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Hybrid PET/MRI Imaging of Alzheimer's Disease Based on 18F-AV-1451
Published on: April 18, 2025
Diagnostic utility of ASL-MRI and FDG-PET in the behavioral variant of FTD and AD
Duygu Tosun1, Norbert Schuff1, Gil D Rabinovici2
1Department of Radiology and Biomedical Imaging University of California San Francisco California.
Objective:
To compare the values of arterial spin-labeled (ASL) MRI and fluorodeoxyglucose (FDG) PET in the diagnosis of behavioral variant of frontotemporal dementia (bvFTD) and Alzheimer's disease (AD).
Methods:
Partial least squares logistic regression was used to identify voxels with diagnostic value in cerebral blood flow (CBF) and cerebral metabolic rate of glucose (CMRgl) maps from patients with bvFTD (n = 32) and AD (n = 28), who were compared with each other and with cognitively normal controls (CN, n = 15). Diagnostic values of these maps were compared with each other.
Results:
Regions that differentiated each disorder from controls were similar for CBF and CMRgl. For differentiating AD from CN, the areas under the curve (AUC) for CBF (0.89) and CMRgl (0.91) were similar, with similar sensitivity (CBF: 86%, CMRgl: 78%) and specificity (CBF: 92%, CMRgl: 100%). Likewise, for differentiating bvFTD from CN performances of CBF (AUC = 0.83) and CMRgl (AUC = 0.85) were equivalent, with similar sensitivity (CBF: 78%, CMRgl: 79%) and specificity (CBF: 92%, CMRgl: 100%). In differentiating bvFTD from AD, classification was again similar for CBF (AUC = 0.87) and CMRgl (AUC = 0.79), as were sensitivity (CBF: 83%, CMRgl: 89%) and specificity (CBF: 93%, CMRgl: 78%). None of the differences in any performance measure were statistically significant.
Interpretation:
ASL-MRI has similar diagnostic utility as FDG-PET in the diagnosis of AD and bvFTD. Continued development of ASL-MRI as a diagnostic tool for neurodegenerative dementias is warranted.
Insights
Arterial spin-labeled MRI and fluorodeoxyglucose PET show similar diagnostic value for Alzheimer's disease and frontotemporal dementia. Further development of ASL-MRI is recommended for diagnosing neurodegenerative dementias.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) are common neurodegenerative dementias.
- Accurate diagnosis is crucial for effective management and treatment.
- Cerebral blood flow (CBF) and glucose metabolism are key biomarkers for differentiating these conditions.
Purpose of the Study:
- To compare the diagnostic accuracy of arterial spin-labeled magnetic resonance imaging (ASL-MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET).
- To evaluate the utility of ASL-MRI and FDG-PET in distinguishing between bvFTD, AD, and cognitively normal controls.
Main Methods:
- Partial least squares logistic regression was employed to analyze CBF maps from ASL-MRI and cerebral metabolic rate of glucose (CMRgl) maps from FDG-PET.
- Patients with bvFTD (n=32) and AD (n=28) were compared with cognitively normal controls (n=15).
- Diagnostic performance was assessed using area under the curve (AUC), sensitivity, and specificity.
Main Results:
- ASL-MRI and FDG-PET demonstrated comparable diagnostic performance in differentiating AD from controls (AUCs 0.89 vs 0.91) and bvFTD from controls (AUCs 0.83 vs 0.85).
- Classification performance between bvFTD and AD was also similar for both modalities (AUCs 0.87 vs 0.79).
- No statistically significant differences were found in sensitivity or specificity between ASL-MRI and FDG-PET for any comparison.
Conclusions:
- ASL-MRI offers similar diagnostic utility to FDG-PET for diagnosing AD and bvFTD.
- ASL-MRI shows promise as a valuable, non-invasive tool for the diagnosis of neurodegenerative dementias.
- Continued research and development of ASL-MRI techniques are warranted.
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