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Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer’s disease



To compare the incremental diagnostic value of amyloid-PET and CSF (Aβ42, tau, and phospho-tau) in AD diagnosis in patients with mild cognitive impairment (MCI) or mild dementia, in order to improve the definition of diagnostic algorithm.


Two independent dementia experts provided etiological diagnosis and relative diagnostic confidence in 71 patients on 3 rounds, based on (1) clinical, neuropsychological, and structural MRI information alone; (2) adding one biomarker (CSF amyloid and tau levels or amyloid-PET with a balanced randomized design); and (3) adding the other biomarker.


Among patients with a pre-biomarker diagnosis of AD, negative PET induced significantly more diagnostic changes than amyloid-negative CSF at both rounds 2 (CSF 67%, PET 100%, P = 0.028) and 3 (CSF 0%; PET 78%, P < 0.001); PET induced a diagnostic confidence increase significantly higher than CSF on both rounds 2 and 3.


Amyloid-PET should be prioritized over CSF biomarkers in the diagnostic workup of patients investigated for suspected AD, as it provides greater changes in diagnosis and diagnostic confidence.

Trial registration

EudraCT no.: 2014-005389-31

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Alzheimer’s disease


Mild cognitive impairment


Positron emission tomography


Cerebrospinal fluid


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The study (EudraCT no. 2014-005389-31) sponsor was the Hôpitaux Universitaires de Genève (HUG). The study was financially supported by Piramal Imaging (now Life Molecular Imaging) that provided 18F-florbetaben at no cost, by the EU-EFPIA Innovative Medicines Initiative 2 Joint Undertaking grant no. 115952 (AMYPAD) and by the Swiss National Science Foundation under grant SNF 320030_169876. Piramal Imaging had no role in the design and conduct of the study: collection, management, analysis, and interpretation of the data.


This study was supported by Hôpitaux Universitaires de Genève (HUG); Piramal Imaging [grant number 115952]; and the Swiss National Science Foundation [grant number SNF 320030_169876].

Author information

Authors and Affiliations



Study concept and design: Frisoni, Parapini.

Clinical consultant and data collection: Assal, Mendes, Picco, Nobili, Fattori, Salvadori, Costa, Tinazzi, Farotti, Moretti, E. Salvatore, M. Salvatore, Tarallo, Cotta Ramusino, Bacchin.

Amyloid PET scan reading: Morbelli, Bauckneht, Dottorini, Tranfaglia, Savelli, Cavaliere.

Statistical analysis and interpretation of data: Cotta Ramusino, Altomare, Garibotto, Boccardi, Frisoni.

Drafting of the manuscript: Cotta Ramusino, Altomare, Bacchin.

Critical revision of the manuscript for important intellectual continent: Garibotto, Dodich, Boccardi, Frisoni.

Obtained funding: Frisoni.

Study supervision: Cotta Ramusino, Frisoni.

Corresponding author

Correspondence to Matteo Cotta Ramusino.

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The authors declare that they have no conflict of interest.

Ethical approval and consent to participate

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee (ethics committee of the University of Geneva) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

All subjects participating in this study have signed an informed consent form.

Data policy

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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The manuscript has been seen and approved by all authors for submission to EJNMMI.

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Ramusino, M.C., Garibotto, V., Bacchin, R. et al. Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer’s disease. Eur J Nucl Med Mol Imaging 47, 270–280 (2020).

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  • Alzheimer’s disease
  • Mild cognitive impairment
  • Positron emission tomography
  • Cerebrospinal fluid
  • Incremental diagnostic value