title: An evidence-based algorithm for the utility of FDG-PET for diagnosing Alzheimer's disease according to presence of medial temporal lobe atrophy.
abstract: Imaging biomarkers for Alzheimer's disease include medial temporal lobe atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose positron emission tomography (FDG-PET).
  
  
  
  To investigate whether MTLA on head CT predicts the diagnostic usefulness of an additional FDG-PET scan.
  
  
  
  Participants had a clinical diagnosis of Alzheimer's disease (n = 37) or dementia with Lewy bodies (DLB; n = 30) or were similarly aged controls (n = 30). We visually rated MTLA on coronally reconstructed CT scans and, separately and blind to CT ratings, abnormal appearances on FDG-PET scans.
  
  
  
  Using a pre-defined cut-off of MTLA ⩾5 on the Scheltens (0-8) scale, 0/30 controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET performed well for diagnosing Alzheimer's disease v DLB in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the high-MTLA group diagnostic performance of FDG-PET was not better than chance.
  
  
  
  In the presence of a high degree of MTLA, the most likely diagnosis is Alzheimer's disease, and an FDG-PET scan will probably not provide significant diagnostic information. However, in cases without MTLA, if the diagnosis is unclear, an FDG-PET scan may provide additional clinically useful diagnostic information.
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK michael.firbank@ncl.ac.uk.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Firbank
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Barber
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Colloby
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Barnett
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Olsen
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Davison
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Karl
authors.initials: K
authors.lastname: Herholz
authors.affiliation: Michael J. Firbank, PhD, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne and Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; Jim Lloyd, PhD, Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; David Williams, PhD, Robert Barber, MD, Sean J. Colloby, PhD, Nicky Barnett, BSc, Kirsty Olsen, BSc, Christopher Davison, MRCPsych, Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne; Cam Donaldson, PhD, Institute of Health and Society, Newcastle University, Newcastle upon Tyne and Yunus Centre, Glasgow Caledonian University, Glasgow; Karl Herholz, PhD, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviours and Mental Health, University of Manchester, Manchester; John T. O'Brien, DM, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge and Institute for Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: John T
authors.initials: JT
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000378:metabolism*; D001284:Atrophy / Q000000981:diagnostic imaging; D055317:Evidence-Based Practice; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D020961:Lewy Body Disease / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008297:Male; D000072078:Positron Emission Tomography Computed Tomography / Q000592:standards; D049268:Positron-Emission Tomography / Q000592:standards*; D013702:Temporal Lobe / Q000000981:diagnostic imaging*
chemical_list: D019788:Fluorodeoxyglucose F18