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Amyloid-Positronenemissionstomographie mit [18 F]-Florbetaben in der Demenzdiagnostik

Amyloid positron-emission-tomography with [18 F]-florbetaben in the diagnostic workup of dementia patients

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Zusammenfassung

Hintergrund

Eine gesicherte Diagnose der Alzheimer-Krankheit beruht auf dem histologischen Nachweis von Neurofibrillen und β‑Amyloid-Ablagerungen. Amyloid-Positronenemissionstomographie (Amyloid-PET) ist eine neue diagnostische Technik, welche die In-vivo-Quantifizierung pathologischer β‑Amyloid-Ablagerungen ermöglicht. Ziel dieser Studie war, zu evaluieren, inwiefern die Durchführung einer [18F]-Florbetaben-PET (FBB-PET) die Diagnosestellung bei Patienten mit demenziellem Syndrom beeinflusst.

Methodik

Wir führten bei 33 Patienten unserer Sprechstunde für kognitive Neurologie, die eine ausführliche Diagnostik inklusive klinischer Untersuchung, Neuropsychologie, Laborchemie und Bildgebung mittels kranieller Magnetresonanztomographie (cMRT) und Fluordesoxyglukose(FDG)-PET erhalten hatten, eine FBB-PET durch und verglichen die Arbeitsdiagnosen vor und nach FBB-PET.

Ergebnisse

In 17 von 33 Fällen zeigte sich eine pathologische FBB-PET. In 4 Fällen konnte aufgrund des positiven FBB-PETs die von der initialen Verdachtsdiagnose abweichende Enddiagnose einer Alzheimer-Krankheit bzw. einer zerebralen Amyloidangiopathie gestellt werden. 16 Patienten wiesen eine negative FBB-PET auf. Bei 3 der Patienten wurde aufgrund des Befundes die Verdachtsdiagnose einer Alzheimer-Krankheit verworfen. Insgesamt wurde bei 7 der 33 Patienten aufgrund der FBB-PET eine von der initialen Verdachtsdiagnose abweichende Enddiagnose gestellt. Bei 24 Patienten erhärtete sich die Verdachtsdiagnose durch die FBB-PET.

Diskussion

Amyloid-PET gehört aktuell noch nicht zum Standard in der Diagnostik von Demenzerkrankungen, kann aber entsprechend der „Appropriate Use Criteria“ sowie der S3-Leitlinie Demenz bei unklaren demenziellen Syndromen, ungewöhnlich frühem Symptombeginn sowie persistierenden, leichten kognitiven Defiziten eine wertvolle Zusatzdiagnostik sein. Darüber hinaus ermöglicht die Amyloid-PET eine Patientenselektion für Anti-Amyloid-Therapiestudien.

Abstract

Background

To this day the definite diagnosis of Alzheimer’s disease still relies on post-mortem histopathological detection of neurofibrillary tangles and beta-amyloid deposits. Amyloid positron emission tomography (PET) is a new diagnostic tool that enables the in vivo quantification of pathological beta-amyloid deposits. The aim of the current study was to evaluate to what extent 18F-florbetaben-PET (FBB-PET) influences the diagnosis of patients with dementia.

Material and methods

Imaging with FBB-PET was performed on 33 patients from our outpatient department for cognitive neurology. Beforehand all patients underwent a comprehensive clinical, neuropsychiatric and laboratory examination as well as imaging by means of magnetic resonance imaging (MRI) and fluorodeoxyglucose-PET. The working diagnoses before and after FBB-PET imaging were compared.

Results

17 out of 33 patients were scored as FBB-PET positive. In four cases the initial diagnosis had to be changed to Alzheimer’s disease (three cases) and cerebral amyloid angiopathy (one case) due to the positive FBB-PET scan. 16 patients showed a negative FBB-PET scan. In three patients the initial diagnosis of Alzheimer’s disease could be ruled out due to the negative FBB-PET scan. Overall, in 7 out of 33 examined patients the initial diagnosis had to be changed because of the findings of the FBB-PET scan. In 24 patients the initial diagnosis was confirmed by the results of the FBB-PET scan.

Conclusion

Amyloid-PET is currently no standard procedure in the diagnosis of dementia; however, it can be a helpful additional diagnostic tool when used according to the “Appropriate Use Criteria” and the S3 guidelines on dementia in cases of unclear clinical presentation, atypically early age of onset as well as in patients with persistent or progressive unexplained mild cognitive impairment. By facilitating early diagnosis amyloid-PET imaging allows patient selection for therapeutic drug trials.

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Danksagung

Wir danken allen Patienten für die Teilnahme an der Studie sowie den medizinisch-technischen Assistenten für die Durchführung der Amyloid-PET. Piramal Imaging sowie der Radiochemie Leipzig danken wir für die Zurverfügungstellung von Florbetaben.

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Authors and Affiliations

  1. Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, München, Deutschland

    S. Schönecker, C. Prix, E. Wlasich, G. Stenglein-Krapf, J. Levin & A. Danek

  2. Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), München, Deutschland

    T. Raiser & J. Levin

  3. Memory Clinic, Psychiatrische Dienste Thurgau, Münsterlingen, Schweiz

    N. Ackl

  4. Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität, München, Deutschland

    E. Mille, M. Brendel, P. Bartenstein & A. Rominger

  5. Klinik und Poliklinik für Nuklearmedizin, Universität Leipzig, Leipzig, Deutschland

    O. Sabri, M. Patt & H. Barthel

  6. Munich Cluster Syst Neurol SyNergy, München, Deutschland

    P. Bartenstein & A. Rominger

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  1. S. Schönecker
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  11. H. Barthel
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  12. P. Bartenstein
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  13. J. Levin
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  14. A. Rominger
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Corresponding author

Correspondence to S. Schönecker.

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Interessenkonflikt

S. Schönecker, C. Prix, T. Raiser, N. Ackl, E. Wlasich, G. Stenglein-Krapf, E. Mille, M. Brendel, M. Patt, J. Levin, und A. Danek geben an, dass kein Interessenkonflikt besteht. P. Bartenstein, H. Barthel, O. Sabri, A. Rominger erhielten Vortragshonorare von Piramal, Siemens und GE.

Alle beschriebenen Untersuchungen wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung; [31]) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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A. Rominger und A. Danek haben gleichermaßen zum Erfolg dieser Arbeit beigetragen und teilen sich die Letztautorenschaft.

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Schönecker, S., Prix, C., Raiser, T. et al. Amyloid-Positronenemissionstomographie mit [18 F]-Florbetaben in der Demenzdiagnostik. Nervenarzt 88, 156–161 (2017). https://doi.org/10.1007/s00115-016-0249-z

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