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 b-amyloid (Ab) 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 Ab to non-Ab diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using x2 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-Ab 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.© 2014 American Academy of Neurology.
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|Titolo:||Practical utility of amyloid and FDG-PET in an academic dementia center|
|Autori:||P., Sanchez Juan; P. M., Ghosh; J., Hagen; B., Gesierich; M., Henry; L. T., Grinberg; J. P., O'Neil; M., Janabi; E. J., Huang; J. Q., Trojanowski; H. V., Vinters; Gorno Tempini, Maria Luisa; W. W., Seeley; A. L., Boxer; H. J., Rosen; J. H., Kramer; B. L., Miller; W. J., Jagust; G. D., Rabinovici|
|Titolo del periodico:||NEUROLOGY|
|Anno di pubblicazione:||2013|
|Codice identificativo Scopus:||2-s2.0-84895742320|
|Codice identificativo Pubmed:||24353340|
|Codice identificativo ISI:||WOS:000336260700011|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1212/WNL.0000000000000032|
|Appare nelle tipologie:||03.1 Articolo su rivista (Journal article)|