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Concordance Between [18F]Flortaucipir PET Visual Reads and CenTauR-Based Quantification
Stamatia Karagianni1,2, Alexis Moscoso3, Sheelakumari Raghavan4
1Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
Summary
Visual tau PET imaging ([18F]flortaucipir) shows limited agreement with quantitative CenTauRz methods, especially in cognitively unimpaired individuals. Visually positive scans, even if quantitatively negative, indicate faster disease progression, highlighting the need for improved quantification methods for Alzheimer's disease (AD) detection.
Area of Science:
- Neurology and Nuclear Medicine
- Alzheimer's Disease (AD) Diagnostics
- Neuroimaging Biomarkers
Background:
- Tau PET imaging with [18F]flortaucipir visualizes tau deposits, a hallmark of Alzheimer's disease (AD).
- Standardized visual interpretation is FDA/EMA-approved, but quantitative methods like CenTauRz aim to harmonize tau PET positivity across tracers.
- The concordance between visual [18F]flortaucipir reads and CenTauRz quantification is not well-established.
Purpose of the Study:
- To assess the concordance between visual and quantitative (CenTauRz) tau PET positivity using [18F]flortaucipir.
- To evaluate the discriminative power of CenTauRz in distinguishing visual read categories.
- To examine clinical progression based on discordant visual and quantitative tau PET assessments.
Main Methods:
- 3991 participants (cognitively unimpaired and impaired) underwent [18F]flortaucipir PET imaging.
- Scans were assessed via approved visual interpretation and quantified using the CenTauRz pipeline.
- Concordance was measured using Cohen κ; discriminative power was assessed via ROC analysis; clinical progression was examined using generalized additive models.
Main Results:
- Moderate concordance was observed between visual and CenTauRz assessments, particularly lower in cognitively unimpaired individuals (κ = 0.23-0.55).
- ROC analysis showed moderate agreement regardless of the CenTauRz cut point (AUC 0.72-0.87 for unimpaired, 0.87-0.97 for impaired).
- Discordant cases revealed that visually positive/CenTauRz-negative scans were associated with higher amyloid positivity and faster clinical progression.
Conclusions:
- Limited agreement exists between visual [18F]flortaucipir assessment and CenTauRz quantification, especially in cognitively unimpaired individuals.
- Visually positive/CenTauRz-negative scans indicate faster progression, suggesting visual reads capture heterogeneous tau patterns missed by ROI-based quantification.
- Novel quantification approaches are needed to accurately capture complex tau deposition patterns for early AD detection and monitoring.
