Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias

Gaël Chételat; Javier Arbizu; Henryk Barthel; Valentina Garibotto; Ian Law; Silvia Morbelli; Elsmarieke van de Giessen; Federica Agosta; Frederik Barkhof; David J Brooks; Maria C Carrillo; Bruno Dubois; Anders M Fjell; Giovanni B Frisoni; Oskar Hansson; Karl Herholz; Brian F Hutton; Clifford R Jack; Adriaan A Lammertsma; Susan M Landau; Satoshi Minoshima; Flavio Nobili; Agneta Nordberg; Rik Ossenkoppele; Wim J G Oyen; Daniela Perani; Gil D Rabinovici; Philip Scheltens; Victor L Villemagne; Henrik Zetterberg; Alexander Drzezga

doi:10.1016/S1474-4422(20)30314-8

Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias

Gaël Chételat, Javier Arbizu, Henryk Barthel, Valentina Garibotto, Ian Law, Silvia Morbelli, Elsmarieke van de Giessen, Federica Agosta, Frederik Barkhof, David J Brooks, Maria C Carrillo, Bruno Dubois, Anders M Fjell, Giovanni B Frisoni, Oskar Hansson, Karl Herholz, Brian F Hutton, Clifford R Jack, Adriaan A Lammertsma, Susan M LandauSatoshi Minoshima, Flavio Nobili, Agneta Nordberg, Rik Ossenkoppele, Wim J G Oyen, Daniela Perani, Gil D Rabinovici, Philip Scheltens, Victor L Villemagne, Henrik Zetterberg, Alexander Drzezga

Department of Clinical Physiology, Nuclear Medicine & PET

Abstract

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.

Original language	English
Journal	The Lancet Neurology
Volume	19
Issue number	11
Pages (from-to)	951-962
Number of pages	12
ISSN	1474-4422
DOIs	https://doi.org/10.1016/S1474-4422(20)30314-8
Publication status	Published - Nov 2020

Keywords

Aged
Alzheimer Disease/diagnostic imaging
Amyloid beta-Protein Precursor/metabolism
Brain/diagnostic imaging
Dementia, Vascular/diagnostic imaging
Diagnosis, Differential
Fluorodeoxyglucose F18
Humans
Male
Positron-Emission Tomography/methods

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10.1016/S1474-4422(20)30314-8

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Chételat, G., Arbizu, J., Barthel, H., Garibotto, V., Law, I., Morbelli, S., van de Giessen, E., Agosta, F., Barkhof, F., Brooks, D. J., Carrillo, M. C., Dubois, B., Fjell, A. M., Frisoni, G. B., Hansson, O., Herholz, K., Hutton, B. F., Jack, C. R., Lammertsma, A. A., ... Drzezga, A. (2020). Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias. The Lancet Neurology, 19(11), 951-962. https://doi.org/10.1016/S1474-4422(20)30314-8

Chételat, G, Arbizu, J, Barthel, H, Garibotto, V, Law, I, Morbelli, S, van de Giessen, E, Agosta, F, Barkhof, F, Brooks, DJ, Carrillo, MC, Dubois, B, Fjell, AM, Frisoni, GB, Hansson, O, Herholz, K, Hutton, BF, Jack, CR, Lammertsma, AA, Landau, SM, Minoshima, S, Nobili, F, Nordberg, A, Ossenkoppele, R, Oyen, WJG, Perani, D, Rabinovici, GD, Scheltens, P, Villemagne, VL, Zetterberg, H & Drzezga, A 2020, 'Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias', The Lancet Neurology, vol. 19, no. 11, pp. 951-962. https://doi.org/10.1016/S1474-4422(20)30314-8

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title = "Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias",

abstract = "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.",

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author = "Ga{\"e}l Ch{\'e}telat and Javier Arbizu and Henryk Barthel and Valentina Garibotto and Ian Law and Silvia Morbelli and {van de Giessen}, Elsmarieke and Federica Agosta and Frederik Barkhof and Brooks, {David J} and Carrillo, {Maria C} and Bruno Dubois and Fjell, {Anders M} and Frisoni, {Giovanni B} and Oskar Hansson and Karl Herholz and Hutton, {Brian F} and Jack, {Clifford R} and Lammertsma, {Adriaan A} and Landau, {Susan M} and Satoshi Minoshima and Flavio Nobili and Agneta Nordberg and Rik Ossenkoppele and Oyen, {Wim J G} and Daniela Perani and Rabinovici, {Gil D} and Philip Scheltens and Villemagne, {Victor L} and Henrik Zetterberg and Alexander Drzezga",

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doi = "10.1016/S1474-4422(20)30314-8",

language = "English",

volume = "19",

pages = "951--962",

journal = "The Lancet Neurology",

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TY - JOUR

T1 - Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias

AU - Chételat, Gaël

AU - Arbizu, Javier

AU - Barthel, Henryk

AU - Garibotto, Valentina

AU - Law, Ian

AU - Morbelli, Silvia

AU - van de Giessen, Elsmarieke

AU - Agosta, Federica

AU - Barkhof, Frederik

AU - Brooks, David J

AU - Carrillo, Maria C

AU - Dubois, Bruno

AU - Fjell, Anders M

AU - Frisoni, Giovanni B

AU - Hansson, Oskar

AU - Herholz, Karl

AU - Hutton, Brian F

AU - Jack, Clifford R

AU - Lammertsma, Adriaan A

AU - Landau, Susan M

AU - Minoshima, Satoshi

AU - Nobili, Flavio

AU - Nordberg, Agneta

AU - Ossenkoppele, Rik

AU - Oyen, Wim J G

AU - Perani, Daniela

AU - Rabinovici, Gil D

AU - Scheltens, Philip

AU - Villemagne, Victor L

AU - Zetterberg, Henrik

AU - Drzezga, Alexander

PY - 2020/11

Y1 - 2020/11

N2 - 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.

AB - 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.

KW - Aged

KW - Alzheimer Disease/diagnostic imaging

KW - Amyloid beta-Protein Precursor/metabolism

KW - Brain/diagnostic imaging

KW - Dementia, Vascular/diagnostic imaging

KW - Diagnosis, Differential

KW - Fluorodeoxyglucose F18

KW - Humans

KW - Male

KW - Positron-Emission Tomography/methods

U2 - 10.1016/S1474-4422(20)30314-8

DO - 10.1016/S1474-4422(20)30314-8

M3 - Review

C2 - 33098804

SN - 1474-4422

VL - 19

SP - 951

EP - 962

JO - The Lancet Neurology

JF - The Lancet Neurology

IS - 11

ER -

Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias

Abstract

Keywords

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