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Why Is Amyloid-β PET Requested After Performing CSF Biomarkers?

Reimand, Juhan ; Groot, Colin ; Teunissen, Charlotte E. ; Windhorst, Albert D. ; Boellaard, Ronald ; Barkhof, Frederik ; Nazarenko, Sergei ; van der Flier, Wiesje M. ; van Berckel, Bart N.M. and Scheltens, Philip , et al. (2020) In Journal of Alzheimer's disease : JAD 73(2). p.559-569
Abstract

BACKGROUND: Amyloid-β positron emission tomography (PET) and cerebrospinal fluid (CSF) Aβ42 are considered interchangeable for clinical diagnosis of Alzheimer's disease. OBJECTIVE: To explore the clinical reasoning for requesting additional amyloid-β PET after performing CSF biomarkers. METHODS: We retrospectively identified 72 memory clinic patients who underwent amyloid-β PET after CSF biomarkers analysis for clinical diagnostic evaluation between 2011 and 2019. We performed patient chart reviews to identify factors which led to additional amyloid-β PET. Additionally, we assessed accordance with appropriate-use-criteria (AUC) for amyloid-β PET. RESULTS: Mean patient age was 62.0 (SD = 8.1) and mean Mini-Mental State Exam score was... (More)

BACKGROUND: Amyloid-β positron emission tomography (PET) and cerebrospinal fluid (CSF) Aβ42 are considered interchangeable for clinical diagnosis of Alzheimer's disease. OBJECTIVE: To explore the clinical reasoning for requesting additional amyloid-β PET after performing CSF biomarkers. METHODS: We retrospectively identified 72 memory clinic patients who underwent amyloid-β PET after CSF biomarkers analysis for clinical diagnostic evaluation between 2011 and 2019. We performed patient chart reviews to identify factors which led to additional amyloid-β PET. Additionally, we assessed accordance with appropriate-use-criteria (AUC) for amyloid-β PET. RESULTS: Mean patient age was 62.0 (SD = 8.1) and mean Mini-Mental State Exam score was 23.6 (SD = 3.8). CSF analysis conflicting with the clinical diagnosis was the most frequent reason for requesting an amyloid-β PET scan (n = 53, 74%), followed by incongruent MRI (n = 16, 22%), unusual clinical presentation (n = 11, 15%) and young age (n = 8, 11%). An amyloid-β PET scan was rarely (n = 5, 7%) requested in patients with a CSF Aβ+/tau+ status. Fifteen (47%) patients with a post-PET diagnosis of AD had a predominantly non-amnestic presentation. In n = 11 (15%) cases, the reason that the clinician requested amyloid-β was not covered by AUC. This happened most often (n = 7) when previous CSF analysis did not support current clinical diagnosis, which led to requesting amyloid-β PET. CONCLUSION: In this single-center study, the main reason for requesting an amyloid-β PET scan after performing CSF biomarkers was the occurrence of a mismatch between the primary clinical diagnosis and CSF Aβ/tau results.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alzheimer’s disease, amyloid, cerebrospinal fluid, positron emission tomography, tau proteins
in
Journal of Alzheimer's disease : JAD
volume
73
issue
2
pages
11 pages
publisher
IOS Press
external identifiers
  • pmid:31796674
  • scopus:85078507057
ISSN
1387-2877
DOI
10.3233/JAD-190836
language
English
LU publication?
yes
id
7831eec0-78aa-4978-bdf8-93da45bb42df
date added to LUP
2020-02-06 15:03:44
date last changed
2020-05-08 03:00:56
@article{7831eec0-78aa-4978-bdf8-93da45bb42df,
  abstract     = {<p>BACKGROUND: Amyloid-β positron emission tomography (PET) and cerebrospinal fluid (CSF) Aβ42 are considered interchangeable for clinical diagnosis of Alzheimer's disease. OBJECTIVE: To explore the clinical reasoning for requesting additional amyloid-β PET after performing CSF biomarkers. METHODS: We retrospectively identified 72 memory clinic patients who underwent amyloid-β PET after CSF biomarkers analysis for clinical diagnostic evaluation between 2011 and 2019. We performed patient chart reviews to identify factors which led to additional amyloid-β PET. Additionally, we assessed accordance with appropriate-use-criteria (AUC) for amyloid-β PET. RESULTS: Mean patient age was 62.0 (SD = 8.1) and mean Mini-Mental State Exam score was 23.6 (SD = 3.8). CSF analysis conflicting with the clinical diagnosis was the most frequent reason for requesting an amyloid-β PET scan (n = 53, 74%), followed by incongruent MRI (n = 16, 22%), unusual clinical presentation (n = 11, 15%) and young age (n = 8, 11%). An amyloid-β PET scan was rarely (n = 5, 7%) requested in patients with a CSF Aβ+/tau+ status. Fifteen (47%) patients with a post-PET diagnosis of AD had a predominantly non-amnestic presentation. In n = 11 (15%) cases, the reason that the clinician requested amyloid-β was not covered by AUC. This happened most often (n = 7) when previous CSF analysis did not support current clinical diagnosis, which led to requesting amyloid-β PET. CONCLUSION: In this single-center study, the main reason for requesting an amyloid-β PET scan after performing CSF biomarkers was the occurrence of a mismatch between the primary clinical diagnosis and CSF Aβ/tau results.</p>},
  author       = {Reimand, Juhan and Groot, Colin and Teunissen, Charlotte E. and Windhorst, Albert D. and Boellaard, Ronald and Barkhof, Frederik and Nazarenko, Sergei and van der Flier, Wiesje M. and van Berckel, Bart N.M. and Scheltens, Philip and Ossenkoppele, Rik and Bouwman, Femke},
  issn         = {1387-2877},
  language     = {eng},
  month        = {01},
  number       = {2},
  pages        = {559--569},
  publisher    = {IOS Press},
  series       = {Journal of Alzheimer's disease : JAD},
  title        = {Why Is Amyloid-β PET Requested After Performing CSF Biomarkers?},
  url          = {http://dx.doi.org/10.3233/JAD-190836},
  doi          = {10.3233/JAD-190836},
  volume       = {73},
  year         = {2020},
}