18F-FDG Is a Superior Indicator of Cognitive Performance Compared to 18F-Florbetapir in Alzheimer’s Disease and Mild Cognitive Impairment Evaluation: A Global Quantitative Analysis

Abstract

Background: 18 F-Fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) and 18 F-florbetapir PET are approved neuroimaging biomarkers for the Alzheimer's disease (AD) and mild cognitive impairment (MCI).Objectives: This study aims to compare the efficacy of 18 F-FDG and 18 F-florbetapir PET at evaluating the cognitive performance of patients with AD, MCI, and normal controls (NC). Methods: 63 subjects (36 male/27 female, mean age = 68.3) including 19 AD, 23 MCI, and 21 NC underwent 18 F-FDG and 18 F-florbetapir PET imaging. A global quantification approach was applied on supra-tentorial, frontal, parieto-occipital, temporal, and cerebellar brain regions by calculating the global SUVmean ratios (GSUVr) as the weighted average of all regional SUVmean. 18 F-FDG and 18 F-florbetapir GSUVr of each region were subsequently correlated with the Mini-Mental State Examination (MMSE). Results: Subjects were studied in five categories as NC, MCI patients, AD patients, MCI and AD patients grouped together (MCI/AD), and a group including all the subjects (NC/MCI/AD). Both 18 F-FDG and 18 F-florbetapir could successfully detect subjects with dementia (p < 0.001). Studied in all regions and groups, the correlation analysis of 18 F-FDG GSUVr with MMSE scores was significant in more regions and groups compared to that of 18 F-florbetapir. We also demonstrated that the correlation of 18 F-FDG GSUVr with MMSE is stronger than that of 18 F-florbetapir in the supra-tentorial and temporal regions. Conclusions: This study reveals how 18 F-FDG-PET global quantification is a superior indicator of cognitive performance in AD and MCI patients compared to 18 F-florbetapir PET. Accordingly, we still recommend 18 F-FDG-PET over amyloid imaging in the evaluation for AD and MCI.

Reinventing Molecular Imaging with Total-Body PET, Part II

“…Data from the approach have similarly demonstrated great importance in patients with cancer, atherosclerosis, systemic inflammation, and musculoskeletal disorders. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18

Fig. 2 Maximum intensity projection (MIP) FDG PET/CT scans of a 60-year-old patient with multiple myeloma ( A ) pretreatment 1 hour and ( B ) pretreatment 3 hours after administration of FDG.

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Suboptimal validity of amyloid imaging-based diagnosis and management of Alzheimer’s disease: why it is time to abandon the approach

“…This partly relates to the structural location of uptake of the agents that target these plaques and partly to their non-specific concentration in the adjacent tissues including the white matter. As such, a recent publication comparing results of FDG-PET imaging to those of amyloid scan data, further confirmed the superior performance of FDG-PET and the limitations of "amyloid imaging" in the evaluation of patients with mild cognitive impairment (MCI) and AD [33].…”

Protective Factors Modulate the Risk of Beta Amyloid in Alzheimer’s Disease

“…In familial AD, the cascade of Abeta, then altered metabolism and then atrophy is definitive [ 24 ]. Khosravi et al's study revealed FDG global quantification to be a superior indicator of cognitive performance in the AD and MCI patients compared to 18F-florbetapir-PET [ 25 ]. However, recent research has indicated that increased Abeta deposition leads to the progression to mild cognitive impairment but decreased glucose metabolism does not contribute to progression [ 26 , 27 ].…”