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Research ArticleClinical Investigations

18F-FDG PET Improves Diagnosis in Patients with Focal-Onset Dementias

Carl Taswell, Victor L. Villemagne, Paul Yates, Hitoshi Shimada, Cristian E. Leyton, Kirrie J. Ballard, Olivier Piguet, James R. Burrell, John R. Hodges and Christopher C. Rowe
Journal of Nuclear Medicine October 2015, 56 (10) 1547-1553; DOI: https://doi.org/10.2967/jnumed.115.161067
Carl Taswell
1Department of Psychiatry, University of California San Diego, San Diego, California
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Victor L. Villemagne
2Austin Health Department Molecular Imaging, Melbourne, Victoria, Australia
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Paul Yates
2Austin Health Department Molecular Imaging, Melbourne, Victoria, Australia
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Hitoshi Shimada
3NIRS Molecular Imaging Center, Chiba, Japan
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Cristian E. Leyton
4University of Sydney Health Sciences, Sydney, New South Wales, Australia
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Kirrie J. Ballard
4University of Sydney Health Sciences, Sydney, New South Wales, Australia
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Olivier Piguet
5ARC Centre of Excellence in Cognition and Its Disorders, Neuroscience Research Australia, Sydney, New South Wales, Australia; and
6University of New South Wales Medical Sciences, Sydney, New South Wales, Australia
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James R. Burrell
5ARC Centre of Excellence in Cognition and Its Disorders, Neuroscience Research Australia, Sydney, New South Wales, Australia; and
6University of New South Wales Medical Sciences, Sydney, New South Wales, Australia
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John R. Hodges
5ARC Centre of Excellence in Cognition and Its Disorders, Neuroscience Research Australia, Sydney, New South Wales, Australia; and
6University of New South Wales Medical Sciences, Sydney, New South Wales, Australia
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Christopher C. Rowe
2Austin Health Department Molecular Imaging, Melbourne, Victoria, Australia
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  • FIGURE 1.
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    FIGURE 1.

    18F-FDG PET scan patterns displayed by Neurostat 3D-SSP for focal-onset dementias. Lat = lateral; LBD = Lewy body dementia; Lt = left; Med = medial; Rt = right.

Tables

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    TABLE 1

    Demographics of Selected Subgroups in Study Cohort

    Subgroup selected by diagnostic markerSex (no. of patients)Age at PET scan (y)
    IdentificationDescriptionNo. of patientsMenWomenMedianMinimum–Maximum
    111C-PiB imaging of AD5127246553–81
    218F-FDG imaging of AD4922276553–81
    3Clinical AD2413116956–81
    4Clinical PPA-L (AD variant)197126753–78
    5Clinical PPA-G161247148–80
    6Clinical PPA-S13856454–77
    7Clinical CBS14686457–73
    8 (pooled 3 and 4)Clinical AD and PPA-L4320236953–81
    9 (pooled 5–7)Clinical PPA-G, PPA-S, and CBS4326176648–80
    10Entire cohort9452426837–81
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    TABLE 2

    AD Prevalence Rates in Cohort Subgroups, as Indicated by Clinical and Imaging Diagnostic Markers

    Selected subgroupAD prevalence rate in subgroupAD prevalence rate in cohort
    IdentificationDescription11C-PiB18F-FDGClinical11C-PiB18F-FDGClinical
    111C-PiB imaging for AD1.000.860.750.540.470.40
    218F-FDG imaging for AD0.901.000.730.470.520.38
    3Clinical AD0.880.751.000.220.190.26
    4Clinical PPA-L (AD variant)0.890.951.000.180.190.20
    5Clinical PPA-G0.310.250.000.050.040.00
    6Clinical PPA-S0.080.000.000.010.000.00
    7Clinical CBS0.360.500.000.050.070.00
    8Clinical AD and PPA-L0.880.841.000.400.380.46
    9Clinical PPA-G, PPA-S, and CBS0.260.260.000.120.120.00
    10Entire cohort0.540.520.460.540.520.46
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    TABLE 3

    Statistical Measures for Diagnostic Accuracy

    NameAcronymFormula
    Positive predictive valuePPVTP/(TP + FP)
    Negative predictive valueNPVTN/(TN + FN)
    Positive likelihood ratioPLR[TP/(TP + FN)]/[FP/(FP + TN)]
    Negative likelihood ratioNLR[FN/(TP + FN)]/[TN/(FP + TN)]
    Sensitivity or rate of TP resultsTPRTP/(TP + FN)
    Specificity or rate of TN resultsTNRTN/(TN + FP)
    Conventional accuracyCA(TP + TN)/(TP + FP + FN + TN)
    Balanced accuracyBA[TP/(TP + FN) + TN/(TN + FP)]/2
    Discordance of accuraciesDA|CA − BA|
    • All measures except DA were expressed in terms of numbers of TP, FP, TN, and FN results.

