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18F-florbetapir PET in patients with frontotemporal dementia and Alzheimer disease.
J Nucl Med 2015; 56(3):386-91JN

Abstract

Pathologic deposition of amyloid β (Aβ) protein is a key component in the pathogenesis of Alzheimer disease (AD) but not a feature of frontotemporal dementia (FTD). PET ligands for Aβ protein are increasingly used in diagnosis and research of dementia syndromes. Here, we report a PET study using (18)F-florbetapir in healthy controls and patients with AD and FTD.

METHODS

Ten healthy controls (mean age ± SD, 62.5 ± 5.2 y), 10 AD patients (mean age ± SD, 62.6 ± 4.5), and 8 FTD patients (mean age ± SD, 62.5 ± 9.6) were recruited to the study. All patients underwent detailed clinical and neuropsychologic assessment and T1-weighted MR imaging and were genotyped for apolipoprotein E status. All participants underwent dynamic (18)F-florbetapir PET on a high-resolution research tomograph, and FTD patients also underwent (18)F-FDG PET scans. Standardized uptake value ratios (SUVRs) were extracted for predefined gray and white matter regions of interest using cerebellar gray matter as a reference region. Static PET images were evaluated by trained raters masked to clinical status and regional analysis.

RESULTS

Total cortical gray matter (18)F-florbetapir uptake values were significantly higher in AD patients (median SUVR, 1.73) than FTD patients (SUVR, 1.13, P = 0.002) and controls (SUVR, 1.26, P = 0.04). (18)F-Florbetapir uptake was also higher in AD patients than FTD patients and controls in the frontal, parietal, occipital, and cingulate cortices and in the central subcortical regions. Only 1 FTD patient (homozygous for apolipoprotein E ε4) displayed high cortical (18)F-florbetapir retention, whereas (18)F-FDG PET demonstrated mesiofrontal hypometabolism consistent with the clinical diagnosis of FTD. Most visual raters classified 1 control (10%) and 8 AD (80%) and 2 FTD (25%) patients as amyloid-positive, whereas ratings were tied in another 2 FTD patients and 1 healthy control.

CONCLUSION

Cortical (18)F-florbetapir uptake is low in most FTD patients, providing good discrimination from AD. However, visual rating of FTD scans was challenging, with a higher rate of discordance between interpreters than in AD and control subjects.

Authors+Show Affiliations

Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Institute of Neuroscience and Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom Department of Older Peoples Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom Manchester Medical School, University of Manchester, Manchester, United Kingdom; and.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.Avid Radiopharmaceuticals, Philadelphia, Pennsylvania.Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom karl.herholz@manchester.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25655625

Citation

Kobylecki, Christopher, et al. "18F-florbetapir PET in Patients With Frontotemporal Dementia and Alzheimer Disease." Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, vol. 56, no. 3, 2015, pp. 386-91.
Kobylecki C, Langheinrich T, Hinz R, et al. 18F-florbetapir PET in patients with frontotemporal dementia and Alzheimer disease. J Nucl Med. 2015;56(3):386-91.
Kobylecki, C., Langheinrich, T., Hinz, R., Vardy, E. R., Brown, G., Martino, M. E., ... Herholz, K. (2015). 18F-florbetapir PET in patients with frontotemporal dementia and Alzheimer disease. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 56(3), pp. 386-91. doi:10.2967/jnumed.114.147454.
Kobylecki C, et al. 18F-florbetapir PET in Patients With Frontotemporal Dementia and Alzheimer Disease. J Nucl Med. 2015;56(3):386-91. PubMed PMID: 25655625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 18F-florbetapir PET in patients with frontotemporal dementia and Alzheimer disease. AU - Kobylecki,Christopher, AU - Langheinrich,Tobias, AU - Hinz,Rainer, AU - Vardy,Emma R L C, AU - Brown,Gavin, AU - Martino,María-Elena, AU - Haense,Cathleen, AU - Richardson,Anna M, AU - Gerhard,Alexander, AU - Anton-Rodriguez,Jose M, AU - Snowden,Julie S, AU - Neary,David, AU - Pontecorvo,Michael J, AU - Herholz,Karl, Y1 - 2015/02/05/ PY - 2015/2/7/entrez PY - 2015/2/7/pubmed PY - 2015/5/20/medline KW - Alzheimer’s disease KW - PET KW - amyloid KW - diagnosis KW - frontotemporal dementia SP - 386 EP - 91 JF - Journal of nuclear medicine : official publication, Society of Nuclear Medicine JO - J. Nucl. Med. VL - 56 IS - 3 N2 - UNLABELLED: Pathologic deposition of amyloid β (Aβ) protein is a key component in the pathogenesis of Alzheimer disease (AD) but not a feature of frontotemporal dementia (FTD). PET ligands for Aβ protein are increasingly used in diagnosis and research of dementia syndromes. Here, we report a PET study using (18)F-florbetapir in healthy controls and patients with AD and FTD. METHODS: Ten healthy controls (mean age ± SD, 62.5 ± 5.2 y), 10 AD patients (mean age ± SD, 62.6 ± 4.5), and 8 FTD patients (mean age ± SD, 62.5 ± 9.6) were recruited to the study. All patients underwent detailed clinical and neuropsychologic assessment and T1-weighted MR imaging and were genotyped for apolipoprotein E status. All participants underwent dynamic (18)F-florbetapir PET on a high-resolution research tomograph, and FTD patients also underwent (18)F-FDG PET scans. Standardized uptake value ratios (SUVRs) were extracted for predefined gray and white matter regions of interest using cerebellar gray matter as a reference region. Static PET images were evaluated by trained raters masked to clinical status and regional analysis. RESULTS: Total cortical gray matter (18)F-florbetapir uptake values were significantly higher in AD patients (median SUVR, 1.73) than FTD patients (SUVR, 1.13, P = 0.002) and controls (SUVR, 1.26, P = 0.04). (18)F-Florbetapir uptake was also higher in AD patients than FTD patients and controls in the frontal, parietal, occipital, and cingulate cortices and in the central subcortical regions. Only 1 FTD patient (homozygous for apolipoprotein E ε4) displayed high cortical (18)F-florbetapir retention, whereas (18)F-FDG PET demonstrated mesiofrontal hypometabolism consistent with the clinical diagnosis of FTD. Most visual raters classified 1 control (10%) and 8 AD (80%) and 2 FTD (25%) patients as amyloid-positive, whereas ratings were tied in another 2 FTD patients and 1 healthy control. CONCLUSION: Cortical (18)F-florbetapir uptake is low in most FTD patients, providing good discrimination from AD. However, visual rating of FTD scans was challenging, with a higher rate of discordance between interpreters than in AD and control subjects. SN - 1535-5667 UR - https://www.unboundmedicine.com/medline/citation/25655625/18F_florbetapir_PET_in_patients_with_frontotemporal_dementia_and_Alzheimer_disease_ L2 - http://jnm.snmjournals.org/cgi/pmidlookup?view=long&pmid=25655625 DB - PRIME DP - Unbound Medicine ER -