title: Amyloid vs FDG-PET in the differential diagnosis of AD and FTLD.
abstract: OBJECTIVE
  To compare the diagnostic performance of PET with the amyloid ligand Pittsburgh compound B (PiB-PET) to fluorodeoxyglucose (FDG-PET) in discriminating between Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD).
  
  
  METHODS
  Patients meeting clinical criteria for AD (n = 62) and FTLD (n = 45) underwent PiB and FDG-PET. PiB scans were classified as positive or negative by 2 visual raters blinded to clinical diagnosis, and using a quantitative threshold derived from controls (n = 25). FDG scans were visually rated as consistent with AD or FTLD, and quantitatively classified based on the region of lowest metabolism relative to controls.
  
  
  RESULTS
  PiB visual reads had a higher sensitivity for AD (89.5% average between raters) than FDG visual reads (77.5%) with similar specificity (PiB 83%, FDG 84%). When scans were classified quantitatively, PiB had higher sensitivity (89% vs 73%) while FDG had higher specificity (83% vs 98%). On receiver operating characteristic analysis, areas under the curve for PiB (0.888) and FDG (0.910) were similar. Interrater agreement was higher for PiB (κ = 0.96) than FDG (κ = 0.72), as was agreement between visual and quantitative classification (PiB κ = 0.88-0.92; FDG κ = 0.64-0.68). In patients with known histopathology, overall classification accuracy (2 visual and 1 quantitative classification per patient) was 97% for PiB (n = 12 patients) and 87% for FDG (n = 10).
  
  
  CONCLUSIONS
  PiB and FDG showed similar accuracy in discriminating AD and FTLD. PiB was more sensitive when interpreted qualitatively or quantitatively. FDG was more specific, but only when scans were classified quantitatively. PiB slightly outperformed FDG in patients with known histopathology.
authors: UCSF Memory & Aging Center, San Francisco, CA 94143, USA. grabinovici@memory.ucsf.edu
authors: G D
authors: GD
authors: Rabinovici
authors: H J
authors: HJ
authors: Rosen
authors: A
authors: A
authors: Alkalay
authors: J
authors: J
authors: Kornak
authors: A J
authors: AJ
authors: Furst
authors: N
authors: N
authors: Agarwal
authors: E C
authors: EC
authors: Mormino
authors: J P
authors: JP
authors: O'Neil
authors: M
authors: M
authors: Janabi
authors: A
authors: A
authors: Karydas
authors: M E
authors: ME
authors: Growdon
authors: J Y
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authors: Jang
authors: E J
authors: EJ
authors: Huang
authors: S J
authors: SJ
authors: Dearmond
authors: J Q
authors: JQ
authors: Trojanowski
authors: L T
authors: LT
authors: Grinberg
authors: M L
authors: ML
authors: Gorno-Tempini
authors: W W
authors: WW
authors: Seeley
authors: B L
authors: BL
authors: Miller
authors: W J
authors: WJ
authors: Jagust
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D000682:Amyloid / Q000378:metabolism*; D001921:Brain / Q000000981:diagnostic imaging* / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D057174:Frontotemporal Lobar Degeneration / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography
chemical_list: D000682:Amyloid; D019788:Fluorodeoxyglucose F18