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Evidence-based Interpretation of Amyloid-- PET Results: A Clinician-s... » Isaúde
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Alzheimer Disease and Associated Disorders
2018-01-01 06:00:00

Evidence-based Interpretation of Amyloid-- PET Results: A Clinician-s Tool

Descrição: Background: Amyloid-- positron emission tomography (PET) allows for in vivo detection of fibrillar amyloid plaques, a pathologic hallmark of Alzheimer-s disease (AD). However, amyloid-- PET interpretation is limited by the imperfect correlation between PET and autopsy, and the fact that it is positive in about 20% to 30% of cognitively normal individuals and non-AD dementias, especially when older or carrying the -4 allele of apolipoprotein E (ApoE4). When facing a positive amyloid PET, clinicians have to evaluate the probability of a pathologic false positive as well as the probability of amyloid positivity being age-related, comorbid to a primary non-AD dementia (clinicopathologic false positive). These probabilities can be calculated to reach an evidence-based interpretation of amyloid--. As literature review and calculations cannot be easily performed in the day-to-day clinic, we propose a clinician friendly, evidence-based Bayesian approach to the interpretation of amyloid-- PET results in the differential diagnosis of patients with cognitive impairment. Methods: We defined AD as a clinicopathologic entity in which amyloid-- is the primary cause of cognitive impairment. We systematically reviewed the literature to estimate the sensitivity and specificity of amyloid-- PET against neuropathologic examination. We inferred rates of clinicopathologic false positivity (non-AD dementia with comorbid amyloid) based on age-dependent and ApoE-dependent prevalence of amyloid positivity in normal individuals and AD patients provided in large meta-analyses published by the Amyloid Biomarker Study Group. We calculated positive predictive value (PPV) and negative predictive value (NPV) of amyloid-- PET, which are presented in a clinician-friendly table. Results: PPV of PET is highest in young ApoE4- patients with high pre-PET probability of AD. In older ApoE4+ patients with low pre-PET probability of AD, positive amyloid-- PET scans must be interpreted with caution. A negative amyloid-- PET makes a diagnosis of AD unlikely except in old patients with high pre-PET probability of AD. Conclusion: This evidence-based approach might provide guidance to clinicians and nuclear medicine physicians to interpret amyloid-- PET results for early and differential diagnosis of patients with progressive cognitive impairment.

Seção: Special Submision
Volume: 0
Autor: Ganguli, Mary; Albanese, Emiliano; Seshadri, Sudha; Bennett, David A.; Lyketsos, Constantine; Kukull, Walter A.; Skoog, Ingmar; Hendrie, Hugh C.

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