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Visual Versus Semi-Quantitative Analysis of 18F-FDG-PET in Amnestic MCI: An European Alzheimer's Disease Consortium (EADC) Project

Article type: Research Article

Authors: Morbelli, Silviaa | Brugnolo, Andreab | Bossert, Irenea | Buschiazzo, Ambraa | Frisoni, Giovanni B.c; d | Galluzzi, Samanthac | van Berckel, Bart N.M.e | Ossenkoppele, Rike | Perneczky, Robertf; g; h | Drzezga, Alexanderi; 1 | Didic, Miraj | Guedj, Erick | Sambuceti, Gianmarioa | Bottoni, Gianlucaa | Arnaldi, Dariob | Picco, Agneseb | De Carli, Fabriziol | Pagani, Marcom; n | Nobili, Flaviob; *

Affiliations: [a] Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino–IST, Genoa, Italy | [b] Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU San Martino–IST, Genoa, Italy | [c] LENITEM Laboratory of Epidemiology and Neuroimaging-IRCCS S. Giovanni di Dio-FBF, Brescia, Italy | [d] University Hospitals and University of Geneva, Geneva, Switzerland | [e] Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands | [f] Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology, and Medicine, London, UK | [g] West London Cognitive Disorders Treatment and Research Unit, London, UK | [h] Department of Psychiatry and Psychotherapy, Technische Universität, Munich, Germany | [i] Department of Nuclear Medicine, Technische Universität, Munich, Germany | [j] APHM, CHU Timone, Service de Neurologie et Neuropsychologie, Aix-Marseille University, INSERM U 1106, Marseille, France | [k] APHM, CHU Timone, Service de MédecineNucléaire; Aix-Marseille University, CERIMED, INT CNRS UMR7289, Marseille, France | [l] Institute of Bioimaging and Molecular Physiology, Consiglio Nazionale delle Ricerche (CNR), Genoa, Italy | [m] Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy | [n] Department of Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden

Correspondence: [*] Correspondence to: Flavio Nobili, MD, Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, IRCCS AOU San Martino-IST, Largo P. Daneo, 3, 16132 Genoa, Italy. Tel.: +390103537568; Fax: +390105556893; E-mail: flaviomariano.nobili@hsanmartino.it.

Note: [1] Current address: Department of Nuclear Medicine, University of Cologne, Cologne, Germany.

Keywords: Alzheimer's disease, amnestic mild cognitive impairment, FDG-PET, PALZ score, visual read

DOI: 10.3233/JAD-142229

Journal: Journal of Alzheimer's Disease, vol. 44, no. 3, pp. 815-826, 2015

Accepted 25 September 2014
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Published: 6 February 2015
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Abstract

We aimed to investigate the accuracy of FDG-PET to detect the Alzheimer's disease (AD) brain glucose hypometabolic pattern in 142 patients with amnestic mild cognitive impairment (aMCI) and 109 healthy controls. aMCI patients were followed for at least two years or until conversion to dementia. Images were evaluated by means of visual read by either moderately-skilled or expert readers, and by means of a summary metric of AD-like hypometabolism (PALZ score). Seventy-seven patients converted to AD-dementia after 28.6 ± 19.3 months of follow-up. Expert reading was the most accurate tool to detect these MCI converters from healthy controls (sensitivity 89.6%, specificity 89.0%, accuracy 89.2%) while two moderately-skilled readers were less (p < 0.05) specific (sensitivity 85.7%, specificity 79.8%, accuracy 82.3%) and PALZ score was less (p < 0.001) sensitive (sensitivity 62.3%, specificity 91.7%, accuracy 79.6%). Among the remaining 67 aMCI patients, 50 were confirmed as aMCI after an average of 42.3 months, 12 developed other dementia, and 3 reverted to normalcy. In 30/50 persistent MCI patients, the expert recognized the AD hypometabolic pattern. In 13/50 aMCI, both the expert and PALZ score were negative while in 7/50, only the PALZ score was positive due to sparse hypometabolic clusters mainly in frontal lobes. Visual FDG-PET reads by an expert is the most accurate method but an automated, validated system may be particularly helpful to moderately-skilled readers because of high specificity, and should be mandatory when even a moderately-skilled reader is unavailable.

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