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Early-Phase 11C-PiB PET in Amyloid Angiopathy-Related Symptomatic Cerebral Hemorrhage: Potential Diagnostic Value?

Farid K, Hong YT, Aigbirhio FI, Fryer TD, Menon DK, Warburton EA, Baron JC - PLoS ONE (2015)

Bottom Line: There was a significant decrease in early-phase atrophy-corrected whole-cortex SUV relative to cerebellar vermis (SUVR) in the CAA vs age-matched HC group.Combining both early- and late-phase 11C-PiB data did not change the sensitivity and specificity of late-phase PiB, but combined early- and late-phase positivity entails a very high suspicion of underlying Aβ-related clinical disorder, i.e., CAA or Alzheimer disease (AD).These pilot data suggest that early-phase 11C-PiB-PET may not only add to late-phase PiB-PET with respect to the unclear situation of late-phase positivity, but also help differentiate CAA from AD.

View Article: PubMed Central - PubMed

Affiliation: APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris, France; Dept of Nuclear Medicine, Martinique University Hospital, Fort-de-France, French West Indies.

ABSTRACT
Although late-phase (>35min post-administration) 11C-PiB-PET has good sensitivity in cerebral amyloid angiopathy (CAA), its specificity is poor due to frequently high uptake in healthy aged subjects. By detecting perfusion-like abnormalities, early-phase 11C-PiB-PET might add diagnostic value. Early-frame (1-6min) 11C-PiB-PET was obtained in 11 non-demented patients with probable CAA-related symptomatic lobar intracerebral haemorrhage (70±7yrs), 9 age-matched healthy controls (HCs) and 10 HCs <55yrs. There was a significant decrease in early-phase atrophy-corrected whole-cortex SUV relative to cerebellar vermis (SUVR) in the CAA vs age-matched HC group. None of the age-matched controls fell below the lower 95% confidence limit derived from the young HCs, while 6/11 CAA patients did (sensitivity = 55%, specificity = 100%). Combining both early- and late-phase 11C-PiB data did not change the sensitivity and specificity of late-phase PiB, but combined early- and late-phase positivity entails a very high suspicion of underlying Aβ-related clinical disorder, i.e., CAA or Alzheimer disease (AD). In order to clarify this ambiguity, we then show that the occipital/posterior cingulate ratio is markedly lower in CAA than in AD (N = 7). These pilot data suggest that early-phase 11C-PiB-PET may not only add to late-phase PiB-PET with respect to the unclear situation of late-phase positivity, but also help differentiate CAA from AD.

No MeSH data available.


Related in: MedlinePlus

Box plot showing the highly significantly lower early-phase 11C-PiB occipital/posterior cingulate SUVR ratio in CAA patients (n = 11) as compared to Alzheimer’s disease (AD; n = 7) (p = 0.002, Mann-Whitney non-parametric test).
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pone.0139926.g001: Box plot showing the highly significantly lower early-phase 11C-PiB occipital/posterior cingulate SUVR ratio in CAA patients (n = 11) as compared to Alzheimer’s disease (AD; n = 7) (p = 0.002, Mann-Whitney non-parametric test).

Mentions: The mean (and 1SD) SUVR values for the occipital and PCC ROIs are shown in Table 3. The within-ROI ANOVA showed significant (p<0.05) differences among the three groups for both ROIs. The post-hoc tests comparing among the three patient groups revealed results entirely consistent with our hypotheses. Thus, the CAA group had significantly lower occipital SUVR than both the age-matched healthy controls and the AD groups, while the AD group did not differ from the healthy controls. Likewise, regarding the PCC, only the AD group had significantly lower early PiB uptake as compared to the aged controls. Accordingly, the Occipital/PCC ratio was strongly significantly lower in the CAA relative to AD group (p = 0.002, Mann-Whitney) (Table 3, Fig 1). As this ratio was also significantly higher in AD relative to HCs but not different between CAA and HCs, it specifically discriminated CAA from AD.


