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First published online February 20, 2008, 10.2967/jnumed.107.045385
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Journal of Nuclear Medicine Vol. 49 No. 3 390-398
© 2008 by Society of Nuclear Medicine
doi: 10.2967/jnumed.107.045385

Clinical Investigation

Multicenter Standardized 18F-FDG PET Diagnosis of Mild Cognitive Impairment, Alzheimer's Disease, and Other Dementias

Lisa Mosconi1, Wai H. Tsui1,2, Karl Herholz3, Alberto Pupi4, Alexander Drzezga5, Giovanni Lucignani6, Eric M. Reiman7, Vjera Holthoff8, Elke Kalbe9, Sandro Sorbi4, Janine Diehl-Schmid5, Robert Perneczky5, Francesca Clerici6, Richard Caselli10, Bettina Beuthien-Baumann8,11, Alexander Kurz5, Satoshi Minoshima12 and Mony J. de Leon1,2

1 New York University School of Medicine, New York, New York; 2 Nathan Kline Institute, New York, New York; 3 University of Manchester, Manchester, United Kingdom; 4 University of Florence, Florence, Italy; 5 University of Munich, Munich, Germany; 6 University of Milan, Milan, Italy; 7 Good Samaritan Banner Center, University of Arizona, Phoenix, Arizona; 8 University Hospital of Dresden, Dresden, Germany; 9 Medical Faculty, University of Cologne, Cologne, Germany; 10 Arizona Center for Alzheimer's Disease Research, Phoenix, Arizona; 11 PET-Center Dresden-Rossendorf, Dresden, Germany; and 12 University of Washington, Seattle, Washington

Correspondence: For correspondence contact: Lisa Mosconi, PhD, Center for Brain Health, MHL 400, New York University School of Medicine, 560 First Ave., New York, NY 10016. E-mail: lisa.mosconi{at}med.nyu.edu

This multicenter study examined 18F-FDG PET measures in the differential diagnosis of Alzheimer's disease (AD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB) from normal aging and from each other and the relation of disease-specific patterns to mild cognitive impairment (MCI). Methods: We examined the 18F-FDG PET scans of 548 subjects, including 110 healthy elderly individuals ("normals" or NLs), 114 MCI, 199 AD, 98 FTD, and 27 DLB patients, collected at 7 participating centers. Individual PET scans were Z scored using automated voxel-based comparison with generation of disease-specific patterns of cortical and hippocampal 18F-FDG uptake that were then applied to characterize MCI. Results: Standardized disease-specific PET patterns were developed that correctly classified 95% AD, 92% DLB, 94% FTD, and 94% NL. MCI patients showed primarily posterior cingulate cortex and hippocampal hypometabolism (81%), whereas neocortical abnormalities varied according to neuropsychological profiles. An AD PET pattern was observed in 79% MCI with deficits in multiple cognitive domains and 31% amnesic MCI. 18F-FDG PET heterogeneity in MCI with nonmemory deficits ranged from absent hypometabolism to FTD and DLB PET patterns. Conclusion: Standardized automated analysis of 18F-FDG PET scans may provide an objective and sensitive support to the clinical diagnosis in early dementia.

Key Words: 18F-FDG PET • Alzheimer's disease • frontotemporal dementia • Lewy body dementia • mild cognitive impairment • normal aging • hippocampus

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.


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