Amyloid PET imaging in clinical practice

Amyloid positron emission tomography (PET) imaging enables in vivo detection of brain Aβ deposition, one of the neuropathological hallmarks of Alzheimer’s disease. There is increasing evidence to support its clinical utility, with major studies showing that amyloid PET imaging improves diagnostic accuracy, increases diagnostic certainty and results in therapeutic changes. The Amyloid Imaging Taskforce has developed appropriate use criteria to guide clinicians by predefining certain scenarios where amyloid PET would be justified. This review provides a practical guide on how and when to use amyloid PET, based on the available research and our own experience. We discuss its three main appropriate indications and illustrate these with clinical cases. We stress the importance of a multidisciplinary approach when deciding who might benefit from amyloid PET imaging. Finally, we highlight some practical points and common pitfalls in its interpretation.

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A Review of Diagnostic Impact of Amyloid Positron Emission Tomography Imaging in Clinical Practice

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000492151 ◽

2018 ◽

Vol 46 (3-4) ◽

pp. 154-167 ◽

Cited By ~ 3

Author(s):

Yejin Kim ◽

Paul Rosenberg ◽

Esther Oh

Keyword(s):

Positron Emission Tomography ◽

Clinical Practice ◽

Pet Imaging ◽

Clinical Utility ◽

Patient Management ◽

Emission Tomography ◽

Amyloid Pet ◽

Diagnostic Confidence ◽

Positron Emission ◽

Amyloid Pet Imaging

Background: Molecular imaging of brain amyloid for the diagnosis of Alzheimer’s disease (AD) using positron emission tomography (PET) has been approved for use in clinical practice by the Food and Drug Administration (FDA) since 2012. However, the clinical utility and diagnostic impact of amyloid PET imaging remain controversial. We conducted a review of the recent studies investigating clinical utility of amyloid PET imaging with focus on changes in diagnosis, diagnostic confidence, and patient management. Summary: A total of 16 studies were included in the final analysis. Overall rate of changes in diagnosis after amyloid PET ranged from 9 to 68% (pooled estimate of 31%, 95% CI 23–39%). All studies reported overall increase in diagnostic confidence or diagnostic certainty after amyloid PET. Changes in patient management ranged from 37 to 87%; the most common type of change in management reported was either the initiation or discontinuation of planned AD medications. Key Messages: Amyloid PET imaging led to moderate to significant changes in diagnosis, diagnostic confidence, and subsequent patient management. It may be most useful in patients with high level of diagnostic uncertainty even after the completing the standard workup.

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CLINICAL UTILITY OF β-AMYLOID PET IMAGING IN PEOPLE LIVING WITH HIV WITH COGNITIVE SYMPTOMS

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000002648 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jaime H Vera ◽

Nicholas Eftychiou ◽

Matti Schuerer ◽

Michael Rullmann ◽

Henryk Barthel ◽

...

Keyword(s):

Pet Imaging ◽

Clinical Utility ◽

People Living With Hiv ◽

Amyloid Pet ◽

Cognitive Symptoms ◽

Β Amyloid ◽

Living With Hiv ◽

Amyloid Pet Imaging

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Clinical Utility of Amyloid PET Imaging in the Differential Diagnosis of Atypical Dementias and Its Impact on Caregivers

Journal of Alzheimer s Disease ◽

10.3233/jad-151180 ◽

2016 ◽

Vol 52 (4) ◽

pp. 1251-1262 ◽

Cited By ~ 27

Author(s):

Mohamed Reda Bensaïdane ◽

Jean-Mathieu Beauregard ◽

Stéphane Poulin ◽

François-Alexandre Buteau ◽

Jean Guimond ◽

...

Keyword(s):

Differential Diagnosis ◽

Pet Imaging ◽

Clinical Utility ◽

Amyloid Pet ◽

Amyloid Pet Imaging

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Positron emission tomography imaging in evaluation of MS pathology in vivo

Multiple Sclerosis Journal ◽

10.1177/1352458518791680 ◽

2018 ◽

Vol 24 (11) ◽

pp. 1399-1412 ◽

Cited By ~ 13

Author(s):

Heidi Högel ◽

Eero Rissanen ◽

Anna Vuorimaa ◽

Laura Airas

Keyword(s):

Positron Emission Tomography ◽

Pet Imaging ◽

Human Subjects ◽

Positron Emission Tomography Imaging ◽

Translocator Protein ◽

Emission Tomography ◽

Amyloid Pet ◽

Positron Emission ◽

Density Evaluation

Positron emission tomography (PET) gives an opportunity to quantitate the expression of specific molecular targets in vivo and longitudinally in brain and thus enhances our possibilities to understand and follow up multiple sclerosis (MS)-related pathology. For successful PET imaging, one needs a relevant target molecule within the brain, to which a blood–brain barrier–penetrating specific radioligand will bind. 18-kDa translocator protein (TSPO)-binding radioligands have been used to detect activated microglial cells at different stages of MS, and remyelination has been measured using amyloid PET. Several PET ligands for the detection of other inflammatory targets, besides TSPO, have been developed but not yet been used for imaging MS patients. Finally, synaptic density evaluation has been successfully tested in human subjects and gives opportunities for the evaluation of the development of cortical and deep gray matter pathology in MS. This review will discuss PET imaging modalities relevant for MS today.

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USING FLORBETAPIR PET TO INCREASE DIAGNOSTIC CERTAINTY IN ATYPICAL DEMENTIAS

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2015-312379.24 ◽

2015 ◽

Vol 86 (11) ◽

pp. e4.112-e4

Author(s):

PSJ Weston ◽

RW Paterson ◽

M Lehmann ◽

M Modat ◽

JB Bomanji ◽

...