Early-Phase 11C-PiB PET in Amyloid Angiopathy-Related Symptomatic Cerebral Hemorrhage: Potential Diagnostic Value?

Farid K, Hong YT, Aigbirhio FI, Fryer TD, Menon DK, Warburton EA, Baron JC - PLoS ONE (2015)

Box plot showing the highly significantly lower early-phase 11C-PiB occipital/posterior cingulate SUVR ratio in CAA patients (n = 11) as compared to Alzheimer’s disease (AD; n = 7) (p = 0.002, Mann-Whitney non-parametric test).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595277&req=5

pone.0139926.g001: Box plot showing the highly significantly lower early-phase 11C-PiB occipital/posterior cingulate SUVR ratio in CAA patients (n = 11) as compared to Alzheimer’s disease (AD; n = 7) (p = 0.002, Mann-Whitney non-parametric test).
Mentions: The mean (and 1SD) SUVR values for the occipital and PCC ROIs are shown in Table 3. The within-ROI ANOVA showed significant (p<0.05) differences among the three groups for both ROIs. The post-hoc tests comparing among the three patient groups revealed results entirely consistent with our hypotheses. Thus, the CAA group had significantly lower occipital SUVR than both the age-matched healthy controls and the AD groups, while the AD group did not differ from the healthy controls. Likewise, regarding the PCC, only the AD group had significantly lower early PiB uptake as compared to the aged controls. Accordingly, the Occipital/PCC ratio was strongly significantly lower in the CAA relative to AD group (p = 0.002, Mann-Whitney) (Table 3, Fig 1). As this ratio was also significantly higher in AD relative to HCs but not different between CAA and HCs, it specifically discriminated CAA from AD.

Bottom Line: There was a significant decrease in early-phase atrophy-corrected whole-cortex SUV relative to cerebellar vermis (SUVR) in the CAA vs age-matched HC group.Combining both early- and late-phase 11C-PiB data did not change the sensitivity and specificity of late-phase PiB, but combined early- and late-phase positivity entails a very high suspicion of underlying Aβ-related clinical disorder, i.e., CAA or Alzheimer disease (AD).These pilot data suggest that early-phase 11C-PiB-PET may not only add to late-phase PiB-PET with respect to the unclear situation of late-phase positivity, but also help differentiate CAA from AD.

View Article: PubMed Central - PubMed

Affiliation: APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris, France; Dept of Nuclear Medicine, Martinique University Hospital, Fort-de-France, French West Indies.

ABSTRACT
Although late-phase (>35min post-administration) 11C-PiB-PET has good sensitivity in cerebral amyloid angiopathy (CAA), its specificity is poor due to frequently high uptake in healthy aged subjects. By detecting perfusion-like abnormalities, early-phase 11C-PiB-PET might add diagnostic value. Early-frame (1-6min) 11C-PiB-PET was obtained in 11 non-demented patients with probable CAA-related symptomatic lobar intracerebral haemorrhage (70±7yrs), 9 age-matched healthy controls (HCs) and 10 HCs <55yrs. There was a significant decrease in early-phase atrophy-corrected whole-cortex SUV relative to cerebellar vermis (SUVR) in the CAA vs age-matched HC group. None of the age-matched controls fell below the lower 95% confidence limit derived from the young HCs, while 6/11 CAA patients did (sensitivity = 55%, specificity = 100%). Combining both early- and late-phase 11C-PiB data did not change the sensitivity and specificity of late-phase PiB, but combined early- and late-phase positivity entails a very high suspicion of underlying Aβ-related clinical disorder, i.e., CAA or Alzheimer disease (AD). In order to clarify this ambiguity, we then show that the occipital/posterior cingulate ratio is markedly lower in CAA than in AD (N = 7). These pilot data suggest that early-phase 11C-PiB-PET may not only add to late-phase PiB-PET with respect to the unclear situation of late-phase positivity, but also help differentiate CAA from AD.

No MeSH data available.


Related in: MedlinePlus