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Underestimated Centiloid Values in Amyloid PET: A Technical Report on Clinically Relevant Quantification Errors.

Heii Arai1,2

  • 1Department of Psychiatry, Juntendo University, Tokyo, JPN.

Cureus
|November 24, 2025
PubMed
Summary

Quantitative amyloid PET scans using the Centiloid scale can misestimate amyloid burden. A case study shows visually positive scans yielding a Centiloid value of 0, potentially impacting Alzheimer's disease treatment decisions.

Keywords:
alzheimer’s diseaseamyloid petanti-amyloid therapycentiloidflorbetapir

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Area of Science:

  • Neurology
  • Radiology
  • Pharmacology

Background:

  • Quantitative amyloid positron emission tomography (PET) interpretation with the Centiloid scale is crucial for guiding anti-amyloid therapy.
  • Discrepancies between visual and quantitative PET assessments can lead to clinical misjudgments.

Purpose of the Study:

  • To highlight a case where quantitative amyloid PET (Centiloid) underestimated cortical amyloid deposition.
  • To investigate the impact of reference region selection on Centiloid values.

Main Methods:

  • Analysis of an 18F-florbetapir PET scan with visually evident cortical amyloid.
  • Comparison of Centiloid values derived from different cerebellar reference regions (whole cerebellum vs. gray matter).

Main Results:

  • A visually positive amyloid PET scan resulted in a Centiloid value of 0 when using the whole cerebellum as a reference.
  • Using cerebellar gray matter as a reference yielded higher Centiloid values compared to the whole cerebellum.

Conclusions:

  • Centiloid underestimation can occur due to reference region selection, potentially excluding patients from vital anti-amyloid therapies.
  • Clinical interpretation of Centiloid values requires caution, corroboration with visual reads, and harmonization of methods is needed.