Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-higashi, Kodaira, Tokyo, 187-8551, Japan.
Department of Biofunctional Imaging, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan.
Ann Nucl Med. 2022 Dec;36(12):1039-1049. doi: 10.1007/s12149-022-01792-y. Epub 2022 Oct 4.
Amyloid positron emission tomography (PET) can reliably detect senile plaques and fluorinated ligands are approved for clinical use. However, the clinical impact of amyloid PET imaging is still under investigation. The aim of this study was to evaluate the diagnostic impact and clinical utility in patient management of amyloid PET using F-florbetapir in patients with cognitive impairment and suspected Alzheimer's disease (AD). We also aimed to determine the cutoffs for amyloid positivity for quantitative measures by investigating the agreement between quantitative and visual assessments.
Ninety-nine patients suspected of having AD underwent F-florbetapir PET at five institutions. Site-specialized physicians provided a diagnosis of AD or non-AD with a percentage estimate of their confidence and their plan for patient management in terms of medication, prescription dosage, additional diagnostic tests, and care planning both before and after receiving the amyloid imaging results. A PET image for each patient was visually assessed and dichotomously rated as either amyloid-positive or amyloid-negative by four board-certified nuclear medicine physicians. The PET images were also quantitatively analyzed using the standardized uptake value ratio (SUVR) and Centiloid (CL) scale.
Visual interpretation obtained 48 positive and 51 negative PET scans. The amyloid PET results changed the AD and non-AD diagnosis in 39 of 99 patients (39.3%). The change rates of 26 of the 54 patients (48.1%) with a pre-scan AD diagnosis were significantly higher than those of 13 of the 45 patients with a pre-scan non-AD diagnosis (χ = 5.334, p = 0.0209). Amyloid PET results also resulted in at least one change to the patient management plan in 42 patients (42%), mainly medication (20 patients, 20%) and care planning (25 patients, 25%). Receiver-operating characteristic analysis determined the best agreement of the quantitative assessments and visual interpretation of PET scans to have an area under the curve of 0.993 at an SUVR of 1.19 and CL of 25.9.
Amyloid PET using F-florbetapir PET had a substantial clinical impact on AD and non-AD diagnosis and on patient management by enhancing diagnostic confidence. In addition, the quantitative measures may improve the visual interpretation of amyloid positivity.
淀粉样蛋白正电子发射断层扫描（PET）可可靠地检测出老年斑，并且氟代配体已获准用于临床。然而，淀粉样蛋白 PET 成像的临床影响仍在研究中。本研究旨在评估使用 F-氟比他滨对认知障碍和疑似阿尔茨海默病（AD）患者进行淀粉样蛋白 PET 的诊断影响和临床实用性。我们还旨在通过研究定量和视觉评估之间的一致性，确定定量测量的淀粉样蛋白阳性的截止值。
99 例疑似 AD 的患者在五家机构接受了 F-氟比他滨 PET 检查。专门的站点医生根据其置信度百分比提供了 AD 或非 AD 的诊断，并根据药物、处方剂量、其他诊断测试以及在获得淀粉样蛋白成像结果前后的护理计划，为患者管理制定了计划。对每位患者的 PET 图像进行视觉评估，并由四位具有核医学专业认证的医生将其分为淀粉样蛋白阳性或阴性。还使用标准化摄取值比（SUV）和百分位数（CL）量表对 PET 图像进行定量分析。
视觉解释获得了 48 例阳性和 51 例阴性 PET 扫描。99 例患者中的 39 例（39.3%）的淀粉样蛋白 PET 结果改变了 AD 和非 AD 的诊断。26 例（48.1%）预扫描 AD 诊断患者的改变率明显高于 13 例（48.1%）预扫描非 AD 诊断患者（χ=5.334，p=0.0209）。淀粉样蛋白 PET 结果还导致 42 例患者（42%）的患者管理计划至少发生一次变化，主要是药物（20 例，20%）和护理计划（25 例，25%）。接受者操作特征分析确定了定量评估和 PET 扫描的视觉解释之间的最佳一致性，在 SUVR 为 1.19 和 CL 为 25.9 时，曲线下面积为 0.993。
使用 F-氟比他滨 PET 的淀粉样蛋白 PET 对 AD 和非 AD 的诊断以及通过增强诊断信心对患者管理产生了重大的临床影响。此外，定量测量可能会改善淀粉样蛋白阳性的视觉解释。
