Pascual Sánchez-Juan1, Pia M Ghosh, Jayne Hagen, Benno Gesierich, Maya Henry, Lea T Grinberg, James P O'Neil, Mustafa Janabi, Eric J Huang, John Q Trojanowski, Harry V Vinters, Marilu Gorno-Tempini, William W Seeley, Adam L Boxer, Howard J Rosen, Joel H Kramer, Bruce L Miller, William J Jagust, Gil D Rabinovici. 1. From the Memory and Aging Center and Department of Neurology (P.S.-J., P.M.G., J.H., B.G., M.H., L.T.G., M.G.-T., W.W.S., A.L.B., H.J.R., J.H.K., B.L.M.,W.J.J., G.D.R.) and Department of Pathology and Laboratory Medicine (E.J.H.), University of California, San Francisco; University Hospital "Marqués de Valdecilla," IFIMAV and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.S.-J.), Santander, Spain; Helen Wills Neuroscience Institute (P.M.G., W.J.J., G.D.R.), University of California, Berkeley; Lawrence Berkeley National Laboratory (P.M.G., J.P.O., M.J., W.J.J., G.D.R.), Berkeley, CA; Center for Neurodegenerative Research (J.Q.T.), University of Pennsylvania, Philadelphia; and Department of Pathology and Laboratory Medicine (H.V.V.), University of California, Los Angeles.
Abstract
OBJECTIVE: To evaluate the effect of amyloid imaging on clinical decision making. METHODS: We conducted a retrospective analysis of 140 cognitively impaired patients (mean age 65.0 years, 46% primary β-amyloid (Aβ) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed for changes between the pre- and post-PET clinical diagnosis (from Aβ to non-Aβ diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ(2) and multivariate logistic regression. Postmortem diagnosis was available for 24 patients (17%). RESULTS: Concordance between scan results and baseline diagnosis was high (PiB 84%, FDG 82%). The primary diagnosis changed after PET in 13/140 patients (9%) overall but in 5/13 (38%) patients considered pre-PET diagnostic dilemmas. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (unadjusted p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (adjusted p = 0.00013). Changes in treatment were associated with discordant PiB in patients with non-Aβ diagnoses (adjusted p = 0.028), while FDG had no effect on therapy. Both PiB (96%) and FDG (91%) showed high agreement with autopsy diagnosis. CONCLUSIONS: PET had a moderate effect on clinical outcomes. Discordant PiB had a greater effect than discordant FDG, and influence on diagnosis was greater than on treatment. Prospective studies are needed to better characterize the clinical role of amyloid PET.
OBJECTIVE: To evaluate the effect of amyloid imaging on clinical decision making. METHODS: We conducted a retrospective analysis of 140 cognitively impairedpatients (mean age 65.0 years, 46% primary β-amyloid (Aβ) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed for changes between the pre- and post-PET clinical diagnosis (from Aβ to non-Aβ diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ(2) and multivariate logistic regression. Postmortem diagnosis was available for 24 patients (17%). RESULTS: Concordance between scan results and baseline diagnosis was high (PiB 84%, FDG 82%). The primary diagnosis changed after PET in 13/140 patients (9%) overall but in 5/13 (38%) patients considered pre-PET diagnostic dilemmas. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (unadjusted p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (adjusted p = 0.00013). Changes in treatment were associated with discordant PiB in patients with non-Aβ diagnoses (adjusted p = 0.028), while FDG had no effect on therapy. Both PiB (96%) and FDG (91%) showed high agreement with autopsy diagnosis. CONCLUSIONS: PET had a moderate effect on clinical outcomes. Discordant PiB had a greater effect than discordant FDG, and influence on diagnosis was greater than on treatment. Prospective studies are needed to better characterize the clinical role of amyloid PET.
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