The need of standardization and of large clinical studies in an emerging indication of [18F]FDG PET: the autoimmune encephalitis
Morbelli S (1), Arbizu J (2), Booij J (3), Chen MK (4), Chetelat G (5,6,7,8), Cross DJ (9), Djekidel M (10,11), Drzezga A (12), Ekmekcioglu O (13), Garibotto V (14), Hesse S (15), Ishii K (16), Saraf LJ (17), Lammertsma AA (18), Law I (19), Mathews D (20), Minoshima S (9), Mosci K (21), Pagani M (22,23), Pappata S (24), Silverman DH (25), Signore A (26), Van De Giessen E (3), Villemagne V (27,28,29), Barthel H (15); European Association of Nuclear Medicine (EANM) and of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
(1) Nuclear Medicine, Department of Health Science (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132, Genoa, Italy. email@example.com.
(2) Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
(3) Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
(4) Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
(5) Inserm, U1077, Caen, France.
(6) Université de Caen Basse-Normandie, UMR-S1077, Caen, France.
(7) Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France.
(8) CHU de Caen, U1077, Caen, France.
(9) Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
(10) University of Michigan Ann Arbor , Hamden, Michigan, USA.
(11) QMC-Quality Medical Consulting , Hamden, Michigan, USA.
(12) Department of Nuclear Medicine, University of Cologne, Cologne, Germany.
(13) Department of Nuclear Medicine, Bagcilar Education and Research Hospital, Istanbul, Turkey.
(14) Department of Medical Imaging, Geneva University and Geneva University Hospitals, Geneva, Switzerland.
(15) Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.
(16) Department of Radiology, Faculty of Medicines, Kindai University, Osaka, Japan.
(17) Department of Radiology, Veterans Affairs Healthcare System, Greater Los Angeles, CA, USA.
(18) Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
(19) Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
(20) Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
(21) Departament of Nuclear Medicine, Hospital das Forças Armadas, Brasilia, Brazil.
(22) Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy.
(23) Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden.
(24) Institute of Biostructure and Bioimaging, CNR, Naples, Italy.
(25) Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA.
(26) Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, Rome, Italy.
(27) Department of Molecular Imaging, Austin Health, Melbourne, Australia.
(28) Department of Medicine, University of Melbourne, Melbourne, Australia.
(29) Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
Magazine: European Journal of Nuclear Medicine and Molecular Imaging
Date: Dec 6, 2016Nuclear Medicine [SP]
[18F]FDG PET is currently the most commonly used functional imaging method for the in vivo investigation of regional brain metabolism in clinical practice. PET/CT scanners are widely available in Europe, in the US, in Australia, and most of the rest of the world  and the clinical role of [18F]FDG brain PET can be regarded as established for a number of diagnostic challenges in Neurology and Psychiatry .
In particular, [18F]FDG PET plays a major role in the early and differential diagnosis of neurodegenerative dementias and Parkinsonian syndromes by showing disease-specific patterns of hypometabolism .
For a substantial period of time, however, the lack of standardisation in reading images and reporting results, as well as the lack of large studies in homogeneous patient cohorts, has delayed a wider routine clinical use of [18F]FDG PET .
This is particularly true in the field of inflammation/infection imaging despite initial attempts to standardize this methodology between the European Association of Nuclear Medicine (EANM) and the American Society of Nuclear medicine and Molecular Imaging (SNMMI) .
In the last decade, thanks to the synergistic efforts of the neuroimaging and neurological communities across different countries, larger data sets and functional imaging repositories have become available. This allowed for assessing the clinical value of [18F]FDG PET as well as that of other imaging biomarkers in the field of neurodegenerative diseases [6–8].
The added value of this large multi-center approach has gained attention in the US for PET imaging in other indications as well, for example, through the National Oncologic PET Registry (NOPR) and more recently the Imaging Dementia Evidence for Amyloid Scanning (IDEAS) clinical trials.
Similarly, software based semi-quantitative approaches have increasingly been used both in the context of published group analyses as well as in clinical practice, thus testifying that objective measures can be incorporated and added to the traditional analysis approach in nuclear medicine, i.e., visual reading [9–11].
Accordingly, the long and rough path needed to develop the proper methodologies for clinical validation of [18F]FDG PET in neurodegenerative diseases now allows for an accelerated process of understanding and validating new emerging indications of this functional imaging tool.
CITATION Eur J Nucl Med Mol Imaging. 2016 Dec 6
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