¹⁸F-FDG Is a Superior Indicator of Cognitive Performance Compared to ¹⁸F-Florbetapir in Alzheimer’s Disease and Mild Cognitive Impairment Evaluation: A Global Quantitative Analysis

Article type: Research Article

Authors: Khosravi, Mohsen^a | Peter, Jonah^b | Wintering, Nancy A.^c | Serruya, Mijail^d | Shamchi, Sara Pourhassan^b | Werner, Thomas J.^b | Alavi, Abass^b | Newberg, Andrew B.^{a; c}

Affiliations: [a] Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA | [b] Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA | [c] Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA | [d] Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA

Correspondence: [*] Correspondence to: Abass Alavi, MD, Professor of Radiology and Neurology, Director of Research Education Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel.: +1 215 662 3069; Fax: +1 215 573 4107; E-mail: abass.alavi@uphs.upenn.edu.

Abstract: Background:18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 18F-florbetapir PET are approved neuroimaging biomarkers for the Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Objectives:This study aims to compare the efficacy of 18F-FDG and 18F-florbetapir PET at evaluating the cognitive performance of patients with AD, MCI, and normal controls (NC). Methods:63 subjects (36 male/27 female, mean age = 68.3) including 19 AD, 23 MCI, and 21 NC underwent 18F-FDG and 18F-florbetapir PET imaging. A global quantification approach was applied on supra-tentorial, frontal, parieto-occipital, temporal, and cerebellar brain regions by calculating the global SUVmean ratios (GSUVr) as the weighted average of all regional SUVmean. 18F-FDG and 18F-florbetapir GSUVr of each region were subsequently correlated with the Mini-Mental State Examination (MMSE). Results:Subjects were studied in five categories as NC, MCI patients, AD patients, MCI and AD patients grouped together (MCI/AD), and a group including all the subjects (NC/MCI/AD). Both 18F-FDG and 18F-florbetapir could successfully detect subjects with dementia (p < 0.001). Studied in all regions and groups, the correlation analysis of 18F-FDG GSUVr with MMSE scores was significant in more regions and groups compared to that of 18F-florbetapir. We also demonstrated that the correlation of 18F-FDG GSUVr with MMSE is stronger than that of 18F-florbetapir in the supra-tentorial and temporal regions. Conclusions:This study reveals how 18F-FDG-PET global quantification is a superior indicator of cognitive performance in AD and MCI patients compared to 18F-florbetapir PET. Accordingly, we still recommend 18F-FDG-PET over amyloid imaging in the evaluation for AD and MCI.

Keywords: Alzheimer’s disease, amyloid-β protein, ¹⁸F-FDG, florbetapir, mild cognitive impairment, Mini-Mental State Examination, positron emission tomography

DOI: 10.3233/JAD-190220

Journal: Journal of Alzheimer's Disease, vol. 70, no. 4, pp. 1197-1207, 2019