title: 18F-florbetapir PET in patients with frontotemporal dementia and Alzheimer disease.
abstract: Pathologic deposition of amyloid β (Aβ) protein is a key component in the pathogenesis of Alzheimer disease (AD) but not a feature of frontotemporal dementia (FTD). PET ligands for Aβ protein are increasingly used in diagnosis and research of dementia syndromes. Here, we report a PET study using (18)F-florbetapir in healthy controls and patients with AD and FTD.
  
  
  METHODS
  Ten healthy controls (mean age ± SD, 62.5 ± 5.2 y), 10 AD patients (mean age ± SD, 62.6 ± 4.5), and 8 FTD patients (mean age ± SD, 62.5 ± 9.6) were recruited to the study. All patients underwent detailed clinical and neuropsychologic assessment and T1-weighted MR imaging and were genotyped for apolipoprotein E status. All participants underwent dynamic (18)F-florbetapir PET on a high-resolution research tomograph, and FTD patients also underwent (18)F-FDG PET scans. Standardized uptake value ratios (SUVRs) were extracted for predefined gray and white matter regions of interest using cerebellar gray matter as a reference region. Static PET images were evaluated by trained raters masked to clinical status and regional analysis.
  
  
  RESULTS
  Total cortical gray matter (18)F-florbetapir uptake values were significantly higher in AD patients (median SUVR, 1.73) than FTD patients (SUVR, 1.13, P = 0.002) and controls (SUVR, 1.26, P = 0.04). (18)F-Florbetapir uptake was also higher in AD patients than FTD patients and controls in the frontal, parietal, occipital, and cingulate cortices and in the central subcortical regions. Only 1 FTD patient (homozygous for apolipoprotein E ε4) displayed high cortical (18)F-florbetapir retention, whereas (18)F-FDG PET demonstrated mesiofrontal hypometabolism consistent with the clinical diagnosis of FTD. Most visual raters classified 1 control (10%) and 8 AD (80%) and 2 FTD (25%) patients as amyloid-positive, whereas ratings were tied in another 2 FTD patients and 1 healthy control.
  
  
  CONCLUSIONS
  Cortical (18)F-florbetapir uptake is low in most FTD patients, providing good discrimination from AD. However, visual rating of FTD scans was challenging, with a higher rate of discordance between interpreters than in AD and control subjects.
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors: Christopher
authors: C
authors: Kobylecki
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors: Tobias
authors: T
authors: Langheinrich
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
authors: Rainer
authors: R
authors: Hinz
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Institute of Neuroscience and Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom Department of Older Peoples Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
authors: Emma R L C
authors: ER
authors: Vardy
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
authors: Gavin
authors: G
authors: Brown
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors: María-Elena
authors: ME
authors: Martino
authors: Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
authors: Cathleen
authors: C
authors: Haense
authors: Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom Manchester Medical School, University of Manchester, Manchester, United Kingdom; and.
authors: Anna M
authors: AM
authors: Richardson
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors: Alexander
authors: A
authors: Gerhard
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
authors: Jose M
authors: JM
authors: Anton-Rodriguez
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors: Julie S
authors: JS
authors: Snowden
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors: David
authors: D
authors: Neary
authors: Avid Radiopharmaceuticals, Philadelphia, Pennsylvania.
authors: Michael J
authors: MJ
authors: Pontecorvo
authors: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom karl.herholz@manchester.ac.uk.
authors: Karl
authors: K
authors: Herholz
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000235:genetics; D058227:Amyloidogenic Proteins / Q000737:chemistry; D000814:Aniline Compounds; D001057:Apolipoproteins E / Q000235:genetics; D016022:Case-Control Studies; D005026:Ethylene Glycols; D005260:Female; D005462:Fluorine Radioisotopes; D057180:Frontotemporal Dementia / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005838:Genotype; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography
chemical_list: D058227:Amyloidogenic Proteins; D000814:Aniline Compounds; D001057:Apolipoproteins E; D005026:Ethylene Glycols; D005462:Fluorine Radioisotopes; C545186:florbetapir
keywords: Alzheimer’s disease; PET; amyloid; diagnosis; frontotemporal dementia