| Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. | |
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MedLine Citation:
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PMID: 21059987 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the cause of diagnostic errors in the visual interpretation of positron emission tomographic scans with fludeoxyglucose F 18 (FDG-PET) in patients with frontotemporal lobar degeneration (FTLD) and patients with Alzheimer disease (AD). DESIGN: Twelve trained raters unaware of clinical and autopsy information independently reviewed FDG-PET scans and provided their diagnostic impression and confidence of either FTLD or AD. Six of these raters also recorded whether metabolism appeared normal or abnormal in 5 predefined brain regions in each hemisphere-frontal cortex, anterior cingulate cortex, anterior temporal cortex, temporoparietal cortex, and posterior cingulate cortex. Results were compared with neuropathological diagnoses. SETTING: Academic medical centers. PATIENTS: Forty-five patients with pathologically confirmed FTLD (n=14) or AD (n=31). RESULTS: Raters had a high degree of diagnostic accuracy in the interpretation of FDG-PET scans; however, raters consistently found some scans more difficult to interpret than others. Unanimity of diagnosis among the raters was more frequent in patients with AD (27 of 31 patients [87%]) than in patients with FTLD (7 of 14 patients [50%]) (P=.02). Disagreements in interpretation of scans in patients with FTLD largely occurred when there was temporoparietal hypometabolism, which was present in 7 of the 14 FTLD scans and 6 of the 7 scans lacking unanimity. Hypometabolism of anterior cingulate and anterior temporal regions had higher specificities and positive likelihood ratios for FTLD than temporoparietal hypometabolism had for AD. CONCLUSIONS: Temporoparietal hypometabolism in FTLD is common and may cause inaccurate interpretation of FDG-PET scans. An interpretation paradigm that focuses on the absence of hypometabolism in regions typically affected in AD before considering FTLD is likely to misclassify a significant portion of FTLD scans. Anterior cingulate and/or anterior temporal hypometabolism indicates a high likelihood of FTLD, even when temporoparietal hypometabolism is present. Ultimately, the accurate interpretation of FDG-PET scans in patients with dementia cannot rest on the presence or absence of a single region of hypometabolism but rather must take into account the relative hypometabolism of all brain regions. |
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Authors:
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Kyle B Womack; Ramon Diaz-Arrastia; Howard J Aizenstein; Steven E Arnold; Nancy R Barbas; Bradley F Boeve; Christopher M Clark; Charles S DeCarli; William J Jagust; James B Leverenz; Elaine R Peskind; R Scott Turner; Edward Y Zamrini; Judith L Heidebrink; James R Burke; Steven T DeKosky; Martin R Farlow; Matthew J Gabel; Roger Higdon; Claudia H Kawas; Robert A Koeppe; Anne M Lipton; Norman L Foster |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-11-08 |
Journal Detail:
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Title: Archives of neurology Volume: 68 ISSN: 1538-3687 ISO Abbreviation: Arch. Neurol. Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-15 Completed Date: 2011-05-19 Revised Date: 2012-03-07 |
Medline Journal Info:
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Nlm Unique ID: 0372436 Medline TA: Arch Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 329-37 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9129, USA. kyle.womack@utsouthwestern.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Age of Onset Aged Alzheimer Disease / metabolism, pathology, radionuclide imaging Brain / pathology Diagnosis, Differential Diagnostic Errors Female Fluorodeoxyglucose F18 / diagnostic use Frontotemporal Lobar Degeneration / metabolism*, pathology, radionuclide imaging* Humans Image Processing, Computer-Assisted Male Middle Aged Neuropsychological Tests Observer Variation Parietal Lobe / metabolism*, pathology, radionuclide imaging* Positron-Emission Tomography Radiopharmaceuticals / diagnostic use Reproducibility of Results Temporal Lobe / metabolism*, pathology, radionuclide imaging* |
| Grant Support | |
ID/Acronym/Agency:
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AG028377/AG/NIA NIH HHS; AG05133/AG/NIA NIH HHS; AG08671/AG/NIA NIH HHS; AG10124/AG/NIA NIH HHS; AG10129/AG/NIA NIH HHS; AG10133/AG/NIA NIH HHS; AG12300/AG/NIA NIH HHS; AG16573/AG/NIA NIH HHS; AG16976/AG/NIA NIH HHS; AG22394/AG/NIA NIH HHS; AG30006/AG/NIA NIH HHS; K23 AG030006-03/AG/NIA NIH HHS; K23 AG030006-05/AG/NIA NIH HHS; P30 AG010124-17/AG/NIA NIH HHS; P30 AG010129-10/AG/NIA NIH HHS; P30 AG010129-19/AG/NIA NIH HHS; P30 AG010133-15/AG/NIA NIH HHS; P30 AG012300-15/AG/NIA NIH HHS; P30 AG028377-029001/AG/NIA NIH HHS; P30 AG028377-04/AG/NIA NIH HHS; P50 AG005133-23/AG/NIA NIH HHS; P50 AG008671-199001/AG/NIA NIH HHS; R01 AG022394-01/AG/NIA NIH HHS; U01 AG016976-03/AG/NIA NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Radiopharmaceuticals; 63503-12-8/Fluorodeoxyglucose F18 |
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