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Biomarkers.

Andreia Rocha1, Bruna Bellaver1, Carolina Soares1

  • 1University of Pittsburgh, Pittsburgh, PA, USA.

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Summary
This summary is machine-generated.

Four tau PET tracers show variable Braak staging in Alzheimer's disease (AD). While tracers offer similar average stages, individual case staging may differ, impacting clinical use.

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Area of Science:

  • Neuroimaging
  • Neuropathology

Background:

  • Alzheimer's disease (AD) Braak staging classifies tau pathology using post-mortem exams.
  • Adapting Braak staging to PET imaging is challenging due to tracer differences.
  • This study compares four tau PET tracers: Flortaucipir, MK6240, PI2620, and RO948.

Purpose of the Study:

  • Compare Braak staging across four tau PET tracers.
  • Evaluate tracer agreement and systematic bias in staging tau pathology.
  • Model tau PET Braak region trajectories based on amyloid-beta (Aβ) burden.

Main Methods:

  • Assessed 90 participants (cognitively unimpaired, MCI, dementia) using Aβ PET and four tau PET tracers.
  • Defined Braak positivity using Aβ-negative cognitively unimpaired individuals.
  • Employed Bland-Altman analysis and Lowess modeling to assess tracer agreement and trajectories.

Main Results:

  • Tau PET Braak staging trajectories varied significantly by tracer and Aβ burden.
  • Earliest abnormal regions differed: Braak I for MK6240, RO948, PI2620; Braak IV for Flortaucipir.
  • Tracer agreement was highest at Braak 0 and Braak IV-V (approx. 70%), with low concordance in intermediate stages.

Conclusions:

  • Discrepancies exist in Braak staging among Flortaucipir, MK6240, PI2620, and RO948.
  • While tracers show comparable average stages, they are not fully interchangeable for individual patient staging.
  • Further research is needed to refine tau PET staging in Alzheimer's disease.