DOI: 10.1007/s00259-018-4032-1Pages: 1487-1496

Diagnostic utility of 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) in asymptomatic subjects at increased risk for Alzheimer’s disease

1. University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Department of Nuclear Medicine, University Hospital of Cologne

2. IRCCS S. Giovanni di Dio Fatebenefratelli, LANE – Laboratory of Alzheimer’s Neuroimaging & Epidemiology

3. University of Brescia, Department of Molecular and Translational Medicine

4. University of Navarra, Department of Nuclear Medicine, Clinica Universidad de Navarra

5. IRCCS S. Giovanni di Dio, Fatebenefratelli, Alzheimer Operative Unit

6. The University of Manchester, Institute of Brain, Behaviour and Mental Health, Wolfson Molecular Imaging Centre

7. German Center for Neurodegenerative Diseases (DZNE)

8. University of Queensland and at the Mater Hospital Brisbane, Queensland Brain Institute

9. Vita-Salute San Raffaele University, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute

10. VU University Medical Center, Department of Neurology & Alzheimer Center, Amsterdam Neuroscience

11. University of Genoa and Polyclinic IRCCS San Martino-IST, Department of Neuroscience (DINOGMI)

12. University College London, Division of Psychiatry & Essex Partnership University NHS Foundation Trust

13. University of Geneva, LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry

14. University Hospitals, Memory Clinic

Correspondence to:
Flavio Nobili
Tel: 0039.010.3537568
Email: flaviomariano.nobili@hsanmartino.it

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Abstract

Purpose

To assess the clinical utility of 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) for detection of early signs of neurodegeneration in conditions of increased risk for Alzheimer’s disease (AD) as defined by: subjective cognitive decline (SCD), evidence of cerebral amyloid-pathology, apolipoprotein E (APOE) ε4-positive genotype, or autosomal dominant forms of AD (ADAD) in asymptomatic stages.

Methods

A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted using the Delphi method on three different diagnostic scenarios.

Results

The level of empirical study evidence for the use of FDG-PET to detect meaningful early signs of neurodegeneration was considered to be poor for ADAD and lacking for SCD and asymptomatic persons at risk, based on APOE ε4-positive genotype or cerebral amyloid pathology. Consequently, and consistent with current diagnostic criteria, panelists decided not to recommend routine clinical use of FDG-PET in these situations and to currently mainly reserve it for research purposes.

Conclusion

Currently, there is limited evidence on which to base recommendations regarding the clinical routine use of FDG-PET to detect diagnostically meaningful early signs of neurodegeneration in asymptomatic subjects with ADAD, with APOE ε4-positive genotype, or with cerebral amyloid pathology, and in subjects with SCD. Future prospective studies are warranted and in part already ongoing, aiming to assess the added value of FDG-PET in this context beyond research applications.

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  • Accepted: Apr 16, 2018
  • Online: May 13, 2018

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