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.
journal_name
Neurologyjournal_title
Neurologyauthors
Sánchez-Juan P,Ghosh PM,Hagen J,Gesierich B,Henry M,Grinberg LT,O'Neil JP,Janabi M,Huang EJ,Trojanowski JQ,Vinters HV,Gorno-Tempini M,Seeley WW,Boxer AL,Rosen HJ,Kramer JH,Miller BL,Jagust WJ,Rabinovici GDdoi
10.1212/WNL.0000000000000032subject
Has Abstractpub_date
2014-01-21 00:00:00pages
230-8issue
3eissn
0028-3878issn
1526-632Xpii
WNL.0000000000000032journal_volume
82pub_type
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