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Amyloid PET Z Score Quantification and Correlation with Visual Semiquantitative Grading.
Divya Yadav1, Ashley Knight-Greenfield1, Joseph Moirano1
1From the Department of Radiology (D.Y., A.K.-G., J.M., S.A.K., B.I., E.J.E., J.R.O., G.C.C., J.I.), Weill Cornell Medicine, New York, New York.
AJNR. American Journal of Neuroradiology
|November 6, 2025
Summary
Quantitative Z-scores from amyloid PET imaging strongly correlate with visual assessment, supporting their use to improve Alzheimer's diagnosis and treatment monitoring. This enhances diagnostic confidence and reduces variability in interpreting amyloid PET scans.
Area of Science:
- Nuclear Medicine
- Neurology
- Radiology
Background:
- Amyloid PET imaging is vital for Alzheimer's Disease (AD) diagnosis and anti-amyloid therapy eligibility.
- Visual interpretation of amyloid PET scans (RCTU/BAPL scores) has limitations including inter-reader variability.
- Quantitative methods like Z-scores may offer more objective assessment of amyloid distribution.
Purpose of the Study:
- To evaluate the feasibility of Z-score quantification from normative database comparison in amyloid PET imaging.
- To assess the correlation between quantitative Z-scores and visual RCTU grading.
- To determine if Z-scores can aid in the interpretation of amyloid PET scans.
Main Methods:
- Retrospective analysis of 100 patients with cognitive impairment undergoing [F18]-Florbetaben PET imaging.
- Visual interpretation using Regional Cortical Tracer Uptake (RCTU) and Brain Amyloid Plaque Load (BAPL) scores.
- Calculation of quantitative Z-scores for four cortical regions and correlation analysis with visual scores using Spearman's correlation.
Main Results:
- Strong positive correlations (ρ = 0.78-0.88, p < 0.0001) were found between regional Z-scores and visual RCTU grading across all evaluated regions.
- Significant differences in Z-scores were observed between all RCTU categories (RCTU1, RCTU2, RCTU3) across all regions (p<0.05).
- Quantitative Z-scores demonstrated significant differences between visual assessment groups, confirming their ability to differentiate amyloid burden levels.
Conclusions:
- Quantitative regional Z-scores derived from amyloid PET imaging correlate strongly with visual assessment.
- Z-score quantification is feasible and can enhance the clinical interpretation of amyloid PET scans.
- Integration of quantitative Z-scores may improve diagnostic confidence, reduce reader variability, and aid monitoring for amyloid-targeted therapies.
