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An evidence based algorithm for the utility of FDG-PET for diagnosing Alzheimer’s disease according to presence of medial temporal lobe atrophy

Lookup NU author(s): Dr Michael FirbankORCiD, Dr James LloydORCiD, Professor David Williams, Dr Robert Barber, Dr Sean Colloby, Nicola Barnett, Kirsty OlsenORCiD, Dr Christopher Davison, Professor Cam Donaldson, Professor John O'Brien

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Abstract

Background Imaging biomarkers for Alzheimer’s disease include medial temporal lobe atrophy (MTLA) depicted on CT or MRI, and patterns of reduced metabolism on FDG-PET. Aims To investigate whether MTLA on head CT predicts the diagnostic usefulness of an additional FDG-PET scan. Methods Participants had a clinical diagnosis of Alzheimer’s disease (AD; n=37), 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. Results Using a pre-defined cutoff of MTLA >=5 on the Scheltens (0-8) scale, 0/30 controls, 6/30 DLB and 23/30 AD had marked MTLA. FDG-PET performed well for diagnosing AD vs DLB in the low MTLA group (sensitivity / specificity of 71%/79%), but in the high MTLA subjects, diagnostic performance of FDG-PET was not better than chance. Conclusions In the presence of a high degree of MTLA, the most likely diagnosis is AD, and an FDG-PET scan will probably not provide significant diagnostic information. However, in cases without MTL atrophy, if the diagnosis is unclear, an FDG-PET scan may provide additional clinically useful diagnostic information.

Publication metadata

Author(s): Firbank MJ, Lloyd JJ, Williams ED, Barber R, Colloby SJ, Barnett NA, Olsen K, Davison C, Donaldson C, Herholz K, O'Brien JT

Publication type: Article

Publication status: Published

Journal: British Journal of Psychiatry

Year: 2016

Volume: 208

Issue: 5

Pages: 491-496

Online publication date: 04/06/2015

Acceptance date: 07/12/2014

Date deposited: 07/01/2016

ISSN (print): 0007-1250

ISSN (electronic): 1472-1465

Publisher: Royal College of Psychiatrists

URL: http://dx.doi.org/10.1192/bjp.bp.114.160804

DOI: 10.1192/bjp.bp.114.160804

PubMed id: 26045347

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