Amyloid-PET and 18 F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias
Gaël Chételat 1 , Javier Arbizu 2 , Henryk Barthel 3 , Valentina Garibotto 4 , Ian Law 5 , Silvia Morbelli 6 , Elsmarieke van de Giessen 7 , Federica Agosta 8 , Frederik Barkhof 9 , David J Brooks 10 , Maria C Carrillo 11 , Bruno Dubois 12 , Anders M Fjell 13 , Giovanni B Frisoni 14 , Oskar Hansson 15 , Karl Herholz 16 , Brian F Hutton 17 , Clifford R Jack Jr 18 , Adriaan A Lammertsma 19 , Susan M Landau 20 , Satoshi Minoshima 21 , Flavio Nobili 22 , Agneta Nordberg 23 , Rik Ossenkoppele 24 , Wim J G Oyen 25 , Daniela Perani 26 , Gil D Rabinovici 27 , Philip Scheltens 28 , Victor L Villemagne 29 , Henrik Zetterberg 30 , Alexander Drzezga 31
Various biomarkers are available to support the diagnosis of neurodegenerative diseases in clinical and research settings. Among the molecular imaging biomarkers, amyloid-PET, which assesses brain amyloid deposition, and 18F-fluorodeoxyglucose (18F-FDG) PET, which assesses glucose metabolism, provide valuable and complementary information.
However, uncertainty remains regarding the optimal timepoint, combination, and an order in which these PET biomarkers should be used in diagnostic evaluations because conclusive evidence is missing. Following an expert panel discussion, we reached an agreement on the specific use of the individual biomarkers, based on available evidence and clinical expertise.
We propose a diagnostic algorithm with optimal timepoints for these PET biomarkers, also taking into account evidence from other biomarkers, for early and differential diagnosis of neurodegenerative diseases that can lead to dementia.
We propose three main diagnostic pathways with distinct biomarker sequences, in which amyloid-PET and 18F-FDG-PET are placed at different positions in the order of diagnostic evaluations, depending on clinical presentation.
We hope that this algorithm can support diagnostic decision making in specialist clinical settings with access to these biomarkers and might stimulate further research towards optimal diagnostic strategies.
CITA DEL ARTÍCULO Lancet Neurol. 2020 Nov;19(11):951-962. doi: 10.1016/S1474-4422(20)30314-8