Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer’s disease

Matteo Cotta Ramusino, Valentina Garibotto, Ruggero Bacchin, Daniele Altomare, Alessandra Dodich, Frederic Assal, Aline Mendes, Alfredo Costa, Michele Tinazzi, Silvia D. Morbelli, Matteo Bauckneht, Agnese Picco, Massimo E. Dottorini, Cristina Tranfaglia, Lucia Farotti, Nicola Salvadori, Davide Moretti, Giordano Savelli, Anna Tarallo, Flavio NobiliMaura Parapini, Carlo Cavaliere, Elena Salvatore, Marco Salvatore, Marina Boccardi, Giovanni B. Frisoni

Research output: Contribution to journalArticle

Abstract

Purpose: To compare the incremental diagnostic value of amyloid-PET and CSF (Aβ42, tau, and phospho-tau) in AD diagnosis in patients with mild cognitive impairment (MCI) or mild dementia, in order to improve the definition of diagnostic algorithm. Methods: Two independent dementia experts provided etiological diagnosis and relative diagnostic confidence in 71 patients on 3 rounds, based on (1) clinical, neuropsychological, and structural MRI information alone; (2) adding one biomarker (CSF amyloid and tau levels or amyloid-PET with a balanced randomized design); and (3) adding the other biomarker. Results: Among patients with a pre-biomarker diagnosis of AD, negative PET induced significantly more diagnostic changes than amyloid-negative CSF at both rounds 2 (CSF 67%, PET 100%, P = 0.028) and 3 (CSF 0%; PET 78%, P < 0.001); PET induced a diagnostic confidence increase significantly higher than CSF on both rounds 2 and 3. Conclusions: Amyloid-PET should be prioritized over CSF biomarkers in the diagnostic workup of patients investigated for suspected AD, as it provides greater changes in diagnosis and diagnostic confidence. Trial registration: EudraCT no.: 2014-005389-31.

Original languageEnglish
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
DOIs
Publication statusPublished - Jan 1 2019

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Amyloid
Alzheimer Disease
Biomarkers
Dementia
Granulocyte-Macrophage Colony-Stimulating Factor

Keywords

  • Alzheimer’s disease
  • Cerebrospinal fluid
  • Incremental diagnostic value
  • Mild cognitive impairment
  • Positron emission tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer’s disease. / Ramusino, Matteo Cotta; Garibotto, Valentina; Bacchin, Ruggero; Altomare, Daniele; Dodich, Alessandra; Assal, Frederic; Mendes, Aline; Costa, Alfredo; Tinazzi, Michele; Morbelli, Silvia D.; Bauckneht, Matteo; Picco, Agnese; Dottorini, Massimo E.; Tranfaglia, Cristina; Farotti, Lucia; Salvadori, Nicola; Moretti, Davide; Savelli, Giordano; Tarallo, Anna; Nobili, Flavio; Parapini, Maura; Cavaliere, Carlo; Salvatore, Elena; Salvatore, Marco; Boccardi, Marina; Frisoni, Giovanni B.

In: European Journal of Nuclear Medicine and Molecular Imaging, 01.01.2019.

