Journal Article

FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease

Norman L. Foster, Judith L. Heidebrink, Christopher M. Clark, William J. Jagust, Steven E. Arnold, Nancy R. Barbas, Charles S. DeCarli, R. Scott Turner, Robert A. Koeppe, Roger Higdon and Satoshi Minoshima

in Brain

Published on behalf of The Guarantors of Brain

Volume 130, issue 10, pages 2616-2635
Published in print October 2007 | ISSN: 0006-8950
Published online August 2007 | e-ISSN: 1460-2156 | DOI: http://dx.doi.org/10.1093/brain/awm177
FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease

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Distinguishing Alzheimer's disease (AD) and frontotemporal dementia (FTD) currently relies on a clinical history and examination, but positron emission tomography with [18F] fluorodeoxyglucose (FDG-PET) shows different patterns of hypometabolism in these disorders that might aid differential diagnosis. Six dementia experts with variable FDG-PET experience made independent, forced choice, diagnostic decisions in 45 patients with pathologically confirmed AD (n = 31) or FTD (n = 14) using five separate methods: (1) review of clinical summaries, (2) a diagnostic checklist alone, (3) summary and checklist, (4) transaxial FDG-PET scans and (5) FDG-PET stereotactic surface projection (SSP) metabolic and statistical maps. In addition, we evaluated the effect of the sequential review of a clinical summary followed by SSP. Visual interpretation of SSP images was superior to clinical assessment and had the best inter-rater reliability (mean kappa = 0.78) and diagnostic accuracy (89.6%). It also had the highest specificity (97.6%) and sensitivity (86%), and positive likelihood ratio for FTD (36.5). The addition of FDG-PET to clinical summaries increased diagnostic accuracy and confidence for both AD and FTD. It was particularly helpful when raters were uncertain in their clinical diagnosis. Visual interpretation of FDG-PET after brief training is more reliable and accurate in distinguishing FTD from AD than clinical methods alone. FDG-PET adds important information that appropriately increases diagnostic confidence, even among experienced dementia specialists.

Keywords: Alzheimer's disease; PET; FDG; frontotemporal dementia

Journal Article.  13466 words.  Illustrated.

Subjects: Neurology ; Neuroscience

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