Clinical utility of FDG-PET for the differential diagnosis among the main forms of dementia
Nestor PJ (1), Altomare D (2,3), Festari C (2,3), Drzezga A (4), Rivolta J (2), Walker Z (5), Bouwman F (6), Orini S (7), Law I (8), Agosta F (9), Arbizu J (10), Boccardi M (11,12), Nobili F (13), Frisoni GB (2,14,15); EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders.
(1) Queensland Brain Institute, University of Queensland and at the Mater Hospital Brisbane, Brisbane, Australia.
(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) Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Cologne, Germany.
(5) Division of Psychiatry & Essex Partnership University NHS Foundation Trust, University College London, London, UK.
(6) Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.
(7) Alzheimer Operative Unit, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
(8) Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
(9) Neuroimaging Research Unit and Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
(10) Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
(11) LANE - Laboratory of Alzheimer's Neuroimaging & Epidemiology, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
(12) LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry, University of Geneva, Chemin du Petit-Bel-Air, 2, 1225, Chene-Bourg, Geneva, Switzerland.
(13) Department of Neuroscience (DINOGMI), University of Genoa and Polyclinic IRCCS San Martino-IST, Genoa, Italy.
(14) LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry, University of Geneva, Chemin du Petit-Bel-Air, 2, 1225, Chene-Bourg, Geneva, Switzerland.
(15) Memory Clinic, University Hospitals, Geneva, Switzerland.
To assess the clinical utility of FDG-PET as a diagnostic aid for differentiating Alzheimer's disease (AD; both typical and atypical forms), dementia with Lewy bodies (DLB), frontotemporal lobar degeneration (FTLD), vascular dementia (VaD) and non-degenerative pseudodementia.
A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted on six different diagnostic scenarios using the Delphi method.
The level of empirical study evidence for the use of FDG-PET was considered good for the discrimination of DLB and AD; fair for discriminating FTLD from AD; poor for atypical AD; and lacking for discriminating DLB from FTLD, AD from VaD, and for pseudodementia. Delphi voting led to consensus in all scenarios within two iterations.
Panellists supported the use of FDG-PET for all PICOs-including those where study evidence was poor or lacking-based on its negative predictive value and on the assistance it provides when typical patterns of hypometabolism for a given diagnosis are observed.
Although there is an overall lack of evidence on which to base strong recommendations, it was generally concluded that FDG-PET has a diagnostic role in all scenarios. Prospective studies targeting diagnostically uncertain patients for assessing the added value of FDG-PET would be highly desirable.
CITATION Eur J Nucl Med Mol Imaging. 2018 May 7. doi: 10.1007/s00259-018-4035-y