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Salloway S, Gamez JE, Singh U, Sadowsky CH, Villena T, Sabbagh MN, Beach TG, Duara R, Fleisher AS, Frey KA, Walker Z, Hunjan A, Escovar YM, Agronin ME, Ross J, Bozoki A, Akinola M, Shi J, Vandenberghe R, Ikonomovic MD, Sherwin PF, Farrar G, Smith APL, Buckley CJ, Thal DR, Zanette M, Curtis C. Performance of [ 18F]flutemetamol amyloid imaging against the neuritic plaque component of CERAD and the current (2012) NIA-AA recommendations for the neuropathologic diagnosis of Alzheimer's disease. Alzheimers Dement (Amst) 2017; 9:25-34. [PMID: 28795133 PMCID: PMC5536824 DOI: 10.1016/j.dadm.2017.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Performance of the amyloid tracer [18F]flutemetamol was evaluated against three pathology standard of truth (SoT) measures including neuritic plaques (CERAD “original” and “modified” and the amyloid component of the 2012 NIA-AA guidelines). Methods After [18F]flutemetamol imaging, 106 end-of-life patients who died underwent postmortem brain examination for amyloid plaque load. Blinded positron emission tomography scan interpretations by five independent electronically trained readers were compared with pathology measures. Results By SoT, sensitivity and specificity of majority image interpretations were, respectively, 91.9% and 87.5% with “original CERAD,” 90.8% and 90.0% with “modified CERAD,” and 85.7% and 100% with the 2012 NIA-AA criteria. Discussion The high accuracy of either CERAD criteria suggests that [18F]flutemetamol predominantly reflects neuritic amyloid plaque density. However, the use of CERAD criteria as the SoT can result in some false-positive results because of the presence of diffuse plaques, which are accounted for when the positron emission tomography read is compared with the 2012 NIA-AA criteria. Determination of the accuracy of [18F]flutemetamol image read against Aβ at autopsy. High sensitivity and specificity to 3 neuropathologic criteria as Standards of Truth. Images are 100% specific when the SoT reflects both neuritic and diffuse plaques. This study has the largest autopsy validation cohort for Aβ PET tracers to date.
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Affiliation(s)
- Stephen Salloway
- Neurology and the Memory and Aging Program, Butler Hospital, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Neurology and Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - Carl H Sadowsky
- Division of Neurology, Nova SE University, Fort Lauderdale, FL, USA
| | | | - Marwan N Sabbagh
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Ranjan Duara
- Mount Sinai Medical Center, Wien Center for Alzheimer's Disease and Memory Disorders, Miami Beach, FL, USA
| | | | - Kirk A Frey
- Department of Radiology (Nuclear Medicine), University of Michigan, Ann Arbor, MI, USA
| | - Zuzana Walker
- Division of Psychiatry, University College London and North Essex Partnership University NHS Foundation Trust, London, UK
| | - Arvinder Hunjan
- Hertfordshire Partnership University NHS Foundation Trust, Essex, UK
| | | | - Marc E Agronin
- Mental Health and Clinical Research, Miami Jewish Health Systems, Miami, FL, USA.,University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joel Ross
- Memory Enhancement Center, Eatontown, NJ, USA
| | - Andrea Bozoki
- Department of Neurology, Cognitive and Geriatric Neurology Team, Michigan State University, East Lansing, MI, USA
| | | | - Jiong Shi
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Rik Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Gill Farrar
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, UK
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