Research output: Contribution to journalArticle

Ramusino, MC, Garibotto, V, Bacchin, R, Altomare, D, Dodich, A, Assal, F, Mendes, A, Costa, A, Tinazzi, M, Morbelli, SD, Bauckneht, M, Picco, A, Dottorini, ME, Tranfaglia, C, Farotti, L, Salvadori, N, Moretti, D, Savelli, G, Tarallo, A, Nobili, F, Parapini, M, Cavaliere, C, Salvatore, E, Salvatore, M, Boccardi, M & Frisoni, GB 2019, 'Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer’s disease', European Journal of Nuclear Medicine and Molecular Imaging. https://doi.org/10.1007/s00259-019-04466-6
Ramusino, Matteo Cotta ; Garibotto, Valentina ; Bacchin, Ruggero ; Altomare, Daniele ; Dodich, Alessandra ; Assal, Frederic ; Mendes, Aline ; Costa, Alfredo ; Tinazzi, Michele ; Morbelli, Silvia D. ; Bauckneht, Matteo ; Picco, Agnese ; Dottorini, Massimo E. ; Tranfaglia, Cristina ; Farotti, Lucia ; Salvadori, Nicola ; Moretti, Davide ; Savelli, Giordano ; Tarallo, Anna ; Nobili, Flavio ; Parapini, Maura ; Cavaliere, Carlo ; Salvatore, Elena ; Salvatore, Marco ; Boccardi, Marina ; Frisoni, Giovanni B. / Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer’s disease. In: European Journal of Nuclear Medicine and Molecular Imaging. 2019.
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abstract = "Purpose: To compare the incremental diagnostic value of amyloid-PET and CSF (Aβ42, tau, and phospho-tau) in AD diagnosis in patients with mild cognitive impairment (MCI) or mild dementia, in order to improve the definition of diagnostic algorithm. Methods: Two independent dementia experts provided etiological diagnosis and relative diagnostic confidence in 71 patients on 3 rounds, based on (1) clinical, neuropsychological, and structural MRI information alone; (2) adding one biomarker (CSF amyloid and tau levels or amyloid-PET with a balanced randomized design); and (3) adding the other biomarker. Results: Among patients with a pre-biomarker diagnosis of AD, negative PET induced significantly more diagnostic changes than amyloid-negative CSF at both rounds 2 (CSF 67{\%}, PET 100{\%}, P = 0.028) and 3 (CSF 0{\%}; PET 78{\%}, P < 0.001); PET induced a diagnostic confidence increase significantly higher than CSF on both rounds 2 and 3. Conclusions: Amyloid-PET should be prioritized over CSF biomarkers in the diagnostic workup of patients investigated for suspected AD, as it provides greater changes in diagnosis and diagnostic confidence. Trial registration: EudraCT no.: 2014-005389-31.",
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AU - Garibotto, Valentina

AU - Bacchin, Ruggero

AU - Altomare, Daniele

AU - Dodich, Alessandra

AU - Assal, Frederic

AU - Mendes, Aline

AU - Costa, Alfredo

AU - Tinazzi, Michele

AU - Morbelli, Silvia D.

AU - Bauckneht, Matteo

AU - Picco, Agnese

AU - Dottorini, Massimo E.

AU - Tranfaglia, Cristina

AU - Farotti, Lucia

AU - Salvadori, Nicola

AU - Moretti, Davide

AU - Savelli, Giordano

AU - Tarallo, Anna

AU - Nobili, Flavio

AU - Parapini, Maura

AU - Cavaliere, Carlo

AU - Salvatore, Elena

AU - Salvatore, Marco

AU - Boccardi, Marina

AU - Frisoni, Giovanni B.

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N2 - Purpose: To compare the incremental diagnostic value of amyloid-PET and CSF (Aβ42, tau, and phospho-tau) in AD diagnosis in patients with mild cognitive impairment (MCI) or mild dementia, in order to improve the definition of diagnostic algorithm. Methods: Two independent dementia experts provided etiological diagnosis and relative diagnostic confidence in 71 patients on 3 rounds, based on (1) clinical, neuropsychological, and structural MRI information alone; (2) adding one biomarker (CSF amyloid and tau levels or amyloid-PET with a balanced randomized design); and (3) adding the other biomarker. Results: Among patients with a pre-biomarker diagnosis of AD, negative PET induced significantly more diagnostic changes than amyloid-negative CSF at both rounds 2 (CSF 67%, PET 100%, P = 0.028) and 3 (CSF 0%; PET 78%, P < 0.001); PET induced a diagnostic confidence increase significantly higher than CSF on both rounds 2 and 3. Conclusions: Amyloid-PET should be prioritized over CSF biomarkers in the diagnostic workup of patients investigated for suspected AD, as it provides greater changes in diagnosis and diagnostic confidence. Trial registration: EudraCT no.: 2014-005389-31.

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