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Updated: May 23, 2026
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Hybrid PET/MRI Imaging of Alzheimer's Disease Based on 18F-AV-1451
Published on: April 18, 2025
Visual versus quantitative tau-PET Braak staging in Alzheimer's disease using [18F]MK6240
Arthur C Macedo1,2,3, Karine Provost3,4, Jean-Paul Soucy3
1Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute, 6875 LaSalle Blvd, Montréal, QC, H4H 1R3, Canada.
Summary
Visual and quantitative tau-PET Braak staging methods for Alzheimer's disease (AD) staging show good agreement. Both approaches effectively stage tau proteinopathy (T2) and correlate with clinical severity, offering complementary insights for AD diagnosis and management.
Area of Science:
- Neuroimaging
- Biomarkers
- Alzheimer's Disease Research
Background:
- The 2024 Alzheimer's Association Workgroup framework highlights tau proteinopathy (T2) as crucial for Alzheimer's disease (AD) staging.
- Optimal in vivo methods for implementing T2 biological staging remain under investigation.
Purpose of the Study:
- To compare visual (vBraak) and quantitative (qBraak) tau-PET-based Braak staging strategies for AD.
- To assess their agreement, clinical correlations, and diagnostic performance.
Main Methods:
- 140 participants from the TRIAD cohort underwent [18F]MK6240 tau-PET.
- vBraak was performed by three physicians; qBraak was derived from SUVR thresholds.
- Inter-rater, inter-method agreement, and associations with clinical/biomarker data were analyzed.
Main Results:
- vBraak showed substantial to near-perfect inter-rater agreement (κ=0.65-0.93).
- Moderate categorical agreement (κ=0.51) and substantial ordinal agreement (weighted κ up to 0.73) were found between vBraak and qBraak.
- Both methods correlated similarly with clinical severity and neurodegeneration; vBraak was more sensitive to amyloid-β positivity.
Conclusions:
- Visual and quantitative tau-PET Braak staging are complementary and largely concordant for T2 staging.
- Quantitative methods support scalable group analyses, while visual assessment is vital for atypical tau patterns and clinical decisions.