Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.
Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
Eur J Nucl Med Mol Imaging. 2017 Dec;44(13):2239-2248. doi: 10.1007/s00259-017-3832-z. Epub 2017 Sep 20.
In recent years, several [F]-labeled amyloid-PET tracers have been developed and have obtained clinical approval. Despite their widespread scientific use, studies in routine clinical settings are limited. We therefore investigated the impact of [F]-florbetaben (FBB)-PET on the diagnostic management of patients with suspected dementia that was still unclarified after [F]-fluordeoxyglucose (FDG)-PET.
All subjects were referred in-house with a suspected dementia syndrome due to neurodegenerative disease. After undergoing an FDG-PET exam, the cases were discussed by the interdisciplinary dementia board, where the most likely diagnosis as well as potential differential diagnoses were documented. Because of persistent diagnostic uncertainty, the patients received an additional FBB-PET exam. Results were interpreted visually and classified as amyloid-positive or amyloid-negative, and we then compared the individual clinical diagnoses before and after additional FBB-PET.
A total of 107 patients (mean age 69.4 ± 9.7y) were included in the study. The FBB-PET was rated as amyloid-positive in 65/107. In 83% of the formerly unclear cases, a final diagnosis was reached through FBB-PET, and the most likely prior diagnosis was changed in 28% of cases. The highest impact was observed for distinguishing Alzheimer's dementia (AD) from fronto-temporal dementia (FTLD), where FBB-PET altered the most likely diagnosis in 41% of cases.
FBB-PET has a high additive value in establishing a final diagnosis in suspected dementia cases when prior investigations such as FDG-PET are inconclusive. The differentiation between AD and FTLD was particularly facilitated by amyloid-PET, predicting a considerable impact on patient management, especially in the light of upcoming disease-modifying therapies.
近年来，已经开发出了几种[F]-标记的淀粉样蛋白-PET 示踪剂，并已获得临床批准。尽管它们在科学界得到了广泛应用，但在常规临床环境中的研究仍有限。因此，我们研究了[F]-florbetaben（FBB）-PET 对疑似痴呆患者的诊断管理的影响，这些患者在进行[F]-氟脱氧葡萄糖（FDG）-PET 后仍未得到明确诊断。
所有受试者均因神经退行性疾病而在内部被转诊为疑似痴呆综合征。在进行 FDG-PET 检查后，由跨学科痴呆委员会对病例进行讨论，记录最可能的诊断以及潜在的鉴别诊断。由于持续存在诊断不确定性，患者接受了额外的 FBB-PET 检查。结果通过视觉进行解释，并分为淀粉样蛋白阳性或阴性，然后我们比较了额外的 FBB-PET 前后的个体临床诊断。
共有 107 名患者（平均年龄 69.4±9.7 岁）纳入研究。107 例中有 65 例 FBB-PET 结果为淀粉样蛋白阳性。在 83%的以前不明确的病例中，通过 FBB-PET 得出了最终诊断，并且在 28%的病例中改变了最可能的先前诊断。区分阿尔茨海默病（AD）和额颞叶痴呆（FTLD）的影响最大，在 41%的病例中，FBB-PET 改变了最可能的诊断。
在疑似痴呆病例中，当先前的研究（如 FDG-PET）不确定时，FBB-PET 在确定最终诊断方面具有很高的附加价值。淀粉样蛋白-PET 特别有助于区分 AD 和 FTLD，这预示着对患者管理的重大影响，特别是考虑到即将出现的疾病修饰疗法。
