PET Scans Help Identify the Presence of Alzheimer’s Disease Lesions in the Brain

The use of positron emission tomography (PET) imaging may help identify findings in brain tissue associated with Alzheimer’s disease (AD), according to new research.

The findings of two articles were published online in July 2011 in the Archives of Neurology, one of the JAMA/Archives journals. As scientists try to find out more about AD and other forms of dementia, they are examining the use of PET. This imaging technique involves the use of radioactive tracers to highlight areas of the brain affected by these disorders. Various teams of researchers are studying the effectiveness of different types of tracers for identifying brain findings associated with these conditions.

In one study, David A. Wolk, MD, from the University of Pennsylvania (Penn Memory Center; Philadelphia, PA, USA) and colleagues, evaluated use of a tracer called fluorine 18-labeled flutemetamol for imaging the brain. The study involved conducting PET scans on seven patients who were given a dose of this agent. All had previously undergone a biopsy for normal pressure hydrocephalus, a progressive condition that includes dementia and can be difficult to distinguish from AD. Researchers found correspondence between readings of the PET scans and evidence of amyloid lesions--the plaque associated with AD--provided by microscopic evaluation of the biopsied tissue.

In another study, Adam S. Fleisher, MD, from the Banner Alzheimer’s Institute (Phoenix, AZ, USA) and colleagues, evaluated PET imaging using the tracer florbetapir F18. The study population included 68 individuals with probable AD, 60 individuals with mild cognitive impairment, and 82 healthy individuals who served as controls. PET scanning was used to monitor activity of the agent being assessed. These researchers discovered differences in the brain uptake of florbetapir F18, between the three groups, and in the detection of amyloid plaque; the differences may be large enough to help differentiate between the conditions, and between impaired versus unimpaired brains.

The authors of both articles suggest that their results may demonstrate ways in which PET imaging can be used with selected tracers to help identify findings associated with AD. “With the potential emergence of disease-specific interventions for AD,” stated Dr. Wolk and colleagues, “biomarkers that provide molecular specificity will likely become of greater importance in the differential diagnosis of cognitive impairment in older adults.” Indeed, Dr. Fleisher and colleagues wrote, “Amyloid imaging offers great promise to facilitate the evaluation of patients in a clinical setting.”

In an editorial accompanying the article, William J. Jagust, MD, from the Helen Wills Neuroscience Institute at the University of California, Berkeley (USA), commented on the role of amyloid in AD and the detection of this plaque as “a topic of active investigation.” The articles by Dr. Wolk et al and Dr. Fleisher et al, he suggested, “continue to advance the field.”

Dr. Jagust noted that the study by Dr. Fleisher and colleagues attempted to define cutoffs for positive or negative presence of amyloid. “Most clinical imaging methods rely on interpretation, not quantitation,” he stated. “Nevertheless, quantitation of these scans has considerable value because it provides a reliable measure that can be compared across laboratories on either a continuous or dichotomous level.”

Dr. Jagust also discussed the problem of how to treat “borderline” or “intermediate” findings. He notes that the study by Dr. Wolk and colleagues found “perfect agreement” between the scans and the biopsied tissue in terms of positive or negative ratings. Moreover, Dr. Jagust added, the two studies show that cutoff levels may be distinct from agent to agent. “These are likely to be related to differences in the tracer as well as to differences in the methods already noted,” he said. Nevertheless, pointed out Dr. Jagust, “Another interesting point is how exceptionally well all of these tracers perform in comparison to pathology.”

Related Links:
Penn Memory Center
Banner Alzheimer’s Institute
Helen Wills Neuroscience Institute at the University of California, Berkeley