Original article

European Journal of Nuclear Medicine

, Volume 21, Issue 10, pp 1052-1060

First online:

HMPAO SPET and FDG PET in Alzheimer's disease and vascular dementia: comparison of perfusion and metabolic pattern

  • Ruediger MielkeAffiliated withMax-Planck-Institut fur Neurologische ForschungUniversitätsklinik fur Neurologie
  • , Uwe PietrzykAffiliated withMax-Planck-Institut fur Neurologische Forschung
  • , Andreas JacobsAffiliated withUniversitätsklinik fur Neurologie
  • , Gereon R. FinkAffiliated withMax-Planck-Institut fur Neurologische Forschung
  • , Atsushi IchimiyaAffiliated withMax-Planck-Institut fur Neurologische Forschung
  • , Josef KesslerAffiliated withMax-Planck-Institut fur Neurologische ForschungUniversitätsklinik fur Neurologie
  • , Karl HerholzAffiliated withMax-Planck-Institut fur Neurologische ForschungUniversitätsklinik fur Neurologie
  • , Wolf D. HeissAffiliated withMax-Planck-Institut fur Neurologische ForschungUniversitätsklinik fur Neurologie

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Positron emission tomography (PET) of 18F-2-fluoro-2-shirlyD-glucose (FDG) and single-photon emission tomography (SPET) of 99mTc-hexamethyl-propylene amine oxime (HMPAO) were performed under identical resting conditions within 3 h in 20 patients with probable Alzheimer's disease (AD), 12 patients with vascular dementia (VD) and 13 normal persons. In the temporoparietal association cortex similar impairment of relative regional cerebral glucose metabolism (rCMRGI) and relative HMPAO uptake (rCBF) was found. In addition PET showed hypometabolism in the occipital association cortex. The functional pattern was condensed to a ratio of regional values of association areas divided by regional values of structures that are typically less affected by AD. In normals this ratio was significantly related to age for PET metabolic data (r = −0.66, P = 0.01). The ratio was significantly lower in AD than in VD and controls for both rCMRGI and rCBF. In AD only, the metabolic ratio was related to severity of dementia (r = 0.54, P = 0.003) and age (r = 0.64, P = 0.003). Metabolic differences between normals and AD patients were less obvious in old age. In contrast, there were no significant correlations between the perfusion ratio and severity of dementia or age. Comparing the metabolic and perfusion ratio by receiver operating characteristic curves, PET differentiated AD from normals only marginally better than SPET. Differentiation between AD and VD was much better achieved by PET. Our results suggest that both PET and SPET can distinguish AD patients from controls, whereas for differentiation between AD and VD SPET is of little value.

Key words

Hexamethylpropylene amine oxime singlephoton emission tomography Fluorodeoxyglucose positron emission tomography Diagnostic accuracy Alzheimer's disease Vascular dementia