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    TABLE 4

    AD Diagnostic Accuracy Estimates for Clinical Evaluations

    Subgroup
    IdentificationDescriptionPPVNPVPLRNLRTPR ± SETNR ± SECA ± SEBA ± DA
    3AD0.880.88 ± 0.070.50 ± 0.38
    4PPA-L (AD variant)0.110.11 ± 0.070.50 ± 0.40
    5PPA-G0.690.69 ± 0.120.50 ± 0.19
    6PPA-S0.920.92 ± 0.070.50 ± 0.42
    7CBS0.640.64 ± 0.130.50 ± 0.14
    8AD and PPA-L0.880.110.921.120.55 ± 0.080.40 ± 0.220.53 ± 0.080.48 ± 0.06
    9PPA-G, PPA-S, and CBS0.740.74 ± 0.070.50 ± 0.24
    10Entire cohort0.880.575.900.630.41 ± 0.070.93 ± 0.040.65 ± 0.050.67 ± 0.02
    • PPV = positive predictive value; NPV = negative predictive value; PLR = positive likelihood ratio; NLR = negative likelihood ratio; TPR = rate of TP results; TNR = rate of TN results; CA = conventional accuracy; BA = balanced accuracy; DA = discordance of accuracies.

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    TABLE 5

    AD Diagnostic Accuracy Estimates for 18F-FDG PET Scans

    Subgroup
    IdentificationDescriptionPPVNPVPLRNLRTPR ± SETNR ± SECA ± SEBA ± DA
    3AD0.960.372.380.270.81 ± 0.080.75 ± 0.200.80 ± 0.080.78 ± 0.05
    4PPA-L (AD variant)0.940.811.910.090.96 ± 0.020.50 ± 0.350.91 ± 0.070.73 ± 0.18
    5PPA-G0.920.9611.00.100.90 ± 0.090.95 ± 0.040.94 ± 0.060.93 ± 0.03
    6PPA-S0.921.100.92 ± 0.050.85 ± 0.100.46 ± 0.39
    7CBS0.680.973.900.060.95 ± 0.040.75 ± 0.140.82 ± 0.100.85 ± 0.03
    8AD and PPA-L0.950.422.710.190.88 ± 0.050.65 ± 0.210.85 ± 0.050.76 ± 0.09
    9PPA-G, PPA-S, and CBS0.720.948.100.180.84 ± 0.110.88 ± 0.060.87 ± 0.050.86 ± 0.02
    10Entire cohort0.860.835.210.180.85 ± 0.050.83 ± 0.060.84 ± 0.040.84 ± 0.00
    • PPV = positive predictive value; NPV = negative predictive value; PLR = positive likelihood ratio; NLR = negative likelihood ratio; TPR = rate of TP results; TNR = rate of TN results; CA = conventional accuracy; BA = balanced accuracy; DA = discordance of accuracies.

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Journal of Nuclear Medicine: 56 (10)
Journal of Nuclear Medicine
Vol. 56, Issue 10
October 1, 2015
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18F-FDG PET Improves Diagnosis in Patients with Focal-Onset Dementias
Carl Taswell, Victor L. Villemagne, Paul Yates, Hitoshi Shimada, Cristian E. Leyton, Kirrie J. Ballard, Olivier Piguet, James R. Burrell, John R. Hodges, Christopher C. Rowe
Journal of Nuclear Medicine Oct 2015, 56 (10) 1547-1553; DOI: 10.2967/jnumed.115.161067

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18F-FDG PET Improves Diagnosis in Patients with Focal-Onset Dementias
Carl Taswell, Victor L. Villemagne, Paul Yates, Hitoshi Shimada, Cristian E. Leyton, Kirrie J. Ballard, Olivier Piguet, James R. Burrell, John R. Hodges, Christopher C. Rowe
Journal of Nuclear Medicine Oct 2015, 56 (10) 1547-1553; DOI: 10.2967/jnumed.115.161067
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