title: A visual [18F]FDG-PET rating scale for the differential diagnosis of frontotemporal lobar degeneration.
abstract: This study presents a visual rating scale for the assessment of cerebral [(18)F]fluoro-2-deoxy-D: -glucose positron emission tomography (FDG-PET) scans to characterize typical findings in dementias associated with frontotemporal lobar degeneration (FTLD) and to differentiate individual patients with FTLD compared to Alzheimer's disease (AD) and mild cognitive impairment (MCI). A total of 43 cerebral PET scans from patients with FTLD (n = 16, mean age 58.4 years), AD (n = 16, 59.9 years) and MCI (n = 11, 57.9 years) were analysed. Every PET data set was visually rated for seven brain regions on each hemisphere (frontal lobe, temporal lobe, parietal lobe, occipital lobe, basal ganglia, thalamus and cerebellum). The extent of the impairment in metabolism was classified as absent, mild, medium or strong. Using this four-stage visual rating scale, characteristic profiles of metabolic impairment in FTLD, AD, MCI and the FTLD-subgroup FTD (n = 9) could be demonstrated. Patients with FTLD showed a significantly lower metabolism in the left frontal lobe and in the left basal ganglia when compared to AD and to MCI. Complementary analyses using statistical parametric mapping (SPM2) supported the findings of the visual analysis. In detecting FTLD with visual rating, sensitivity/specificity was 81/94% compared to AD and 81/64% compared to MCI. Patients with FTD were correctly attributed to a diagnosis of FTLD with a sensitivity of 89%. This visual rating scale may facilitate the differential diagnosis of FTLD in clinical routine.
authors.affiliation: Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Regensburg, Germany. stefan.poljansky@medbo.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Poljansky
authors.forename: Bernd
authors.initials: B
authors.lastname: Ibach
authors.forename: Barbara
authors.initials: B
authors.lastname: Hirschberger
authors.forename: Peter
authors.initials: P
authors.lastname: Männer
authors.forename: Hans
authors.initials: H
authors.lastname: Klünemann
authors.forename: Göran
authors.initials: G
authors.lastname: Hajak
authors.forename: Jörg
authors.initials: J
authors.lastname: Marienhagen
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D000544:Alzheimer Disease / Q000175:diagnosis / Q000000981:diagnostic imaging; D001284:Atrophy; D001921:Brain / Q000000981:diagnostic imaging; D001931:Brain Mapping; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D057174:Frontotemporal Lobar Degeneration / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015588:Observer Variation; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
chemical_list: D002556:Cerebrospinal Fluid Proteins; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18