P4-250: Appraisal of the utility of the amyloid imaging taskforce recommendations for amyloid-PET prescription

AbstractRecent advances along clinical and neuropathological lines, as well as in our ability to detect the deposition of β-amyloid (Aβ) in vivo using positron emission tomography (PET), have helped redefine Alzheimer’s disease (AD) as a dynamic clinicobiological entity. On the basis of these advances, AD is now conceptualized as a continuum comprising asymptomatic, minimally symptomatic, and dementia phases, with detection of brain Aβ — in particular, via PET amyloid imaging — central to the diagnostic process. In this respect, [18F]florbetapir (Amyvid™) and [18F]flutemetamol (Vizamyl™) have recently received approval for clinical use from the Food and Drug Administration (FDA) and the European Medicines Agency (EMA), with additional radiofluorinated tracers for detection of Aβ in phase III trials. Recent initiatives such as the Alzheimer’s Disease Neuroimaging Initiative (ADNI) suggest that Aβ production, oligomerization and aggregation begins many years, possibly decades, before detectable cognitive impairment, with Aβ shown to associate with cognitive decline and conversion to dementia. While personalized medicine has now emerged as a prospect for the field, the recent decision by the Centers for Medicare & Medicaid Services (CMS) — who declined to cover the cost of amyloid PET imaging citing insufficient evidence to support its clinical utility — highlights that such a move may be premature.

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The Who, When, Why, and How of PET Amyloid Imaging in Management of Alzheimer’s Disease—Review of Literature and Interesting Images

Diagnostics ◽

10.3390/diagnostics9020065 ◽

2019 ◽

Vol 9 (2) ◽

pp. 65 ◽

Cited By ~ 8

Author(s):

Subapriya Suppiah ◽

Mellanie-Anne Didier ◽

Sobhan Vinjamuri

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Area Under The Curve ◽

Standard Uptake Value ◽

Amyloid Imaging ◽

Carrier Status ◽

Amyloid Pet ◽

Positron Emission ◽

Cutoff Points ◽

Pet Amyloid

Amyloid imaging using positron emission tomography (PET) has an emerging role in the management of Alzheimer’s disease (AD). The basis of this imaging is grounded on the fact that the hallmark of AD is the histological detection of beta amyloid plaques (Aβ) at post mortem autopsy. Currently, there are three FDA approved amyloid radiotracers used in clinical practice. This review aims to take the readers through the array of various indications for performing amyloid PET imaging in the management of AD, particularly using 18F-labelled radiopharmaceuticals. We elaborate on PET amyloid scan interpretation techniques, their limitations and potential improved specificity provided by interpretation done in tandem with genetic data such as apolipiprotein E (APO) 4 carrier status in sporadic cases and molecular information (e.g., cerebral spinal fluid (CSF) amyloid levels). We also describe the quantification methods such as the standard uptake value ratio (SUVr) method that utilizes various cutoff points for improved accuracy of diagnosing AD, such as a threshold of 1.122 (area under the curve 0.894), which has a sensitivity of 92.3% and specificity of 90.5%, whereas the cutoff points may be higher in APOE ε4 carriers (1.489) compared to non-carriers (1.313). Additionally, recommendations for future developments in this field are also provided.

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Quantitative appraisal of the Amyloid Imaging Taskforce appropriate use criteria for amyloid-PET

Alzheimer s & Dementia ◽

10.1016/j.jalz.2018.02.022 ◽

2018 ◽

Vol 14 (8) ◽

pp. 1088-1098 ◽

Cited By ~ 6

Author(s):

Daniele Altomare ◽

Clarissa Ferrari ◽

Cristina Festari ◽

Ugo Paolo Guerra ◽

Cristina Muscio ◽

...

Keyword(s):

Amyloid Imaging ◽

Amyloid Pet ◽

Appropriate Use Criteria ◽

Appropriate Use ◽

Quantitative Appraisal

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Effect of Amyloid Imaging on the Diagnosis and Management of Patients with Cognitive Decline: Impact of Appropriate Use Criteria

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000441139 ◽

2016 ◽

Vol 41 (1-2) ◽

pp. 80-92 ◽

Cited By ~ 21

Author(s):

Michael Grundman ◽

Keith A. Johnson ◽

Ming Lu ◽

Andrew Siderowf ◽

Grazia Dell''Agnello ◽

...

