Centiloid recommendations for clinical context‐of‐use from the AMYPAD consortium

Abstract

Amyloid‐PET quantification through the tracer‐independent Centiloid (CL) scale has emerged as an essential tool for the accurate measurement of amyloid‐β (Aβ) pathology in Alzheimer's disease (AD) patients. The AMYPAD consortium set out to integrate existing literature and recent work from the consortium to provide clinical context‐of‐use recommendations for the CL scale. Compared to histopathology, visual reads, and cerebrospinal fluid, CL quantification accurately reflects the amount of AD pathology. With high certainty, a CL value below 10 excludes the presence of Aβ pathology, while a value above 30 corresponds well with pathological amounts. Values falling in between these two cutoffs (“intermediate range”) are related to an increased risk of disease progression. Together, CL quantification is a valuable adjunct to visual assessments of amyloid‐PET images. An abnormal amyloid biomarker assessment is a key criterion to determine eligibility for anti‐amyloid disease‐modifying therapies, and amyloid‐PET quantification can add further value by precisely monitoring amyloid clearance, and hence guiding patient management decisions.Highlights Centiloid (CL) quantification robustly reflects of the amount of Aβ pathology. CL < 10/CL > 30 reflects Aβ‐negativity/positivity thresholds with high certainty. CL quantification is a valuable adjunct to visual assessments of amyloid‐PET. CL quantification can support trial design and treatment management. CL quantification could support the identification of early or emerging Aβ pathology.