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Abstract
Objective: To compare the diagnostic performance of PET with the amyloid ligand Pittsburgh compound B (PiB-PET) to fluorodeoxyglucose (FDG-PET) in discriminating between Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD).
Methods: Patients meeting clinical criteria for AD (n = 62) and FTLD (n = 45) underwent PiB and FDG-PET. PiB scans were classified as positive or negative by 2 visual raters blinded to clinical diagnosis, and using a quantitative threshold derived from controls (n = 25). FDG scans were visually rated as consistent with AD or FTLD, and quantitatively classified based on the region of lowest metabolism relative to controls.
Results: PiB visual reads had a higher sensitivity for AD (89.5% average between raters) than FDG visual reads (77.5%) with similar specificity (PiB 83%, FDG 84%). When scans were classified quantitatively, PiB had higher sensitivity (89% vs 73%) while FDG had higher specificity (83% vs 98%). On receiver operating characteristic analysis, areas under the curve for PiB (0.888) and FDG (0.910) were similar. Interrater agreement was higher for PiB (κ = 0.96) than FDG (κ = 0.72), as was agreement between visual and quantitative classification (PiB κ = 0.88–0.92; FDG κ = 0.64–0.68). In patients with known histopathology, overall classification accuracy (2 visual and 1 quantitative classification per patient) was 97% for PiB (n = 12 patients) and 87% for FDG (n = 10).
Conclusions: PiB and FDG showed similar accuracy in discriminating AD and FTLD. PiB was more sensitive when interpreted qualitatively or quantitatively. FDG was more specific, but only when scans were classified quantitatively. PiB slightly outperformed FDG in patients with known histopathology.
Glossary
- GLOSSARY
- Aβ=
- β-amyloid;
- AD=
- Alzheimer disease;
- CERAD=
- Consortium to Establish a Registry for Alzheimer's Disease;
- CI=
- confidence interval;
- DVR=
- distribution volume ratio;
- FDG=
- fluorodeoxyglucose;
- FTLD=
- frontotemporal lobar degeneration;
- NC=
- normal control;
- PiB=
- Pittsburgh compound B;
- ROC=
- receiver operator characteristic;
- ROI=
- region of interest;
- TDP=
- TAR DNA-binding protein 43
Footnotes
Study funding: This work was supported by the National Institute on Aging grants K23-AG031861, R01-AG027859, P01-AG1972403, and P50-AG023501; State of California Department of Health Services Alzheimer's Disease Research Center of California grant 04-33516; Alzheimer's Association grants NIRG-07-59422 and ZEN-08-87090; John Douglas French Alzheimer's Foundation; and the Consortium for Frontotemporal Dementia Research.
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Editorial, page 2008
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Supplemental data at www.neurology.org
- Received April 21, 2011.
- Accepted June 14, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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