TY - JOUR
T1 - An evidence-based algorithm for the utility of FDG-PET for diagnosing Alzheimer's disease according to presence of medial temporal lobe atrophy.
AU - Firbank, Michael J
AU - Lloyd, Jim
AU - Williams, David
AU - Barber, Robert
AU - Colloby, Sean J
AU - Barnett, Nicky
AU - Olsen, Kirsty
AU - Davison, Christopher
AU - Donaldson, Cam
AU - Herholz, Karl
AU - O'Brien, John T
PY - 2015/6/4
Y1 - 2015/6/4
N2 - BackgroundImaging biomarkers for Alzheimer's disease include medial temporal lobe atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose positron emission tomography (FDG-PET).AimsTo investigate whether MTLA on head CT predicts the diagnostic usefulness of an additional FDG-PET scan.MethodParticipants had a clinical diagnosis of Alzheimer's disease (n = 37) or dementia with Lewy bodies (DLB; n = 30) or were similarly aged controls (n = 30). We visually rated MTLA on coronally reconstructed CT scans and, separately and blind to CT ratings, abnormal appearances on FDG-PET scans.ResultsUsing a pre-defined cut-off of MTLA ≥5 on the Scheltens (0-8) scale, 0/30 controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET performed well for diagnosing Alzheimer's disease v. DLB in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the high-MTLA group diagnostic performance of FDG-PET was not better than chance.ConclusionsIn the presence of a high degree of MTLA, the most likely diagnosis is Alzheimer's disease, and an FDG-PET scan will probably not provide significant diagnostic information. However, in cases without MTLA, if the diagnosis is unclear, an FDG-PET scan may provide additional clinically useful diagnostic information.
AB - BackgroundImaging biomarkers for Alzheimer's disease include medial temporal lobe atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose positron emission tomography (FDG-PET).AimsTo investigate whether MTLA on head CT predicts the diagnostic usefulness of an additional FDG-PET scan.MethodParticipants had a clinical diagnosis of Alzheimer's disease (n = 37) or dementia with Lewy bodies (DLB; n = 30) or were similarly aged controls (n = 30). We visually rated MTLA on coronally reconstructed CT scans and, separately and blind to CT ratings, abnormal appearances on FDG-PET scans.ResultsUsing a pre-defined cut-off of MTLA ≥5 on the Scheltens (0-8) scale, 0/30 controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET performed well for diagnosing Alzheimer's disease v. DLB in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the high-MTLA group diagnostic performance of FDG-PET was not better than chance.ConclusionsIn the presence of a high degree of MTLA, the most likely diagnosis is Alzheimer's disease, and an FDG-PET scan will probably not provide significant diagnostic information. However, in cases without MTLA, if the diagnosis is unclear, an FDG-PET scan may provide additional clinically useful diagnostic information.
U2 - 10.1192/bjp.bp.114.160804
DO - 10.1192/bjp.bp.114.160804
M3 - Article
C2 - 26045347
SN - 1472-1465
JO - The British journal of psychiatry : the journal of mental science
JF - The British journal of psychiatry : the journal of mental science
ER -