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Comparing 18 F-AV-1451 with CSF t-tau and p-tau for diagnosis of Alzheimer disease

Mattsson, Niklas LU ; Smith, Ruben LU ; Strandberg, Olof LU ; Palmqvist, Sebastian LU ; Schöll, Michael LU ; Insel, Philip S. LU ; Hägerström, Douglas LU ; Ohlsson, Tomas; Zetterberg, Henrik LU and Blennow, Kaj LU , et al. (2018) In Neurology 90(5). p.388-395
Abstract

Objective To compare PET imaging of tau pathology with CSF measurements (total tau [t-tau] and phosphorylated tau [p-tau]) in terms of diagnostic performance for Alzheimer disease (AD). Methods We compared t-tau and p-tau and 18 F-AV-1451 in 30 controls, 14 patients with prodromal AD, and 39 patients with Alzheimer dementia, recruited from the Swedish BioFINDER study. All patients with AD (prodromal and dementia) were screened for amyloid positivity using CSF β-amyloid 42. Retention of 18 F-AV-1451 was measured in a priori specified regions, selected for known associations with tau pathology in AD. Results Retention of 18 F-AV-1451 was markedly elevated in Alzheimer dementia and moderately elevated in prodromal AD. CSF t-tau and p-tau... (More)

Objective To compare PET imaging of tau pathology with CSF measurements (total tau [t-tau] and phosphorylated tau [p-tau]) in terms of diagnostic performance for Alzheimer disease (AD). Methods We compared t-tau and p-tau and 18 F-AV-1451 in 30 controls, 14 patients with prodromal AD, and 39 patients with Alzheimer dementia, recruited from the Swedish BioFINDER study. All patients with AD (prodromal and dementia) were screened for amyloid positivity using CSF β-amyloid 42. Retention of 18 F-AV-1451 was measured in a priori specified regions, selected for known associations with tau pathology in AD. Results Retention of 18 F-AV-1451 was markedly elevated in Alzheimer dementia and moderately elevated in prodromal AD. CSF t-tau and p-tau was increased to similar levels in both AD dementia and prodromal AD. 18 F-AV-1451 had very good diagnostic performance for Alzheimer dementia (area under the receiver operating characteristic curve [AUROC] ∼1.000), and was significantly better than t-tau (0.876), p-tau (0.890), hippocampal volume (0.824), and temporal cortical thickness (0.860). For prodromal AD, there were no significant AUROC differences between CSF tau and 18 F-AV-1451 measures (0.836-0.939), but MRI measures had lower AUROCs (0.652-0.769). Conclusions CSF tau and 18 F-AV-1451 have equal performance in early clinical stages of AD, but 18 F-AV-1451 is superior in the dementia stage, and exhibits close to perfect diagnostic performance for mild to moderate AD. Classification of evidence This study provides Class III evidence that CSF tau and 18 F-AV-1451 PET have similar performance in identifying early AD, and that 18 F-AV-1451 PET is superior to CSF tau in identifying mild to moderate AD.

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published
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Neurology
volume
90
issue
5
pages
388 - 395
publisher
American Academy of Neurology
external identifiers
  • scopus:85049785075
ISSN
0028-3878
DOI
10.1212/WNL.0000000000004887
language
English
LU publication?
yes
id
fc515405-ddc9-45cf-9c69-f94512df15cd
date added to LUP
2018-09-18 14:48:34
date last changed
2019-03-19 03:59:30
@article{fc515405-ddc9-45cf-9c69-f94512df15cd,
  abstract     = {<p>Objective To compare PET imaging of tau pathology with CSF measurements (total tau [t-tau] and phosphorylated tau [p-tau]) in terms of diagnostic performance for Alzheimer disease (AD). Methods We compared t-tau and p-tau and 18 F-AV-1451 in 30 controls, 14 patients with prodromal AD, and 39 patients with Alzheimer dementia, recruited from the Swedish BioFINDER study. All patients with AD (prodromal and dementia) were screened for amyloid positivity using CSF β-amyloid 42. Retention of 18 F-AV-1451 was measured in a priori specified regions, selected for known associations with tau pathology in AD. Results Retention of 18 F-AV-1451 was markedly elevated in Alzheimer dementia and moderately elevated in prodromal AD. CSF t-tau and p-tau was increased to similar levels in both AD dementia and prodromal AD. 18 F-AV-1451 had very good diagnostic performance for Alzheimer dementia (area under the receiver operating characteristic curve [AUROC] ∼1.000), and was significantly better than t-tau (0.876), p-tau (0.890), hippocampal volume (0.824), and temporal cortical thickness (0.860). For prodromal AD, there were no significant AUROC differences between CSF tau and 18 F-AV-1451 measures (0.836-0.939), but MRI measures had lower AUROCs (0.652-0.769). Conclusions CSF tau and 18 F-AV-1451 have equal performance in early clinical stages of AD, but 18 F-AV-1451 is superior in the dementia stage, and exhibits close to perfect diagnostic performance for mild to moderate AD. Classification of evidence This study provides Class III evidence that CSF tau and 18 F-AV-1451 PET have similar performance in identifying early AD, and that 18 F-AV-1451 PET is superior to CSF tau in identifying mild to moderate AD.</p>},
  author       = {Mattsson, Niklas and Smith, Ruben and Strandberg, Olof and Palmqvist, Sebastian and Schöll, Michael and Insel, Philip S. and Hägerström, Douglas and Ohlsson, Tomas and Zetterberg, Henrik and Blennow, Kaj and Jögi, Jonas and Hansson, Oskar},
  issn         = {0028-3878},
  language     = {eng},
  month        = {01},
  number       = {5},
  pages        = {388--395},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Comparing 18 F-AV-1451 with CSF t-tau and p-tau for diagnosis of Alzheimer disease},
  url          = {http://dx.doi.org/10.1212/WNL.0000000000004887},
  volume       = {90},
  year         = {2018},
}