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FDG PET Imaging in Patients with Pathologically Verified Dementia

National Cancer Institute, Bethesda, Maryland; Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham; Department of Radiology, Duke University Medical Center, Durham, North Carolina; Department of Pathology, Johns Hopkins University, Baltimore, Maryland; and Department of Pathology, Duke University Medical Center, Durham, North Carolina

View larger version (114K): [in this window] [in a new window]   FIGURE 1. FDG PET scan of 54-y-old woman with progressive dementing illness (patient 7; Table 1). Note significant reduction in FDG in parietal, temporal, and frontal cortices (arrows). The metabolic pattern noted on this particular study would be considered classic for AD. The patient had AD, verified by pathological examination.

View larger version (95K): [in this window] [in a new window]   FIGURE 2. FDG PET scans of 60-y-old man with a rapidly progressive dementia syndrome (patient 2; Table 1). Patient had both biopsy and autopsy confirmation of diagnosis of Creutzfeldt-Jacob disease. FDG PET scans at 2 levels show marked reduction in FDG uptake in temporo-parietal (A) and parietal (B) regions bilaterally. A pattern very similar to AD has been reported in previous cases of Creutzfeldt-Jacob disease studied with FDG PET imaging (31–33).

View larger version (68K): [in this window] [in a new window]   FIGURE 3. (A–C) FDG PET scans at 3 transaxial levels of 64-y-old man with progressive dementing illness (patient 5; Table 1). Pathologic diagnosis was nonspecific neuronal degeneration. FDG PET scan was interpreted as abnormal but not AD pattern. FDG PET images at 3 levels are shown. Note asymmetric FDG uptake, particularly in the left frontal area (arrow) on multiple imaging levels. Temporo-parietal hypometabolism was not a prominent finding in this patient with non–Alzheimer's type dementia.

View larger version (116K): [in this window] [in a new window]   FIGURE 4. FDG PET scan of 66-y-old man with progressive dementia with extrapyramidal features (patient 13; Table 1). This individual had histologically proven progressive supranuclear palsy. FDG PET scan was interpreted as abnormal but not AD pattern. FDG PET image showed reduction in FDG uptake in frontal regions bilaterally. Prominent frontal hypometabolism has been previously described in patients with progressive supranuclear palsy with FDG PET (34–36).