title: Clinical impact and diagnostic accuracy of 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography/computed tomography (PET/CT) brain imaging in patients with cognitive impairment: a tertiary centre experience in the UK.
abstract: OBJECTIVE
  To evaluate the clinical impact of combined 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) brain imaging performed in selected patients with cognitive impairment at a tertiary referral centre in the UK, and to assess the accuracy of FDG PET/CT to correctly establish the diagnosis of Alzheimer's dementia (AD) in "real-world" clinical practice.
  
  
  METHODS
  Using an institutional radiology database, 136 patients were identified for inclusion in the study. FDG PET/CT was performed using a standard technique and interpreted by dual-trained radiologists and nuclear medicine physicians. Standardised questionnaires were sent to the referring clinicians to establish the final clinical diagnosis and to obtain information about the clinical impact of FDG PET/CT.
  
  
  RESULTS
  There was a 72% questionnaire return (98/136), with mean patient follow-up of 471 (standard deviation 205) days. FDG PET/CT had an impact on patient management in 81%, adding confidence to the pre-test diagnosis in 43%, changing the pre-test diagnosis in 35%, reducing the need for further investigations in 42%, and resulting in a change in therapy in 32%. There was substantial correlation between the PET/CT diagnosis and final clinical diagnosis with a correlation (k) coefficient of 0.78 (p<0.0001). The accuracy of FDG PET/CT in diagnosis of AD was 94% (95% confidence interval [CI]: 87-99), with a sensitivity of 87% (95% CI: 75-92) and a specificity of 97% (95% CI: 87-99).
  
  
  CONCLUSIONS
  FDG PET/CT brain imaging has a significant clinical impact when performed selectively in patients with cognitive impairment and shows high accuracy in the diagnosis of AD in "real-world" clinical practice.
authors.affiliation: University of Leeds, Leeds, UK.
authors.forename: H
authors.initials: H
authors.lastname: Motara
authors.affiliation: Psychiatry for the Elderly, Tees, Esk and Wear Valleys NHS Foundation Trust, Harrogate, UK.
authors.forename: T
authors.initials: T
authors.lastname: Olusoga
authors.affiliation: Psychiatry for the Elderly, Bradford and District Care Foundation Trust, Saltaire, UK.
authors.forename: G
authors.initials: G
authors.lastname: Russell
authors.affiliation: Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jamieson
authors.affiliation: Psychiatry for the Elderly, Tees, Esk and Wear Valleys NHS Foundation Trust, Harrogate, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Psychiatry, Leeds and York Partnerships Foundation Trust, Leeds, UK.
authors.forename: N
authors.initials: N
authors.lastname: Brindle
authors.affiliation: Psychiatry for the Elderly, Bradford and District Care Foundation Trust, Saltaire, UK.
authors.forename: A
authors.initials: A
authors.lastname: Pillai
authors.affiliation: Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: A F
authors.initials: AF
authors.lastname: Scarsbrook
authors.affiliation: Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: C N
authors.initials: CN
authors.lastname: Patel
authors.affiliation: Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: Fahmid.Chowdhury@nhs.net.
authors.forename: F U
authors.initials: FU
authors.lastname: Chowdhury
mesh_terms: D000328:Adult; D000368:Aged; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D003287:Contrast Media; D019788:Fluorodeoxyglucose F18