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Diagnostic Accuracy of MRI and Additional [18F]FDG-PET for Behavioral Variant Frontotemporal Dementia in Patients
Everard G B Vijverberg1,2, Mike P Wattjes3, Annemiek Dols4
1Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.
Background:
Neuroimaging has a reasonable accuracy to differentiate behavioral variant frontotemporal dementia (bvFTD) from other neurodegenerative disorders, its value for the differentiation of bvFTD among subjects with acquired behavioral disturbances is unknown.
Objective:
To determine the diagnostic accuracy of MRI, additional [18F]FDG-PET, and their combination for bvFTD among subjects with late onset behavioral changes.
Methods:
Patients with late onset behavioral changes referred to a memory clinic or psychiatric services were included. At baseline, 111 patients had a brain MRI scan and 74 patients received an additional [18F]FDG-PET when the MRI was inconclusive. The consensus diagnosis after two-year-follow-up was used as the gold standard to calculate sensitivity and specificity for baseline neuroimaging.
Results:
27 patients had probable/definite bvFTD and 84 patients had a non-bvFTD diagnosis (primary psychiatric diagnosis or other neurological disorders). MRI had a sensitivity of 70% (95% CI 52-85%) with a specificity of 93% (95% CI 86-97%). Additional [18F]FDG-PET had a sensitivity of 90% (95% CI 66-100%) with a specificity of 68% (95% CI 56-79%). The sensitivity of combined neuroimaging was 96% (95% CI 85-100%) with a specificity of 73% (95% CI 63-81%). In 66% of the genetic FTD cases, MRI lacked typical frontotemporal atrophy. 40% of cases with a false positive [18F]FDG-PET scan had a primary psychiatric diagnosis.
Conclusion:
A good diagnostic accuracy was found for MRI and additional [18F]FDG-PET for bvFTD in patients with late onset behavioral changes. Caution with the interpretation of neuroimaging results should especially be taken in cases with a genetic background and in cases with a primary psychiatric differential diagnosis where [18F]FDG-PET is the only abnormal investigation.
Insights
Neuroimaging accurately diagnoses behavioral variant frontotemporal dementia (bvFTD) in patients with late-onset behavioral changes. Combined MRI and [18F]FDG-PET offer high sensitivity, but interpretation requires caution in genetic or psychiatric cases.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Neuroimaging shows promise in differentiating behavioral variant frontotemporal dementia (bvFTD) from other neurodegenerative disorders.
- The diagnostic value of neuroimaging for bvFTD in patients with acquired behavioral disturbances remains unclear.
Purpose of the Study:
- To assess the diagnostic accuracy of MRI, [18F]FDG-PET, and their combination for identifying bvFTD in individuals with late-onset behavioral changes.
- To determine the sensitivity and specificity of these neuroimaging techniques.
Main Methods:
- Patients with late-onset behavioral changes underwent baseline brain MRI.
- 74 patients received additional [18F]FDG-PET if MRI results were inconclusive.
- A two-year follow-up consensus diagnosis served as the gold standard.
Main Results:
- MRI demonstrated 70% sensitivity and 93% specificity for bvFTD.
- [18F]FDG-PET showed 90% sensitivity and 68% specificity.
- Combined imaging achieved 96% sensitivity and 73% specificity.
- MRI missed typical atrophy in 66% of genetic FTD cases; 40% of false positive [18F]FDG-PET scans were in psychiatric patients.
Conclusions:
- MRI and [18F]FDG-PET offer good diagnostic accuracy for bvFTD in patients with late-onset behavioral changes.
- Interpretation of neuroimaging requires caution, particularly in genetic FTD cases or when psychiatric disorders are the primary differential diagnosis.
- Combined imaging provides the highest diagnostic performance, but careful consideration of differential diagnoses is crucial.
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