Predicting amyloid status in corticobasal syndrome using modified clinical criteria, magnetic resonance imaging and fluorodeoxyglucose positron emission tomography.
BACKGROUND
Group comparisons demonstrate greater visuospatial and memory deficits and temporoparietal-predominant degeneration on neuroimaging in patients with corticobasal syndrome (CBS) found to have Alzheimer's disease (AD) pathology versus those with underlying frontotemporal lobar degeneration (FTLD). The value of these features in predicting underlying AD pathology in individual patients is unknown. The goal of this study is to evaluate the utility of modified clinical criteria and visual interpretations of magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET) for predicting amyloid deposition (as a surrogate of Alzheimer's disease neuropathology) in patients presenting with CBS.


METHODS
In total, 25 patients meeting CBS core criteria underwent amyloid (Pittsburgh compound B; PIB) PET scans. Clinical records, MRI, and FDG scans were reviewed blinded to PIB results. Modified clinical criteria were used to classify CBS patients as temporoparietal variant CBS (tpvCBS) or frontal variant CBS (fvCBS). MRI and FDG-PET were classified based on the predominant atrophy/hypometabolism pattern (frontal or temporoparietal).


RESULTS
A total of 9 out of 13 patients classified as tpvCBS were PIB+, compared to 2out of 12 patients classified as fvCBS (P < 0.01, sensitivity 82%, specificity 71% for PIB+ status). Visual MRI reads had 73% sensitivity and 46% specificity for PIB+ status with moderate intra-rater reliability (Cohen's kappa = 0.42). Visual FDG reads had higher sensitivity (91%) for PIB+ status with perfect intra-rater reliability (kappa = 1.00), though specificity was low (50%). PIB results were confirmed in all 8 patients with available histopathology (3 PIB+ with confirmed AD, 5 PIB- with FTLD).


CONCLUSIONS
Splitting CBS patients into frontal or temporoparietal clinical variants can help predict the likelihood of underlying AD, but criteria require further refinement. Temporoparietal-predominant neuroimaging patterns are sensitive but not specific for AD.
Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive, Rm A343, Stanford, CA 94305 USA.
Sharon J
SJ
Sha
Department of Neurology, University of California, San Francisco, San Francisco, CA USA ; Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA USA.
Pia M
PM
Ghosh
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
Suzee E
SE
Lee
Department of Neurology, University of California, San Francisco, San Francisco, CA USA ; Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA USA.
Chiara
C
Corbetta-Rastelli
Department of Neurology, University of California, San Francisco, San Francisco, CA USA ; Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA USA ; Lawrence Berkeley National Laboratory, Berkeley, CA USA.
Willian J
WJ
Jagust
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA USA.
John
J
Kornak
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
Katherine P
KP
Rankin
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
Lea T
LT
Grinberg
Department of Neurology, University of California, Los Angeles, CA USA ; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA USA.
Harry V
HV
Vinters
Department of Neurology, University of California, Los Angeles, CA USA.
Mario F
MF
Mendez
Department of Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL USA.
Dennis W
DW
Dickson
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
William W
WW
Seeley
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
Marilu
M
Gorno-Tempini
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
Joel
J
Kramer
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
Bruce L
BL
Miller
Department of Neurology, University of California, San Francisco, San Francisco, CA USA.
Adam L
AL
Boxer
Department of Neurology, University of California, San Francisco, San Francisco, CA USA ; Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA USA ; Lawrence Berkeley National Laboratory, Berkeley, CA USA.
Gil D
GD
Rabinovici