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

  • Review Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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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Acknowledgements

The procedure for assessing scientific evidence and defining consensual recommendations was funded by the EANM and by the EAN. We thank the Guidelines Working Group of the EAN, particularly Simona Arcuti and Maurizio Leone, for their 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. Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain

    Javier Arbizu

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

    Cristina Festari, Daniele Altomare, Jasmine Rivolta, Marina Boccardi & Giovanni Battista Frisoni

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

    Cristina Festari & Daniele Altomare

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

    Zuzana Walker

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

    Femke Bouwman

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

    Stefania Orini

  7. Department of Nuclear Medicine, Leipzig University Hospital, Leipzig, Germany

    Henryk Barthel

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

    Federica Agosta

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

    Alexander Drzezga

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

    Peter Nestor

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

    Peter Nestor

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

    Marina Boccardi & Giovanni Battista Frisoni

  13. Memory Clinic, University Hospitals, Geneva, Switzerland

    Giovanni Battista Frisoni

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

    Flavio Nobili

Authors
  1. Javier Arbizu
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  2. Cristina Festari
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  3. Daniele Altomare
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  4. Zuzana Walker
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  5. Femke Bouwman
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  6. Jasmine Rivolta
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  7. Stefania Orini
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  8. Henryk Barthel
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  9. Federica Agosta
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  10. Alexander Drzezga
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  11. Peter Nestor
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  12. Marina Boccardi
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  13. Giovanni Battista Frisoni
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  14. Flavio Nobili
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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 Javier Arbizu or Marina Boccardi.

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Conflict of interest

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

Cristina Festari: declares that she has no conflict of interest.

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.

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

Femke Bouwman: declares that she has no conflict of interest.

Jasmine Rivolta: declares that she has no conflict of interest.

Stefania Orini: declares that she has no conflict of interest.

Henrik Barthel: declares that he has no conflict of interest.

Federica Agosta: is Section Editor of NeuroImage: Clinical; 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. She received personal fees from Elsevier Inc.

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: received radiotracer from Piramal at a discounted rate as part of a research collaboration.

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.

Giovanni B Frisoni is principal investigator of industry-sponsored trials funded by AbbVie, Acadia, Altoida, Amoneta, Araclon, Biogen, Janssen, Novartis, Piramal; has received funding for investigator-initiated trials from GE, Piramal, and Avid-Lilly; and has received speaker fees from a number of pharma and imaging companies.

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

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 papers.

Informed consent

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

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Arbizu, J., Festari, C., Altomare, D. et al. Clinical utility of FDG-PET for the clinical diagnosis in MCI. Eur J Nucl Med Mol Imaging 45, 1497–1508 (2018). https://doi.org/10.1007/s00259-018-4039-7

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  • DOI: https://doi.org/10.1007/s00259-018-4039-7

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