title: Imaging characteristic of dual-phase (18)F-florbetapir (AV-45/Amyvid) PET for the concomitant detection of perfusion deficits and beta-amyloid deposition in Alzheimer's disease and mild cognitive impairment.
abstract: OBJECTIVE
  We investigated dual-phase (18)F-florbetapir (AV-45/Amyvid) PET imaging for the concomitant detection of brain perfusion deficits and beta-amyloid deposition in patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI), and in cognitively healthy controls (HCs).
  
  
  METHODS
  A total of 82 subjects (24 AD patients, 44 MCI patients and 14 HCs) underwent both dual-phase (18)F-AV-45 PET and MRI imaging. Dual-phase dynamic PET imaging consisted of (1) five 1-min scans obtained 1 - 6 min after tracer injection (perfusion (18)F-AV-45 imaging, pAV-45), and (2) ten 1-min scans obtained 50 - 60 min after tracer injection (amyloid (18)F-AV-45 imaging). Amyloid-negative MCI/AD patients were excluded. Volume of interest analysis and statistical parametric mapping of pAV-45 and (18)F-AV-45 images were performed to investigate the perfusion deficits and the beta-amyloid burden in the three study groups. The associations between Mini-Mental State Examination (MMSE) scores and global perfusion deficits and amyloid deposition were investigated with linear and segmental linear correlation analyses.
  
  
  RESULTS
  HCs generally had normal pAV-45 findings, whereas perfusion deficits were evident in the hippocampus, and temporal, parietal and middle frontal cortices in both MCI and AD patients. The motor-sensory cortex was relatively preserved. MMSE scores in the entire study cohort were significantly associated with the degree of perfusion impairment as assessed by pAV-45 imaging (r = 0.5156, P < 0.0001). (18)F-AV-45 uptake was significantly higher in AD patients than in the two other study groups. However, the correlation between MMSE scores and (18)F-AV-45 uptake in MCI patients was more of a binary phenomenon and began in MCI patients with MMSE score 23.14 when (18)F-AV-45 uptake was higher and MMSE score lower than in patients with early MCI. Amyloid deposition started in the precuneus and the frontal and temporal regions in early MCI, ultimately reaching the maximum burden in advanced MCI.
  
  
  CONCLUSIONS
  Our results indicate that brain perfusion deficits and beta-amyloid deposition in AD follow different trajectories that can be successfully traced using dual-phase (18)F-AV-45 PET imaging.
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and University, 5. Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan, Taiwan. lin4857@adm.cgmh.org.tw.|Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. lin4857@adm.cgmh.org.tw.
authors.forename: Kun-Ju
authors.identifier: http://orcid.org/0000-0003-1933-4564
authors.initials: KJ
authors.lastname: Lin
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and University, 5. Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan, Taiwan.|Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ing-Tsung
authors.initials: IT
authors.lastname: Hsiao
authors.affiliation: Section of Dementia and Cognitive Impairment, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jung-Lung
authors.initials: JL
authors.lastname: Hsu
authors.affiliation: Department of Neurology, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Neurology, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Kuo-Lun
authors.initials: KL
authors.lastname: Huang
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and University, 5. Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan, Taiwan.|Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chia-Ju
authors.initials: CJ
authors.lastname: Hsieh
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and University, 5. Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan, Taiwan.|Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shiaw-Pyng
authors.initials: SP
authors.lastname: Wey
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and University, 5. Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan, Taiwan.|Department of Medical Imaging and Radiological Sciences and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D016229:Amyloid beta-Peptides / Q000378:metabolism*; D000814:Aniline Compounds / Q000378:metabolism; D001692:Biological Transport; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D005026:Ethylene Glycols / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography
chemical_list: D016229:Amyloid beta-Peptides; D000814:Aniline Compounds; D005026:Ethylene Glycols; C545186:florbetapir
keywords: 18F-Florbetapir (AV-45/Amyvid); Alzheimer’s disease; Amyloid; Dementia; Dual-phase scan; Mild cognitive impairment; Perfusion deficits