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18F-florbetapir positron emission tomography in patients with frontotemporal dementia and Alzheimer's disease
Kobylecki, C; Langheinrich, T; Hinz, R; Vardy, E; Brown, G; Martino, M; Haense, C; Richardson, A; Gerhard, A; Anton-Rodriguez, J; Snowden, J; Neary, D; Pontecorvo, M; Herholz, K
J Nucl Med. 2015;.
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Abstract
Pathological deposition of amyloid beta (Abeta) protein is a key component in the pathogenesis of Alzheimer's disease (AD), but not a feature of frontotemporal dementia (FTD). PET ligands for Abeta protein are increasingly used in diagnosis and research of dementia syndromes. Here we report a PET study using 18F-florbetapir in healthy control subjects and patients with AD and FTD. METHODS: Ten healthy controls (mean age 62.5+/-5.2 years), 10 AD patients (mean age 62.6+/-4.5) and 8 FTD patients (mean age 62.5+/-9.6) were recruited to the study. All patients underwent detailed clinical and neuropsychological assessment, T1-weighted MR, and were genotyped for apolipoprotein E (APOE) status. All participants underwent dynamic 18F-florbetapir PET on a high-resolution research tomograph, and FTD patients also underwent FDG PET scans. Standardised uptake value ratios (SUVRs) were extracted for predefined grey and white matter regions of interest using cerebellar grey matter as reference region. Static PET images were evaluated by trained raters blinded to clinical status and regional analysis. RESULTS: Total cortical grey matter florbetapir uptake values were significantly higher in AD (median SUVR 1.73) compared to FTD patients (1.13, P = 0.002) and controls (1.26, P = 0.04). Florbetapir uptake was also higher in AD compared to FTD and controls in frontal, parietal, occipital and cingulate cortex as well as central subcortical regions. Only one FTD patient (homozygous for APOE 4) displayed high cortical florbetapir retention, while FDG PET demonstrated mesiofrontal hypometabolism consistent with the clinical diagnosis of FTD. The majority of visual raters classified 1 control (10%), 8 AD (80%), and 2 FTD (25%) patients as amyloid positive, while ratings were tied in another 2 FTD patients and 1 healthy control. CONCLUSION: Cortical 18F-florbetapir uptake is low in the majority of FTD patients, providing good discrimination from AD. However, visual rating of FTD scans was challenging with a higher rate of discordance between readers than in AD and control subjects.
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- Kobylecki, Christopher Langheinrich, Tobias Hinz, Rainer Vardy, Emma Brown, Gavin Martino, Maria Haense, Cathleen Richardson, Anna Gerhard, Alexander Anton-Rodriguez, Jose Snowden, Julie Neary, David Pontecorvo, Michael Herholz, Karl J Nucl Med. 2015 Feb 5. pii: jnumed.114.147454.