title: Feasibility and acceptance of simultaneous amyloid PET/MRI.
abstract: OBJECTIVE
  Established Alzheimer's disease (AD) biomarker concepts classify into amyloid pathology and neuronal injury biomarkers, while recent alternative concepts classify into diagnostic and progression AD biomarkers. However, combined amyloid positron emission tomography/magnetic resonance imaging (PET/MRI) offers the chance to obtain both biomarker category read-outs within one imaging session, with increased patient as well as referrer convenience. The aim of this pilot study was to investigate this matter for the first time.
  
  
  METHODS
  100 subjects (age 70 ± 10 yrs, 46 female), n = 51 with clinically defined mild cognitive impairment (MCI), n = 44 with possible/probable AD dementia, and n = 5 with frontotemporal lobe degeneration, underwent simultaneous [18F]florbetaben or [11C]PIB PET/MRI (3 Tesla Siemens mMR). Brain amyloid load, mesial temporal lobe atrophy (MTLA) by means of the Scheltens scale, and other morphological brain pathologies were scored by respective experts. The patients/caregivers as well as the referrers were asked to assess on a five-point scale the convenience related to the one-stop-shop PET and MRI approach.
  
  
  RESULTS
  In three subjects, MRI revealed temporal lobe abnormalities other than MTLA. According to the National Institute on Aging-Alzheimer's Association classification, the combined amyloid-beta PET/MRI evaluation resulted in 31 %, 45 %, and 24 % of the MCI subjects being categorized as "MCI-unlikely due to AD", "MCI due to AD-intermediate likelihood", and "MCI due to AD-high likelihood", respectively. 50 % of the probable AD dementia patients were categorized as "High level of evidence of AD pathophysiological process", and 56 % of the possible AD dementia patients as "Possible AD dementia - with evidence of AD pathophysiological process". With regard to the International Working Group 2 classification, 36 subjects had both positive diagnostic and progression biomarkers. The patient/caregiver survey revealed a gain of convenience in 88 % of responders as compared to a theoretically separate PET and MR imaging. In the referrer survey, an influence of the combined amyloid-beta PET/MRI on the final diagnosis was reported by 82 % of responders, with a referrer acceptance score of 3.7 ± 1.0 on a 5-point scale.
  
  
  CONCLUSIONS
  Simultaneous amyloid PET/MRI is feasible and provides imaging biomarkers of all categories which are able to supplement the clinical diagnosis of MCI due to AD and that of AD dementia. Further, patient and referrer convenience is improved by this one-stop-shop imaging approach.
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Schütz
authors.affiliation: Department of Neuroradiology, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Donald
authors.initials: D
authors.lastname: Lobsien
authors.affiliation: Department of Neuroradiology, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Fritzsch
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
authors.forename: Solveig
authors.initials: S
authors.lastname: Tiepolt
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Werner
authors.affiliation: Day Clinic for Cognitive Neurology, Leipzig University Hospital & Max Planck Institute for Human Cognitive and Brain Sciences, 04103, Leipzig, Germany.|IFB Adiposity Diseases, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Matthias L
authors.initials: ML
authors.lastname: Schroeter
authors.affiliation: Clinical Centre Altenburger Land, 04600, Altenburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Berrouschot
authors.affiliation: Department of Neurology, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Saur
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.|IFB Adiposity Diseases, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Swen
authors.initials: S
authors.lastname: Hesse
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
authors.forename: Thies
authors.initials: T
authors.lastname: Jochimsen
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rullmann
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Sattler
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
authors.forename: Marianne
authors.initials: M
authors.lastname: Patt
authors.affiliation: Department of Psychiatry, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Hermann-Josef
authors.initials: HJ
authors.lastname: Gertz
authors.affiliation: Day Clinic for Cognitive Neurology, Leipzig University Hospital & Max Planck Institute for Human Cognitive and Brain Sciences, 04103, Leipzig, Germany.|IFB Adiposity Diseases, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Arno
authors.initials: A
authors.lastname: Villringer
authors.affiliation: Department of Neurology, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Joseph
authors.initials: J
authors.lastname: Claßen
authors.affiliation: Department of Neuroradiology, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Karl-Titus
authors.initials: KT
authors.lastname: Hoffmann
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.|IFB Adiposity Diseases, Leipzig University Hospital, 04103, Leipzig, Germany.
authors.forename: Osama
authors.initials: O
authors.lastname: Sabri
authors.affiliation: Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany. barh@medizin.uni-leipzig.de.
authors.forename: Henryk
authors.initials: H
authors.lastname: Barthel
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000378:metabolism; D000682:Amyloid / Q000378:metabolism*; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000378:metabolism; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000378:metabolism; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D057054:Molecular Imaging / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods; D010342:Patient Acceptance of Health Care; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000682:Amyloid; D015415:Biomarkers
keywords: Alzheimer’s disease; Amyloid; MCI; PET/MRI