Clinical Relevance of [18F]Florbetaben and [18F]FDG PET/CT Imaging on the Management of Patients with Dementia

Abstract

PET of β-Amyloid plaques (Aβ) using [18F]florbetaben ([18F]FBB) and [18F]fluorodeoxyglucose ([18F]FDG) increasingly aid clinicians in early diagnosis of dementia, including Alzheimer’s disease (AD), frontotemporal disease, dementia with Lewy bodies, and vascular dementia. The aim of this retrospective analysis was to evaluate clinical relevance of [18F]FBB, [18F]FDG PET and complimentary CSF measurements in patients with suspected dementia. In this study, 40 patients with clinically suspected or history of dementia underwent (1) measurement of Aβ peptides, total tau, and p-tau protein levels in the cerebrospinal fluid (CSF) compared with healthy controls (HC); (2) clinical and neuropsychological assessment, which included Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological assessment battery (CERAD-NAB); (3) [18F]FBB and [18F]FDG PET imaging within an average of 3 weeks. The subjects were within 15 days stratified using PET, CSF measurements as HC, mild cognitive impaired (MCI) and dementia including Alzheimer´s disease. The predictive dementia-related cognitive decline values were supporting the measurements. PET images were evaluated visually and quantitatively using standard uptake value ratios (SUVR). Twenty-one (52.5%) subjects were amyloid-positive (Aβ+), with a median neocortical SUVR of 1.80 for AD versus 1.20 relative to the respective 19 (47.5 %) amyloid-negative (Aβ-) subjects. Moreover, the [18F]FDG and [18F]FBB confirmed within a sub-group of 10 patients a good complimentary role by correlation between amyloid pathology and brain glucose metabolism in 8 out of 10 subjects. The results suggest the clinical relevance for [18F]FBB combined with [18F]FDG PET retention and CFS measurements serving the management of our patients with dementia. Therefore, [18F]FBB combined with [18F]FDG PET is a helpful tool for differential diagnosis, and supports the patients’ management as well as treatment.

Quantitative Brain Positron Emission Tomography in Female 5XFAD Alzheimer Mice: Pathological Features and Sex-Specific Alterations

“…PET is a functional, non-invasive imaging technique that allows in vivo monitoring of pathological and physiological processes (4). 18 F-Fluorodeoxyglucose (FDG)-PET and 18 F-Florbetaben-PET are clinically established biomarkers for the diagnosis of AD capturing two key pathological features of the disease (5,6). FDG-PET can visualize cerebral glucose metabolism that reflects regional neuronal and synaptic activity and can therefore be used to assess synaptic dysfunctions and neuron loss in the brain (7).…”

A Systematic Review of the Impact of Physical Exercise-Induced Increased Resting Cerebral Blood Flow on Cognitive Functions

“…Such mechanism might have played a role in described studies in AD (Castellano et al, 2017 ; Shimizu et al, 2018 ) where increase in glucose metabolism (Castellano et al, 2017 ) and activation measured with BOLD signal (Shimizu et al, 2018 ) were not associated with any changes in cognitive functioning. AD is typically associated with glucose hypometabolism (Guan et al, 2021 ; Librizzi et al, 2021 ). Thus, reversal of glucose metabolism decline should be seen as a positive outcome.…”

The Status and Development of Biomarkers of Alzheimer's disease

“…18 F-florbetaben (Neuraceq), 18 F-flutemetamol (Vizamyl), and 18 F-florbetapir (Amyvid) are all clinically authorized for use, all of which showed positive association with amyloid plaque load in autopsy correlation, and despite the lack of pathological specificity of cerebral hypometabolism detected by [18] FDG PET compared with 11 C-PiB. As a result, a multi-biomarker strategy is advised to add further data to support categorization of individuals whose diagnosis is unknown [6].…”