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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 4/2005

01-04-2005 | Review Article

Brain glucose metabolism in the early and specific diagnosis of Alzheimer’s disease

FDG-PET studies in MCI and AD

Author: Lisa Mosconi

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2005

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Abstract

The demographics of aging suggest a great need for the early diagnosis of dementia and the development of preventive strategies. Neuropathology and structural MRI studies have pointed to the medial temporal lobe (MTL) as the brain region earliest affected in Alzheimer’s disease (AD). MRI findings provide strong evidence that in mild cognitive impairments (MCI), AD-related volume losses can be reproducibly detected in the hippocampus, the entorhinal cortex (EC) and, to a lesser extent, the parahippocampal gyrus; they also indicate that lateral temporal lobe changes are becoming increasingly useful in predicting the transition to dementia. Fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) imaging has revealed glucose metabolic reductions in the parieto-temporal, frontal and posterior cingulate cortices to be the hallmark of AD. Overall, the pattern of cortical metabolic changes has been useful for the prediction of future AD as well as in distinguishing AD from other neurodegenerative diseases. FDG-PET on average achieves 90% sensitivity in identifying AD, although specificity in differentiating AD from other dementias is lower. Moreover, recent MRI-guided FDG-PET studies have shown that MTL hypometabolism is the most specific and sensitive measure for the identification of MCI, while the utility of cortical deficits is controversial. This review highlights cross-sectional, prediction and longitudinal FDG-PET studies and attempts to put into perspective the value of FDG-PET in diagnosing AD-like changes, particularly at an early stage, and in providing diagnostic specificity. The examination of MTL structures, which has so far been exclusive to MRI protocols, is then examined as a possible strategy to improve diagnostic specificity. All told, there is considerable promise that early and specific diagnosis is feasible through a combination of imaging modalities.
Footnotes
1
MEDLINE (PubMed) database search for literature published between 1989 and present (November 2004). The search strategy involved the combined concepts of AD and FDG-PET, and the search was limited to articles in the English language that involved human subjects. Investigations that did not involve FDG PET were excluded. (Keywords: FDG-PET or PET or positron emission tomography, mild cognitive impairment, cognitively impaired not demented, Alzheimer’s disease, differential diagnosis, diagnostic accuracy.)
 
2
Sensitivity = number of decliners correctly identified/total number of decliners; specificity = number of non-decliners correctly identified/total number of non-decliners; accuracy = number of total cases correctly identified/total number of cases.
 
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Metadata
Title
Brain glucose metabolism in the early and specific diagnosis of Alzheimer’s disease
FDG-PET studies in MCI and AD
Author
Lisa Mosconi
Publication date
01-04-2005
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2005
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-005-1762-7

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