title: Use of amyloid PET across the spectrum of Alzheimer's disease: clinical utility and associated ethical issues.
abstract: Abstract Recent advances have made possible the in vivo detection of beta-amyloid (Aβ) pathology using positron emission tomography. While the gold standard for amyloid imaging, carbon-11 labeled Pittsburgh compound B is increasingly being replaced by fluorine-18 labeled radiopharmaceuticals, with three already approved for clinical use by US and European regulatory bodies. Appropriate use criteria proposed by an amyloid imaging taskforce convened by the Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging recommend restricting use of this technology to the evaluation of patients with mild cognitive impairment or atypical dementia syndromes. While use among asymptomatic individuals is currently viewed as inappropriate due prognostic uncertainty, elevated levels of brain Aβ among asymptomatic individuals may represent preclinical Alzheimer's disease. Amyloid imaging is likewise expected to play a role in the design of clinical trials. Though preliminary results suggest amyloid imaging to possess clinical utility and cost-effectiveness, both domains have yet to be assessed systematically. As the field moves toward adoption of a pro-disclosure stance for amyloid imaging findings, it is imperative that a broad range of stakeholders be involved to ensure the appropriateness of emerging policies and protocols.
authors.affiliation: Translational Neuroimaging Laboratory (TNL), Douglas Mental Health University Institute , Montreal , Canada .
authors.forename: Antoine
authors.initials: A
authors.lastname: Leuzy
authors.forename: Eduardo Rigon
authors.initials: ER
authors.lastname: Zimmer
authors.forename: Kerstin
authors.initials: K
authors.lastname: Heurling
authors.forename: Pedro
authors.initials: P
authors.lastname: Rosa-Neto
authors.forename: Serge
authors.initials: S
authors.lastname: Gauthier
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D016229:Amyloid beta-Peptides / Q000032:analysis* / Q000378:metabolism; D000814:Aniline Compounds; D058070:Asymptomatic Diseases; D052160:Benzothiazoles; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002250:Carbon Radioisotopes; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003704:Dementia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005026:Ethylene Glycols; D005462:Fluorine Radioisotopes; D006801:Humans; D049268:Positron-Emission Tomography / Q000941:ethics* / Q000706:statistics & numerical data; D019275:Radiopharmaceuticals; D013844:Thiazoles
chemical_list: C475519:2-(4'-(methylamino)phenyl)-6-hydroxybenzothiazole; D016229:Amyloid beta-Peptides; D000814:Aniline Compounds; D052160:Benzothiazoles; D002250:Carbon Radioisotopes; D005026:Ethylene Glycols; D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D013844:Thiazoles; C581552:flutemetamol; C545186:florbetapir
keywords: [18F]Florbetapir; [18F]flutemetamol; appropriate use criteria; diagnosis; mild cognitive impairment; positron emission tomography