TY - JOUR
T1 - The Early Perfusion Image Is Useful to Support the Visual Interpretation of Brain Amyloid-PET With 18F-Flutemetamol in Borderline Cases
AU - Mathies, Franziska L.
AU - Heeman, Fiona
AU - Visser, Pieter Jelle
AU - Den Braber, Anouk
AU - Yaqub, Maqsood
AU - Klutmann, Susanne
AU - Schöll, Michael
AU - Van De Giessen, Elsmarieke
AU - Collij, Lyduine E.
AU - Buchert, Ralph
N1 - Funding Information:
This work has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking EMIF grant agreement no 115372. This work also received in-kind sponsoring of the Diagnostick device from Applied Biomedical Systems BV, the CANTAB device from Cambridge Cognition, the CSF assay fromADx NeuroSciences, and the PET tracer from GE Health Care.
Funding Information:
Conflicts of interest and sources of funding: L.E.C. received research support from GE Healthcare and Spinger Healthcare (funded by Eli Lilly). Both contributions have been paid to the institution. There is no actual or potential conflict of interest for the other authors.
Funding Information:
This work has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking EMIF grant agreement n\u00B0115372. This work also received in-kind sponsoring of the Diagnostick device from Applied Biomedical Systems BV, the CANTAB device from Cambridge Cognition, the CSF assay from ADx NeuroSciences, and the PET tracer from GE Health Care.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/9/1
Y1 - 2024/9/1
N2 - Purpose Visual interpretation of brain amyloid-ß (Aß) PET can be difficult in individuals with borderline Aß burden. Coregistration with individual MRI is recommended in these cases, which, however, is not always available. This study evaluated coregistration with the early perfusion frames acquired immediately after tracer injection to support the visual interpretation of the late Aß-frames in PET with 18F-flutemetamol (FMM). Patients and Methods Fifty dual-time-window FMM-PET scans of cognitively normal subjects with 0 to 60 Centiloids were included retrospectively (70.1 ± 6.9 years, 56% female, MMSE score 28.9 ± 1.3, 42% APOE ?4 carrier). Regional Aß load was scored with respect to a 6-point Likert scale by 3 independent raters in the 10 regions of interest recommended for FMM reading using 3 different settings: Aß image only, Aß image coregistered with MRI, and Aß image coregistered with the perfusion image. The impact of setting, within- and between-readers variability, region of interest, and Aß-status was tested by repeated-measure analysis of variance of the Likert score. Results The Centiloid scale ranged between 2 and 52 (interquartile range, 7-19). Support of visual scoring by the perfusion image resulted in the best discrimination between Aß-positive and Aß-negative cases, mainly by improved certainty of excluding Aß plaques in Aß-negative cases (P = 0.030). It also resulted in significantly higher between-rater agreement. The setting effect was most pronounced in the frontal lobe and in the posterior cingulate cortex/precuneus area (P = 0.005). Conclusions The early perfusion image is a suitable alternative to T1-weighted MRI to support the visual interpretation of the late Aß image in FMM-PET.
AB - Purpose Visual interpretation of brain amyloid-ß (Aß) PET can be difficult in individuals with borderline Aß burden. Coregistration with individual MRI is recommended in these cases, which, however, is not always available. This study evaluated coregistration with the early perfusion frames acquired immediately after tracer injection to support the visual interpretation of the late Aß-frames in PET with 18F-flutemetamol (FMM). Patients and Methods Fifty dual-time-window FMM-PET scans of cognitively normal subjects with 0 to 60 Centiloids were included retrospectively (70.1 ± 6.9 years, 56% female, MMSE score 28.9 ± 1.3, 42% APOE ?4 carrier). Regional Aß load was scored with respect to a 6-point Likert scale by 3 independent raters in the 10 regions of interest recommended for FMM reading using 3 different settings: Aß image only, Aß image coregistered with MRI, and Aß image coregistered with the perfusion image. The impact of setting, within- and between-readers variability, region of interest, and Aß-status was tested by repeated-measure analysis of variance of the Likert score. Results The Centiloid scale ranged between 2 and 52 (interquartile range, 7-19). Support of visual scoring by the perfusion image resulted in the best discrimination between Aß-positive and Aß-negative cases, mainly by improved certainty of excluding Aß plaques in Aß-negative cases (P = 0.030). It also resulted in significantly higher between-rater agreement. The setting effect was most pronounced in the frontal lobe and in the posterior cingulate cortex/precuneus area (P = 0.005). Conclusions The early perfusion image is a suitable alternative to T1-weighted MRI to support the visual interpretation of the late Aß image in FMM-PET.
KW - amyloid PET
KW - Centiloid
KW - flutemetamol
KW - perfusion
KW - regional visual read
U2 - 10.1097/RLU.0000000000005360
DO - 10.1097/RLU.0000000000005360
M3 - Article
SN - 0363-9762
VL - 49
SP - 838
EP - 846
JO - Clinical Nuclear Medicine
JF - Clinical Nuclear Medicine
IS - 9
ER -