Clinical Impact of PET With 18F-FDG and 11C-PIB in Patients With Dementia in a Developing Country

Abstract

Introduction: The objective of this study was to evaluate the clinical impact PET with 18F-FDG and 11C-PIB in patients with dementia in a developing country.Methodology: Retrospective study of the patients referred for the evaluation of dementia to the only PET center in Uruguay. A total of 248 patients were identified, from which 70 patients were included based on the availability of medical history and clinical follow-up. Main outcomes included change in diagnosis, diagnostic dilemma and AD treatment. We evaluated the association of clinical outcomes with PET concordance with baseline diagnosis, diagnostic dilemma, level of education, AD pathology/Non-AD pathology (AD/Non-AD), baseline diagnosis and 11C-PIB PET result.Results: Baseline clinical diagnosis was concordant with 18F-FDG and 11C-PIB PET results in 64.7 and 77.1% of the patients, respectively. Change in diagnosis after PET was identified in 30.0% of the patients and was associated with discordant 18F-FDG (p = 0.002) and 11C-PIB (p < 0.001) PET results, previous diagnostic dilemma (p = 0.005), low education (p = 0.027), Non-AD baseline diagnosis (p = 0.027), and negative 11C-PIB PET result (p < 0.001). Only the last variable remained significant in the multivariate analysis (adjusted p = 0.038). Diagnostic dilemma decreased after PET from 15.7 to 7.1% (p = 0.11) and was associated with Non-AD diagnosis (p = 0.002) and negative 11C-PIB PET result (p = 0.003). Change in AD treatment after PET occurred in 45.7% of the patients.Conclusion:18F-FDG and 11C-PIB PET had a significant clinical impact in terms of change in diagnosis and treatment in patients with dementia in a developing country, similar to that reported in high-income countries.

Biomarkers for dementia in Latin American countries: Gaps and opportunities

“…Among others, the lack of infrastructure was highlighted (e.g., neighboring cyclotron). 45 [46][47][48][49][50][51][52] Regarding CSF, sample collection is the main barrier identified in LAC. The invasiveness of this procedure poses significant limitations to its wide use and acceptance.…”

“…Among others, the lack of infrastructure was highlighted (e.g., neighboring cyclotron) 45 . Since these earlier reports, we have witnessed the emergence of multiple PET facilities in LAC (Instituto Neurologico Fleni in Buenos Aires, Argentina; University of São Paulo‐USP and PUC‐RS in Porto Alegre, Brazil; Centro Uruguayo de Imagenología Molecular CUDIM in Montevideo, Uruguay; and Instituto Nacional de Neurologia y Neurocirugia [INNN] in Mexico City, Mexico) 46–52 . Regarding CSF, sample collection is the main barrier identified in LAC.…”