Press Release on joint EANM-EAN publication:
Guiding the prescription of brain FDG-PET in neurodegenerative conditions
Brain positron emission tomography (PET) with F-18 fluorodeoxyglucose has long been used in the diagnostic procedure of Alzheimer’s disease and related disorders to detect regions of cerebral hypometabolism, i.e., to identify parts of the brain that consume less glucose than expected, and thus work less than normal, due to neurodegeneration. With this function of detecting presence and location of brain damage even at early stages of neurodegenerative diseases, brain FDG-PET can be considered, together with magnetic resonance imaging, the first biomarker ever used in the field. Surprisingly, however, guidelines or recommendations for its clinical use had never been produced, at odds with other much more recent biomarkers, like for example the PET using tracers to detect the pathological amyloid brain protein, the typical hallmark of Alzheimer’s disease.
Based on this lack, two European scientific societies, the European Association of Nuclear Medicine and the European Academy of Neurology, have undertaken the initiative of formulating recommendations for the clinical use of the exam. The recommendations are aimed to help clinicians in using FDG-PET in the most fruitful and cost-effective way, while diagnosing Alzheimer’s disease and the other neurodegenerative conditions associated with cognitive impairment, that need to be discriminated one another in order to plan the best treatment options and to formulate a prognostic evaluation.
The two societies nominated a panel of specialists from different European countries, with direct expertise both in the clinical and research aspects of brain FDG-PET: Flavio Nobili, leading the initiative, from the Dept of Neuroscience, University and IRCCS Polyclinic S. Martino in Genoa, Italy, Zuzana Walker, Femke Bouwmann, Federica Agosta, Peter Nestor, Alexander Drzezga and Javier Arbizu. Panelists were helped by a group of facilitators, led by Marina Boccardi, from the team of Giovanni Frisoni, at University of Geneva, Switzerland and IRCCS S. Giovanni di Dio-Fatebenefratelli in Brescia, Italy. They performed an extensive work in order to base the required recommendations on scientific evidence of utility of the exam. From the wide scientific production on FDG-PET, the facilitators extracted the quantitative indices of utility, and summarized them in order to answer as many as 21 clinical questions, entailing the utility of the exam in different diagnostic scenarios, and relative to the use of semi-quantitative tools to assist scan reading. Using solid methodology, facilitators also assessed the scientific strength of such evidence, allowing the panel of experts to make decisions grounded as much as possible on scientific data.
This extensive work also offered the chance to highlight the limitations of the available scientific studies on FDG-PET, and a precious set of methodological improvements and research priorities has been published, together with the evidence extracted from the literature to outline the recommendations, in press on a dedicated issue on the European Journal of Nuclear Medicine and Molecular Imaging
(DOI: 10.1007/s00259-018-4031-2; 10.1007/s00259-018-4032-1; 10.1007/s00259-018-4034-z; 10.1007/s00259-018- 4035-y; 10.1007/s00259-018-4030-3; 10.1007/s00259-018-4033-0; 10.1007/s00259- 018-4024-1; 10.1007/s00259-018-4039-7; 10.1007/s00259-018-4027-y). This complex work is pivot to the next era of precision medicine for the field of dementing neurodegenerative conditions: completing the validation of biomarkers according to the latest methodological standard will allow their most versatile and cost-effective use, boosting drug development and improving time and reliability of diagnosis.