortical regions of interest (ROIs). RESULTS Amyloid deposition increased across stages of preclinical AD in all cortical ROIs, with SUVRs in the later stages reaching levels seen in MCI. Several subcortical areas showed a pattern of results similar to the cortical regions; however, SUVRs in the hippocampus, pallidum, and thalamus largely did not differ across stages of preclinical AD. CONCLUSIONS Substantial amyloid accumulation in cortical areas has already occurred before one meets criteria for a clinical diagnosis. Potential explanations for the unexpected pattern of results in some allocortical/subcortical ROIs include lack of correspondence between (1) cerebrospinal fluid and florbetapir PET measures of amyloid, or between (2) subcortical florbetapir PET SUVRs and underlying neuropathology. Findings support the utility of our novel method for staging preclinical AD. By combining imaging biomarkers with detailed cognitive assessment to better characterize preclinical AD, we can advance our understanding of who is at risk for future progression. (JINS, 2016, 22, 978-990).
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