DOI: 10.1007/s00259-018-4039-7Pages: 1497-1508

Clinical utility of FDG-PET for the clinical diagnosis in MCI

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

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

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

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

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

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

7. Leipzig University Hospital, Department of Nuclear Medicine

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

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

10. German Center for Neurodegenerative Diseases (DZNE)

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

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

13. University Hospitals, Memory Clinic

14. University of Genoa and Polyclinic San Martino Hospital, Department of Neuroscience (DINOGMI)

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

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Abstract

Purpose

We aim to report the quality of accuracy studies investigating the utility of [18F]fluorodeoxyglucose (FDG)-PET in supporting the diagnosis of prodromal Alzheimer’s Disease (AD), frontotemporal lobar degeneration (FTLD) and prodromal dementia with Lewy bodies (DLB) in mild cognitive impairment (MCI) subjects, and the corresponding recommendations made by a panel of experts.

Methods

Seven panellist, four from the European Association of Nuclear Medicine, and three from the European Academy of Neurology, produced recommendations taking into consideration the incremental value of FDG-PET, as added on clinical-neuropsychological examination, to ascertain the aetiology of MCI (AD, FTLD or DLB). A literature search using harmonized population, intervention, comparison, and outcome (PICO) strings was performed, and an evidence assessment consistent with the European Federation of Neurological Societies guidance was provided. The consensual recommendation was achieved based on Delphi rounds.

Results

Fifty-four papers reported the comparison of interest. The selected papers allowed the identification of FDG patterns that characterized MCI due to AD, FTLD and DLB. While clinical outcome studies supporting the diagnosis of MCI due to AD showed varying accuracies (ranging from 58 to 100%) and varying areas under the receiver-operator characteristic curves (0.66 to 0.97), no respective data were identified for MCI due to FTLD or for MCI due to DLB. However, the high negative predictive value of FDG-PET and the existence of different disease-specific patterns of hypometabolism support the consensus recommendations for the clinical use of this imaging technique in MCI subjects.

Conclusions

FDG-PET has clinical utility on a fair level of evidence in detecting MCI due to AD. Although promising also in detecting MCI due to FTLD and MCI due to DLB, more research is needed to ultimately judge the clinical utility of FDG-PET in these entities.

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  • Accepted: Apr 19, 2018
  • Online: Apr 27, 2018

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