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

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  • 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
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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 languageEnglish
JournalThe Lancet Neurology
Volume19
Issue number11
Pages (from-to)951-962
Number of pages12
ISSN1474-4422
DOIs
Publication statusPublished - Nov 2020

    Research areas

  • 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

ID: 62405062