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IC‐P‐133: A Voxel Based Morphometry of Apathy Associated with Alzheimer's Disease
Author(s) -
Lim Hyun Kook
Publication year - 2010
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2010.05.148
Subject(s) - apathy , voxel based morphometry , anterior cingulate cortex , psychology , orbitofrontal cortex , dementia , superior frontal gyrus , voxel , cingulate cortex , frontal lobe , brain morphometry , neuroimaging , neuroscience , temporal lobe , alzheimer's disease , medicine , disease , prefrontal cortex , magnetic resonance imaging , central nervous system , cognition , radiology , white matter , epilepsy
AD (N 1⁄4 47, mean age 66.5 6 10.7, MMSE 22.3 6 5.7) and Neary criteria for FTLD (N 1⁄4 42, age 64.7 6 6.8, MMSE 21.2 6 9.1) underwent [11C]PIB and [18F]FDG PET. PIB distribution volume ratio images (Logan, cerebellar reference) were classified by two raters blinded to clinical data as positive or negative for cortical tracer uptake. FDG images (normalized to pons) were rated as consistent with the metabolic pattern of AD or FTLD. Results: The sensitivity of PIB visual reads for AD was 88% (mean of two raters, combined 95% confidence interval 74%-96%) and specificity was 82% (65%-92%). In comparison, the sensitivity of FDGPET for AD was 84% (66%-94%) and specificity was 74% (57%-86%). Inter-rater reliability for visual reads was nearly perfect for PIB (Cohen’s k 1⁄4 0.98) and excellent for FDG (k 1⁄4 0.76). 5/8 PIB-positive scans in FTLD showed diffuse cortical PIB uptake, while 3 showed only focal binding (primarily in precuneus). In contrast, 41/42 PIB-positive scans in AD showed diffuse cortical PIB binding, while one scan showed uptake restricted to precuneus. Agreement between PIB and FDG in classifying subjects was moderate (k 1⁄4 0.53-0.66 depending on rating set), and disagreement between PIB and FDG occurred at similar rates in AD (27%) and FTLD (27%). PIB reads correctly classified all six patients who have undergone autopsy (2 AD, 2 FTLD-Pick’s, 2 FTLD-TDP), while FDG reads misclassified two of these subjects. Conclusions: PIB-PET compared favorably with FDG-PET in discriminating clinically diagnosed AD and FTLD, and PIB outperformed FDG in the small subset of patients with pathologically confirmed diagnosis. Classifying scans as ‘‘PIB-positive’’ based on diffuse (rather than focal) PIB uptake may improve the specificity of PIBPET in this scenario, with minimal impact on sensitivity. Amyloid imaging with PIB-PET is a highly promising tool for better discriminating AD and FTLD during life.