Head-to-Head Comparison of ¹⁸F-Florbetaben and ¹⁸F-Flutemetamol in the Cortical and Striatal Regions

Article type: Research Article

Authors: Cho, Soo Hyun^{a; b; 1} | Choe, Yeong Sim^{a; c; d; 1} | Kim, Young Ju^{a; d} | Kim, Hee Jin^{a; d} | Jang, Hyemin^{a; d} | Kim, Yeshin^e | Kim, Si Eun^f | Kim, Seung Joo^g | Kim, Jun Pyo^{a; d} | Jung, Young Hee^h | Kim, Byeong C.^b | Lockhart, Samuel N.ⁱ | Farrar, Gill^j | Na, Duk L.^{a; c; d; k} | Moon, Seung Hwan^{l; *} | Seo, Sang Won^{a; d; m; n; o; *}

Affiliations: [a] Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea | [b] Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea | [c] Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea | [d] Neuroscience Center, Samsung Medical Center, Seoul, Korea | [e] Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea | [f] Departments of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea | [g] Department of Neurology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea | [h] Department of Neurology, Myoungji Hospital, Hanyang University, Goyangsi, Korea | [i] Internal Medicine - Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA | [j] Pharmaceutical Diagnostics, GE Healthcare, Chalfont St Giles, UK | [k] Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea | [l] Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea | [m] Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea | [n] Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea | [o] Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea

Correspondence: [*] Correspondence to: Sang Won Seo, MD, PhD, Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. Tel.: +82 2 3410 1233; Fax: +82 2 3410 0052; E-mail: sangwonseo@empal.com; Seung Hwan Moon, MD, PhD, Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. Tel.: +82 2 3410 3114; Fax: +82 2 3410 6600; E-mail: shmoon0914@gmail.com.

Note: [1] These authors contributed equally to this work.

Abstract: Background:18F-florbetaben (FBB) and 18F-flutemetamol (FMM) amyloid PET have been developed and approved for clinical use. It is important to understand the distinct features of these ligands to compare and correctly interpret the results of different amyloid PET studies. Objective:We performed a head-to-head comparison of FBB and FMM to compare with regard to imaging characteristics, including dynamic range of retention, and differences in quantitative measurements between the two ligands in cortical, striatal, and white matter (WM) regions. Methods:Paired FBB and FMM PET images were acquired in 107 participants. Correlations of FBB and FMM amyloid deposition in the cortex, striatum, and WM were investigated and compared in different reference regions (cerebellar gray matter (CG), whole cerebellum (WC), WC with brainstem (WC + B), and pons). Results:The cortical SUVR (R2 = 0.97) and striatal SUVR (R2 = 0.95) demonstrated an excellent linear correlation between FBB and FMM using a WC as reference region. There was no difference in the cortical SUVR ratio between the two ligands (p = 0.90), but the striatal SUVR ratio was higher in FMM than in FBB (p < 0.001). Also, the effect size of differences in striatal SUVR seemed to be higher with FMM (2.61) than with FBB (2.34). These trends were similarly observed according to four different reference regions (CG, WC, WC + B, and pons). Conclusion:Our findings suggest that FMM might be better than FBB to detect amyloid burden in the striatum, although both ligands are comparable for imaging AD pathology in vivo.

Keywords: Alzheimer’s disease, amyloid imaging, ¹⁸F-florbetaben, ¹⁸F-flutemetamol, head to head

DOI: 10.3233/JAD-200079

Journal: Journal of Alzheimer's Disease, vol. 76, no. 1, pp. 281-290, 2020