Brain Advance Access published online on August 18, 2007
Brain, doi:10.1093/brain/awm177
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FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease
1Center for Alzheimer's Care, Imaging and Research and Department of Neurology, University of Utah, 2Department of Neurology, University of Michigan, 3Division of Nuclear Medicine, University of Michigan, 4Ann Arbor Veterans Administration Hospital, 5Alzheimer's Disease Center, Institute on Aging and Department of Neurology, University of Pennsylvania, 6Department of Psychiatry, University of Pennsylvania, 7Department of Neuroscience, University of California, 8Department of Neurology, University of California at Davis, 9BIATECH Institute and 10Department of Radiology, University of Washington, USA
Correspondence to:
Norman L. Foster, MD, 650 Komas Drive, #106-A, Salt Lake City, UT 84108-1225, USA E-mail: norman.foster{at}hsc.utah.edu
Distinguishing Alzheimer's disease (AD) and frontotemporal dementia (FTD) currently relies on a clinical history and examination, but positron emission tomography with [18F] fluorodeoxyglucose (FDG-PET) shows different patterns of hypometabolism in these disorders that might aid differential diagnosis. Six dementia experts with variable FDG-PET experience made independent, forced choice, diagnostic decisions in 45 patients with pathologically confirmed AD (n = 31) or FTD (n = 14) using five separate methods: (1) review of clinical summaries, (2) a diagnostic checklist alone, (3) summary and checklist, (4) transaxial FDG-PET scans and (5) FDG-PET stereotactic surface projection (SSP) metabolic and statistical maps. In addition, we evaluated the effect of the sequential review of a clinical summary followed by SSP. Visual interpretation of SSP images was superior to clinical assessment and had the best inter-rater reliability (mean kappa = 0.78) and diagnostic accuracy (89.6%). It also had the highest specificity (97.6%) and sensitivity (86%), and positive likelihood ratio for FTD (36.5). The addition of FDG-PET to clinical summaries increased diagnostic accuracy and confidence for both AD and FTD. It was particularly helpful when raters were uncertain in their clinical diagnosis. Visual interpretation of FDG-PET after brief training is more reliable and accurate in distinguishing FTD from AD than clinical methods alone. FDG-PET adds important information that appropriately increases diagnostic confidence, even among experienced dementia specialists.
Key Words: Alzheimer's disease; PET; FDG; frontotemporal dementia
Abbreviations: AD, Alzheimer's disease; FDG, fluorodeoxyglucose; FTD, frontotemporal dementia
Received February 21, 2007. Revised July 6, 2007. Accepted July 11, 2007.
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