Clinical utility of FDG-PET for the clinical diagnosis in MCI
Arbizu J (1), Festari C 2,3, Altomare D 2,3, Walker Z 4, Bouwman F 5, Rivolta J (2), Orini S (6), Barthel H (7), Agosta F (8), Drzezga A (9), Nestor P (10,11), Boccardi M (12,13), Frisoni GB (2,14,15), Nobili F (16); EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders.
(1) Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
(2) LANE - Laboratory of Alzheimer's Neuroimaging & Epidemiology, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
(3) Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
(4) Division of Psychiatry & Essex Partnership University NHS Foundation Trust, University College London, London, UK.
(5) Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.
(6) Alzheimer Operative Unit, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
(7) Department of Nuclear Medicine, Leipzig University Hospital, Leipzig, Germany.
(8) Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
(9) Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Cologne, Germany.
(10) German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.
(11) Queensland Brain Institute, University of Queensland and at the Mater Hospital Brisbane, Brisbane, Australia.
(12) LANE - Laboratory of Alzheimer's Neuroimaging & Epidemiology, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
(13) LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry, University of Geneva, Geneva, Switzerland.
(14) LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry, University of Geneva, Geneva, Switzerland.
(15) Memory Clinic, University Hospitals, Geneva, Switzerland.
(16) Department of Neuroscience (DINOGMI), University of Genoa and Polyclinic San Martino Hospital, Genoa, Italy.
We aim to report the quality of accuracy studies investigating the utility of [18F]fluorodeoxyglucose (FDG)-PET in supporting the diagnosis of prodromal Alzheimer's Disease (AD), frontotemporal lobar degeneration (FTLD) and prodromal dementia with Lewy bodies (DLB) in mild cognitive impairment (MCI) subjects, and the corresponding recommendations made by a panel of experts.
Seven panellist, four from the European Association of Nuclear Medicine, and three from the European Academy of Neurology, produced recommendations taking into consideration the incremental value of FDG-PET, as added on clinical-neuropsychological examination, to ascertain the aetiology of MCI (AD, FTLD or DLB).
A literature search using harmonized population, intervention, comparison, and outcome (PICO) strings was performed, and an evidence assessment consistent with the European Federation of Neurological Societies guidance was provided. The consensual recommendation was achieved based on Delphi rounds.
Fifty-four papers reported the comparison of interest. The selected papers allowed the identification of FDG patterns that characterized MCI due to AD, FTLD and DLB. While clinical outcome studies supporting the diagnosis of MCI due to AD showed varying accuracies (ranging from 58 to 100%) and varying areas under the receiver-operator characteristic curves (0.66 to 0.97), no respective data were identified for MCI due to FTLD or for MCI due to DLB.
However, the high negative predictive value of FDG-PET and the existence of different disease-specific patterns of hypometabolism support the consensus recommendations for the clinical use of this imaging technique in MCI subjects.
FDG-PET has clinical utility on a fair level of evidence in detecting MCI due to AD. Although promising also in detecting MCI due to FTLD and MCI due to DLB, more research is needed to ultimately judge the clinical utility of FDG-PET in these entities.
CITATION Eur J Nucl Med Mol Imaging. 2018 Apr 27. doi: 10.1007/s00259-018-4039-7