Keyword(s):

Pet Imaging ◽

Diagnostic Assessment ◽

Diagnostic Utility ◽

Amyloid Pet ◽

Diagnostic Certainty ◽

Additional Value ◽

Pet Scans ◽

Alzheimer Pathology ◽

Csf Examination

Amyloid PET or CSF can be used to determine Alzheimer pathology in vivo. Few studies have assessed the additional value of amyloid imaging where CSF results are equivocal. We recruited 20 cognitive patients (65.5+/–7.6 y) with MRI, neuropsychology, and CSF Aβ1–42 and tau measured during their diagnostic assessment. Individuals were selected to have a range of CSF results; ten had amnestic and ten non-amnestic presentations. Following the investigations, the treating neurologist gave a diagnosis (AD or non-AD). Four controls (63+/–7.0y) also had CSF examination. All subjects had Florbetapir PET imaging, reported as positive/negative. The clinicians were given the PET results and asked to review their diagnoses. Eighteen patients had positive Florbetapir scans; two patients and all controls were Florbetapir negative. Following initial investigations, thirteen patients were diagnosed with AD, and seven with non-AD pathology. Providing the Florbetapir result led to a change in diagnosis in seven patients, five of whom had atypical phenotypes. For all seven the CSF results were close to or in a “grey” area, where results overlapped for positive and negative PET scans. Even in individuals with CSF measures of Aβ1–42, and tau, Florbetapir PET imaging may have diagnostic utility, particularly in atypical cases and/or equivocal CSF results.

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Amyloid PET imaging in cardiac amyloidosis: a pilot study using 18F-flutemetamol positron emission tomography

Annals of Nuclear Medicine ◽

10.1007/s12149-019-01372-7 ◽

2019 ◽

Vol 33 (8) ◽

pp. 624-628 ◽

Cited By ~ 15

Author(s):

Sebastien Dietemann ◽

René Nkoulou

Keyword(s):

Positron Emission Tomography ◽

Pilot Study ◽

Pet Imaging ◽

Cardiac Amyloidosis ◽

Emission Tomography ◽

Amyloid Pet ◽

Positron Emission ◽

Amyloid Pet Imaging

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Development of a blood sample detector for multi-tracer positron emission tomography using gamma spectroscopy

EJNMMI Physics ◽

10.1186/s40658-019-0263-x ◽

2019 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Carlos Velasco ◽

Adriana Mota-Cobián ◽

Jesús Mateo ◽

Samuel España

Keyword(s):

Positron Emission Tomography ◽

Blood Sample ◽

Pet Imaging ◽

Spectroscopic Analysis ◽

Gamma Spectroscopy ◽

Emission Tomography ◽

Blood Samples ◽

Positron Emission

Abstract Background Multi-tracer positron emission tomography (PET) imaging can be accomplished by applying multi-tracer compartment modeling. Recently, a method has been proposed in which the arterial input functions (AIFs) of the multi-tracer PET scan are explicitly derived. For that purpose, a gamma spectroscopic analysis is performed on blood samples manually withdrawn from the patient when at least one of the co-injected tracers is based on a non-pure positron emitter. Alternatively, these blood samples required for the spectroscopic analysis may be obtained and analyzed on site by an automated detection device, thus minimizing analysis time and radiation exposure of the operating personnel. In this work, a new automated blood sample detector based on silicon photomultipliers (SiPMs) for single- and multi-tracer PET imaging is presented, characterized, and tested in vitro and in vivo. Results The detector presented in this work stores and analyzes on-the-fly single and coincidence detected events. A sensitivity of 22.6 cps/(kBq/mL) and 1.7 cps/(kBq/mL) was obtained for single and coincidence events respectively. An energy resolution of 35% full-width-half-maximum (FWHM) at 511 keV and a minimum detectable activity of 0.30 ± 0.08 kBq/mL in single mode were obtained. The in vivo AIFs obtained with the detector show an excellent Pearson’s correlation (r = 0.996, p < 0.0001) with the ones obtained from well counter analysis of discrete blood samples. Moreover, in vitro experiments demonstrate the capability of the detector to apply the gamma spectroscopic analysis on a mixture of 68Ga and 18F and separate the individual signal emitted from each one. Conclusions Characterization and in vivo evaluation under realistic experimental conditions showed that the detector proposed in this work offers excellent sensibility and stability. The device also showed to successfully separate individual signals emitted from a mixture of radioisotopes. Therefore, the blood sample detector presented in this study allows fully automatic AIFs measurements during single- and multi-tracer PET studies.

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11C- and 18F-Radiotracers for In Vivo Imaging of the Dopamine System: Past, Present and Future

Biomedicines ◽

10.3390/biomedicines9020108 ◽

2021 ◽

Vol 9 (2) ◽

pp. 108

Author(s):

Michael R. Kilbourn

Keyword(s):

Pet Imaging ◽

In Vivo Imaging ◽

Dopamine Synthesis ◽

Dopamine System ◽

Synaptic Release ◽

Positron Emission ◽

The Central Nervous System ◽

Pet Radiotracers ◽

Selection Of

The applications of positron emission tomography (PET) imaging to study brain biochemistry, and in particular the aspects of dopamine neurotransmission, have grown significantly over the 40 years since the first successful in vivo imaging studies in humans. In vivo PET imaging of dopaminergic functions of the central nervous system (CNS) including dopamine synthesis, vesicular storage, synaptic release and receptor binding, and reuptake processes, are now routinely used for studies in neurology, psychiatry, drug abuse and addiction, and drug development. Underlying these advances in PET imaging has been the development of the unique radiotracers labeled with positron-emitting radionuclides such as carbon-11 and fluorine-18. This review focuses on a selection of the more accepted and utilized PET radiotracers currently available, with a look at their past, present and future.

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