DOI: 10.1007/s00259-018-4035-yPages: 1509-1525

Clinical utility of FDG-PET for the differential diagnosis among the main forms of dementia

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

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

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

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

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

8. University of Copenhagen, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet

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

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

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

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

13. University Hospitals, Memory Clinic

Correspondence to:
Marina Boccardi
Tel: 0041.(0)22.3055764
Email: marina.boccardi@unige.ch

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Abstract

Aim

To assess the clinical utility of FDG-PET as a diagnostic aid for differentiating Alzheimer’s disease (AD; both typical and atypical forms), dementia with Lewy bodies (DLB), frontotemporal lobar degeneration (FTLD), vascular dementia (VaD) and non-degenerative pseudodementia.

Methods

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

Results

The level of empirical study evidence for the use of FDG-PET was considered good for the discrimination of DLB and AD; fair for discriminating FTLD from AD; poor for atypical AD; and lacking for discriminating DLB from FTLD, AD from VaD, and for pseudodementia. Delphi voting led to consensus in all scenarios within two iterations. Panellists supported the use of FDG-PET for all PICOs—including those where study evidence was poor or lacking—based on its negative predictive value and on the assistance it provides when typical patterns of hypometabolism for a given diagnosis are observed.

Conclusion

Although there is an overall lack of evidence on which to base strong recommendations, it was generally concluded that FDG-PET has a diagnostic role in all scenarios. Prospective studies targeting diagnostically uncertain patients for assessing the added value of FDG-PET would be highly desirable.

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  • Accepted: Apr 18, 2018
  • Online: May 7, 2018

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