Keyword(s):

Cognitive Decline ◽

Management Plan ◽

Amyloid Imaging ◽

Amyloid Pet ◽

Appropriate Use Criteria ◽

Appropriate Use ◽

Diagnosis And Management ◽

Positron Emission ◽

Before And After ◽

The Impact

Background: Published appropriate use criteria (AUC) describe patients for whom amyloid positron emission tomography (PET) might be most useful. This study compared the impact of amyloid PET on diagnosis and management in subjects likely to either meet or not meet AUC. Methods: Physicians provided a provisional diagnosis and management plan for patients presenting with cognitive decline before and after amyloid PET imaging with florbetapir F 18. Participants were classified as AUC-like or not, based on the prescan diagnosis and demographic features. Results: In all, 125 of 229 participants (55%) were classified as AUC-like. Sixty-two percent of the AUC-like subjects had a change in diagnosis after scanning compared with 45% of the non-AUC subjects (p = 0.011). Both groups demonstrated high rates of change in their management plans after scanning (88.0% for AUC-like cases, 85.6% for non-AUC cases). Conclusions: The impact of amyloid imaging on diagnosis and planned management was maintained and, if anything, amplified in AUC-like patients.

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Appropriate Use Criteria for Amyloid PET: A Report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association

Journal of Nuclear Medicine ◽

10.2967/jnumed.113.120618 ◽

2013 ◽

Vol 54 (3) ◽

pp. 476-490 ◽

Cited By ~ 132

Author(s):

K. A. Johnson ◽

S. Minoshima ◽

N. I. Bohnen ◽

K. J. Donohoe ◽

N. L. Foster ◽

...

Keyword(s):

Nuclear Medicine ◽

Molecular Imaging ◽

Task Force ◽

Amyloid Imaging ◽

Amyloid Pet ◽

Appropriate Use Criteria ◽

Appropriate Use

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Amyloid PET in European and North American cohorts; and exploring age as a limit to clinical use of amyloid imaging

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-015-3115-5 ◽

2015 ◽

Vol 42 (10) ◽

pp. 1492-1506 ◽

Cited By ~ 8

Author(s):

Konstantinos Chiotis ◽

◽

Stephen F. Carter ◽

Karim Farid ◽

Irina Savitcheva ◽

...

Keyword(s):

North American ◽

Amyloid Imaging ◽

Amyloid Pet ◽

Clinical Use

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[P2-418]: METHODOLOGICAL AND LOGISTIC STRATEGIES FOR A LARGE MULTI-CENTER β-AMYLOID PET EUROPEAN PROJECT: AMYLOID IMAGING TO PREVENT ALZHEIMER's DISEASE (AMYPAD)

Alzheimer s & Dementia ◽

10.1016/j.jalz.2017.06.1074 ◽

2017 ◽

Vol 13 (7S_Part_16) ◽

pp. P794-P794

Author(s):

Juan Domingo Gispert ◽

Chris Foley ◽

Adriaan A. Lammertsma ◽

Bart N.M. van Berckel ◽

Maqsood M. Yaqub ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Amyloid Imaging ◽

Amyloid Pet ◽

European Project ◽

Β Amyloid

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Canadian Consensus Guidelines on Use of Amyloid Imaging in Canada: Update and Future Directions from the Specialized Task Force on Amyloid imaging in Canada

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.401 ◽

2016 ◽

Vol 43 (4) ◽

pp. 503-512 ◽

Cited By ~ 12

Author(s):

Robert Laforce ◽

Pedro Rosa-Neto ◽

Jean-Paul Soucy ◽

Gil D. Rabinovici ◽

Bruno Dubois ◽

...

Keyword(s):

Task Force ◽

The United States ◽

Amyloid Imaging ◽

Future Research ◽

Amyloid Pet ◽

Consensus Guidelines ◽

Research Guidelines ◽

The United Kingdom ◽

Positron Emission ◽

Health Canada

AbstractPositron emission tomography (PET) imaging of brain amyloid beta is now clinically available in several countries including the United States and the United Kingdom, but not Canada. It has become an established technique in the field of neuroimaging of aging and dementia, with data incorporated in the new consensus guidelines for the diagnosis of Alzheimer disease and predementia Alzheimer’s disease–related conditions. At this point, there are three US Food and Drug Administration– and European Union–approved tracers. Guided by appropriate use criteria developed in 2013 by the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging, the utility of amyloid imaging in medical practice is now supported by a growing body of research. In this paper, we aimed to provide an update on the 2012 Canadian consensus guidelines to dementia care practitioners on proper use of amyloid imaging. We also wished to generate momentum for the industry to submit a new drug proposal to Health Canada. A group of local, national, and international dementia experts and imaging specialists met to discuss scenarios in which amyloid PET could be used appropriately. Peer-reviewed and published literature between January 2004 and May 2015 was searched. Technical and regulatory considerations pertaining to Canada were considered. The results of a survey of current practices in Canadian dementia centers were considered. A set of specific clinical and research guidelines was agreed on that defines the types of patients and clinical circumstances in which amyloid PET could be used in Canada. Future research directions were also outlined, notably the importance of studies that would assess the pharmaco-economics of amyloid imaging.

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