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Clinical utility of FDG-PET in amyotrophic lateral sclerosis and Huntington’s disease

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aim

To evaluate the incremental value of FDG-PET over clinical tests in: (i) diagnosis of amyotrophic lateral sclerosis (ALS); (ii) picking early signs of neurodegeneration in patients with a genetic risk of Huntington’s disease (HD); and detecting metabolic changes related to cognitive impairment in (iii) ALS and (iv) HD patients.

Methods

Four comprehensive literature searches were conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted using the Delphi method on these four diagnostic scenarios.

Results

The availability of evidence was good for FDG-PET utility to support the diagnosis of ALS, poor for identifying presymptomatic subjects carrying HD mutation who will convert to HD, and lacking for identifying cognitive-related metabolic changes in both ALS and HD. After the Delphi consensual procedure, the panel did not support the clinical use of FDG-PET for any of the four scenarios.

Conclusion

Relative to other neurodegenerative diseases, the clinical use of FDG-PET in ALS and HD is still in its infancy. Once validated by disease-control studies, FDG-PET might represent a potentially useful biomarker for ALS diagnosis. FDG-PET is presently not justified as a routine investigation to predict conversion to HD, nor to detect evidence of brain dysfunction justifying cognitive decline in ALS and HD.

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Acknowledgements

We thank the Guidelines working group of EAN, particularly Simona Arcuti and Maurizio Leone, for methodological advice.

Funding

This project was partially funded by the European Association of Nuclear Medicine (EANM) and the European Academy of Neurology (EAN).

Author information

Authors and Affiliations

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

    Federica Agosta

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

    Daniele Altomare, Cristina Festari & Marina Boccardi

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

    Daniele Altomare & Cristina Festari

  4. Alzheimer Operative Unit, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy

    Stefania Orini & Federica Gandolfo

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

    Marina Boccardi

  6. Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain

    Javier Arbizu

  7. Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands

    Femke Bouwman

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

    Alexander Drzezga

  9. German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany

    Peter Nestor

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

    Peter Nestor

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

    Flavio Nobili

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

    Zuzana Walker

  13. Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy

    Marco Pagani

  14. Department of Nuclear Medicine, Karolinska Hospital Stockholm, Stockholm, Sweden

    Marco Pagani

Authors
  1. Federica Agosta
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  2. Daniele Altomare
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  3. Cristina Festari
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  4. Stefania Orini
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  5. Federica Gandolfo
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  6. Marina Boccardi
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  8. Femke Bouwman
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  9. Alexander Drzezga
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  10. Peter Nestor
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Consortia

for the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders

Corresponding authors

Correspondence to Federica Agosta or Marina Boccardi.

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Conflict of interest

Federica Agosta: is Section Editor of NeuroImage: Clinical and receives personal fees from Elsevier INC; has received speaker fees from Biogen Idec, Novartis, and Excellence in Medical Education; and receives or has received research supports from the Italian Ministry of Health, AriSLA (Fondazione Italiana di Ricerca per la SLA), and the European Research Council.

Daniele Altomare was the recipient of the grant allocated by the European Academy of Neurology (EAN) for data extraction and evidence assessment for the present project.

Cristina Festari: none.

Stefania Orini: none.

Federica Gandolfo: none.

Marina Boccardi: has received funds from the European Association of Nuclear Medicine (EANM) to perform the evidence assessment and the global coordination of the present project. Moreover, she has received research grants from Piramal and served as a paid member of advisory boards for Eli Lilly.

Javier Arbizu: received grants from Eli-Lilly & Co, Piramal and GE Healthcare.

Femke Bouwman: none.

Alexander Drzezga: received grants and non-financial support from Eli-Lilly & Co, Siemens and GE Healthcare; he also received non-financial support from Piramal.

Peter Nestor: none.

Flavio Nobili: received personal fees and non-financial support from GE Healthcare, non-financial support from Eli-Lilly and grants from Chiesi Farmaceutici.

Zuzana Walker: received from G.E. Healthcare grants and tracers, personal fees for consultancy and speakers fee.

Marco Pagani: none.

Ethical approval

This is a review article that does not contain any original study with human participants performed by any of the authors. Ethical approval is shown in each of the quoted original paper.

Informed consent

Not applicable, this is a review article. Informed consent statement is declared in each of the revised paper.

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Agosta, F., Altomare, D., Festari, C. et al. Clinical utility of FDG-PET in amyotrophic lateral sclerosis and Huntington’s disease. Eur J Nucl Med Mol Imaging 45, 1546–1556 (2018). https://doi.org/10.1007/s00259-018-4033-0

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