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Additive value of amyloid-PET in routine cases of clinical dementia work-up after FDG-PET

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In recent years, several [18F]-labeled amyloid-PET tracers have been developed and have obtained clinical approval. Despite their widespread scientific use, studies in routine clinical settings are limited. We therefore investigated the impact of [18F]-florbetaben (FBB)-PET on the diagnostic management of patients with suspected dementia that was still unclarified after [18F]-fluordeoxyglucose (FDG)-PET.

Methods

All subjects were referred in-house with a suspected dementia syndrome due to neurodegenerative disease. After undergoing an FDG-PET exam, the cases were discussed by the interdisciplinary dementia board, where the most likely diagnosis as well as potential differential diagnoses were documented. Because of persistent diagnostic uncertainty, the patients received an additional FBB-PET exam. Results were interpreted visually and classified as amyloid-positive or amyloid-negative, and we then compared the individual clinical diagnoses before and after additional FBB-PET.

Results

A total of 107 patients (mean age 69.4 ± 9.7y) were included in the study. The FBB-PET was rated as amyloid-positive in 65/107. In 83% of the formerly unclear cases, a final diagnosis was reached through FBB-PET, and the most likely prior diagnosis was changed in 28% of cases. The highest impact was observed for distinguishing Alzheimer’s dementia (AD) from fronto-temporal dementia (FTLD), where FBB-PET altered the most likely diagnosis in 41% of cases.

Conclusions

FBB-PET has a high additive value in establishing a final diagnosis in suspected dementia cases when prior investigations such as FDG-PET are inconclusive. The differentiation between AD and FTLD was particularly facilitated by amyloid-PET, predicting a considerable impact on patient management, especially in the light of upcoming disease-modifying therapies.

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Acknowledgements

Parts of this paper originated from the doctoral thesis of Jonas Schnabel and Eva Brendel. Florbetaben precursor was kindly provided by Piramal Imaging and partial financial support rested on philanthropic donations to the Department of Neurology (Adrian Danek). We note editing of the manuscript by Inglewood Biomedical Editing.

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Author notes

  1. Matthias Brendel and Jonas Schnabel contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

    Matthias Brendel, Jonas Schnabel, Leonie Wagner, Eva Brendel, Johanna Meyer-Wilmes, Marcus Unterrainer, Peter Bartenstein & Axel Rominger

  2. Department of Neurology, University Hospital, LMU Munich, Munich, Germany

    Sonja Schönecker, Catharina Prix, Nibal Ackl, Johannes Levin & Adrian Danek

  3. Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany

    Andreas Schildan, Marianne Patt, Henryk Barthel & Osama Sabri

  4. Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany

    Cihan Catak & Katharina Buerger

  5. Department of Psychiatry, University Hospital, LMU Munich, Munich, Germany

    Oliver Pogarell

  6. DZNE – German Center for Neurodegenerative Diseases, Munich, Germany

    Johannes Levin, Adrian Danek & Katharina Buerger

  7. Munich Cluster for Systems Neurology (SyNergy), Munich, Germany

    Peter Bartenstein & Axel Rominger

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  1. Matthias Brendel
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  2. Jonas Schnabel
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Corresponding author

Correspondence to Axel Rominger.

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Conflict of interest

MB, JS, SS, LW, EB, JMW, MU, AS, MP, CP, NA, CC, OP, JL, KB have nothing to disclose. AD received speaker honoraria from GE Healthcare. PB received speaker honoraria from Siemens and GE Healthcare. HB and OS received speaker honoraria and travel expenses from Piramal Imaging. AR received speaker honoraria from Piramal Imaging and GE Healthcare.

Ethical approval

All procedures described in the study were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Brendel, M., Schnabel, J., Schönecker, S. et al. Additive value of amyloid-PET in routine cases of clinical dementia work-up after FDG-PET. Eur J Nucl Med Mol Imaging 44, 2239–2248 (2017). https://doi.org/10.1007/s00259-017-3832-z

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  • DOI: https://doi.org/10.1007/s00259-017-3832-z

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