Journal of the Formosan Medical Association (Dec 2017)

Dual-phase 18F-florbetapir positron emission tomography in patients with primary progressive aphasia, Alzheimer's disease, and healthy controls: A preliminary study

  • Hung-Chou Kuo,
  • Ing-Tsung Hsiao,
  • Chia-Ju Hsieh,
  • Chu-Yun Huang,
  • Kuo-Lun Huang,
  • Yau-Yau Wai,
  • Wen-Li Chuang,
  • Mei-Ping Kung,
  • Yi-Chuan Chu,
  • Tzu-Chen Yen,
  • Kun-Ju Lin,
  • Chin-Chang Huang

Journal volume & issue
Vol. 116, no. 12
pp. 964 – 972

Abstract

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Background/Purpose: To determine whether dual-phase 18F-florbetapir positron emission tomography imaging with perfusion-like and amyloid deposition information can distinguish among primary progressive aphasia (PPA), Alzheimer's disease (AD), and healthy controls (HCs). Methods: Patients diagnosed with PPA, including four semantic dementia (SD) and two progressive nonfluent aphasia (PNFA), as well as one logopenic variant (LV) of PPA, were studied. All PPA patients, and age-/sex-matched patients with probable AD (n=8) and HCs (n=8) were subjected to dual-phase 18F-florbetapir imaging. Atlas-based quantitative volumes of interest (VOIs) analysis for six cortical areas and whole cerebellum was performed. The standardized uptake value ratios were calculated by normalizing the dual-phase-integrated activities of the six VOIs to whole cerebellum counts. Results: Early phase 18F-florbetapir image showed significantly lower global perfusion index in six PPA patients as compared with HCs. According to VOI analysis, the hypoperfusion lesions were identified in the frontal, anterior cingulate, parietal, precuneus, and temporal regions. Similar findings were confirmed by voxel-base image comparison. 18F-florbetapir late-phase image showed significantly increased amyloid burden in the global cortex index and all six brain regions of eight AD and LV patients when compared with the other six PPA patients and eight HCs. There was no apparent uptake of amyloid tracer in both six PPA patients and eight HCs. Conclusion: Dual-phase 18F-florbetapir images of six PPA (SD and PNFA) patients showed hypoperfusion in the frontotemporal cortex, and little global amyloid uptake, which may be a distinct image pattern for differentiation among HC, AD, and PPA patients. Keywords: 18F-florbetapir (AV-45/Amyvid amyloid imaging), Alzheimer's disease, logopenic variant, primary progressive aphasia, progressive nonfluent aphasia, semantic dementia, dementia, clinical neurology, diagnostic imaging, radiology, nuclear medicine and medical imaging