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 DeCarli, R. Scott Turner, Robert A. Koeppe, Roger Higdon, Satoshi Minoshima

Research output: Contribution to journalArticle

364 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2616-2635
Number of pages20
JournalBrain
Volume130
Issue number10
DOIs
StatePublished - Oct 2007

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Keywords

  • Alzheimer's disease
  • FDG
  • Frontotemporal dementia
  • PET

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Foster, N. L., Heidebrink, J. L., Clark, C. M., Jagust, W. J., Arnold, S. E., Barbas, N. R., DeCarli, C., Scott Turner, R., Koeppe, R. A., Higdon, R., & Minoshima, S. (2007). FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease. Brain, 130(10), 2616-2635. https://doi.org/10.1093/brain/awm177