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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

Representative early-phase PiB SUVR axial images (normalized to the subject’s vermis value) for the basal ganglia (left column) and centrum semiovale level (right column) from one subject each from the age-matched healthy controls (A), AD (B) and probable CAA-related sLICH groups (C).The thin arrows point to the occipital region, showing the typical low uptake in the CAA profile as compared to age-matched controls and AD. The bold arrows point to the posterior cingulate area showing reduced uptake in AD as compared to age-matched controls and CAA. SUVRs were obtained from early-phase 11C-PiB-PET using the cerebellar vermis as reference ROI (see Methods).
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pone.0139926.g002: Representative early-phase PiB SUVR axial images (normalized to the subject’s vermis value) for the basal ganglia (left column) and centrum semiovale level (right column) from one subject each from the age-matched healthy controls (A), AD (B) and probable CAA-related sLICH groups (C).The thin arrows point to the occipital region, showing the typical low uptake in the CAA profile as compared to age-matched controls and AD. The bold arrows point to the posterior cingulate area showing reduced uptake in AD as compared to age-matched controls and CAA. SUVRs were obtained from early-phase 11C-PiB-PET using the cerebellar vermis as reference ROI (see Methods).

Mentions: Fig 2 displays typical imaging findings in one subject from each group.


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)

Representative early-phase PiB SUVR axial images (normalized to the subject’s vermis value) for the basal ganglia (left column) and centrum semiovale level (right column) from one subject each from the age-matched healthy controls (A), AD (B) and probable CAA-related sLICH groups (C).The thin arrows point to the occipital region, showing the typical low uptake in the CAA profile as compared to age-matched controls and AD. The bold arrows point to the posterior cingulate area showing reduced uptake in AD as compared to age-matched controls and CAA. SUVRs were obtained from early-phase 11C-PiB-PET using the cerebellar vermis as reference ROI (see Methods).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0139926.g002: Representative early-phase PiB SUVR axial images (normalized to the subject’s vermis value) for the basal ganglia (left column) and centrum semiovale level (right column) from one subject each from the age-matched healthy controls (A), AD (B) and probable CAA-related sLICH groups (C).The thin arrows point to the occipital region, showing the typical low uptake in the CAA profile as compared to age-matched controls and AD. The bold arrows point to the posterior cingulate area showing reduced uptake in AD as compared to age-matched controls and CAA. SUVRs were obtained from early-phase 11C-PiB-PET using the cerebellar vermis as reference ROI (see Methods).
Mentions: Fig 2 displays typical imaging findings in one subject from each group.

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