Clinical Developments in Amyloid PET Imaging

Transcript

1 Clinical Developments in Amyloid PET Imaging I Iakovou Assist. Professor Academic Nuclear Medicine dpt. PAPAGEORGIOU hsp.

2 Nuclear medicine

3 Τι «βλέπουμε»? ανατομία φυσιολογία μεταβολισμός CT US MRI Nuclear Optical Μοριακό επίπεδο

4 Imaging Anatomical vs Molecular

5 Imaging Anatomical vs Molecular

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7 Hybrid imaging

8 PET / CT

9 Hybrid imaging

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11 Alzheimer s disease?

12 Alzheimer s disease? Πλάκες β-αμυλοειδούς νευροϊνιδιακά τολύπια

13 What is the role of beta-amyloid in Alzheimer s disease?

14 What is the role of beta-amyloid in Alzheimer s disease?

15 What is the role of beta-amyloid in Alzheimer s disease? Pittsburgh compound-b

16 geriatric psychiatrist William E. Klunk radiochemist Chester A. Mathis benzothiazoles derived from thioflavin T 2-(4'-[11]methylaminophenyl)-6-hydroxybenzothiazole Aß40 and Aß42 in dense core plaques first trials of this new agent in human research subjects

17 geriatric psychiatrist William E. Klunk radiochemist Chester A. Mathis benzothiazoles derived from thioflavin T 2-(4'-[11]methylaminophenyl)-6-hydroxybenzothiazole Aß40 and Aß42 in dense core plaques first trials of this new agent in human research subjects

18 Tracking pathophysiological processes in Alzheimer s disease: an updated hypothetical model of dynamic biomarkers. Jack CR Jr, Knopman DS, Jagust WJ, et al Lancet Neurol Feb;12(2):

19 Είναι σημαντική η διάγνωση άνοιας ; Βλάβες νευρώνων συμπτώματα

20 Υποθετικά βήματα προόδου νόσου Γνωστική λειτουργία FDG διάγνωση PIB Διάγνωση FDG PIB Γνωστική λειτουργία PIB Engler, 2006 FDG χρόνος

21 When should brain amyloid imaging be considered?

22 When should brain amyloid imaging be considered?

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24 When should brain amyloid imaging be considered? For patients WITH ALL of the following core elements: 1.A cognitive complaint with objectively confirmed impairment. 2. Alzheimer s disease is a possible diagnosis, but the diagnosis remains uncertain upon comprehensive evaluation by a dementia expert. 3. The presence or absence of amyloid would increase certainty in the diagnosis and alter the treatment plan.

25 Which patients are appropriate for brain amyloid imaging? Amyloid imaging is APPROPRIATE in the situations listed below. 1.Patients with persistent or progressive unexplained mild cognitive impairment. 2. Patients satisfying core clinical criteria for possible Alzheimer s disease because of unclear clinical presentation, either atypical clinical course or etiologically mixed presentation 3. Patients with progressive dementia and atypically early age of onset (usually defined as 65 years or less in age).

26 Which patients are inappropriate for brain amyloid imaging? Amyloid imaging is INAPPROPRIATE in the situations listed below. 1.Patients with core clinical criteria for probable Alzheimer s disease with typical age of onset 2. To determine dementia severity 3. Solely based on a positive family history of dementia 4. Patients with a cognitive complaint that is unconfirmed on clinical examination 5. In lieu of genotyping for suspected autosomal mutation carriers 6. In asymptomatic individuals 7. Non-medical usage (e.g. legal, insurance coverage, or employment screening)

27 18F- Florbetabir Normal Abnormal Lilly/Amyvid

28 18F- Flutemetamol GE Healthcare/Vizamyl Normal Abnormal

29 18F- Florbetaben Piramal Imaging/Neuraceq Normal Abnormal

30 11C-PiB, 18F-florbetaben, 18F-florbetapir, and 18F-flutemetamol images of healthy subjects and AD patients. Christopher C. Rowe, and Victor L. Villemagne J Nucl Med 2011;52: (c) Copyright 2014 SNMMI; all rights reserved

31 Amyloid PET Imaging

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33 ?

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35 Amyloid PET Imaging

36 Amyloid PET Imaging

37 Does the PRESENCE of brain amyloid on a PET scan indicate Alzheimer s disease? Normal

38 Does the PRESENCE of brain amyloid on a PET scan indicate Alzheimer s disease? Amyloid PET results do not establish a diagnosis of AD or other cognitive disorders. it is an adjunct to other diagnostic evaluations a tool giving physicians additional information to help clarify an otherwise unclear diagnosis. Amyloid PET imaging should only be used as part of a clinical workup in limited situations as determined by a dementia expert.

39 Amyloid PET Imaging

40 Amyloid PET Imaging

41 What is the significance of the ABSENCE of beta-amyloid in the brain? Normal

42 What is the significance of the ABSENCE of beta-amyloid in the brain? The presence of amyloid plaques in a patient with confirmed cognitive complaints increases the likelihood that the cognitive impairment is due to AD. The test is not a definitive diagnosis; it only determines the presence or absence of beta-amyloid. The potential clinical use of amyloid PET requires careful consideration so that its proper role is identified.

43 Implications of PET amyloid imaging findings

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45 Who is considered a dementia expert? The Amyloid Imaging Taskforce concluded that a dementia EXPERT can be a self-identified physician as a physician trained and board-certified in neurology, psychiatry, or geriatric medicine, who devotes a substantial proportion of his or her medical practice, at least 25% (patient contact), to the evaluation and care of adult patients with acquired cognitive impairment or dementia, including probable or suspected AD, as confirmed by peer recognition.

46 Who is considered a dementia expert?

47 imaging procedure, compounds, adverse effects and precautions

48 imaging procedure, compounds, adverse effects and precautions

49 imaging procedure, compounds, adverse effects and precautions

50 imaging procedure, compounds, adverse effects and precautions

51 imaging procedure, compounds, adverse effects and precautions the mean effective dose solely (without CT exposure) resulting from the administration of 300 MBq to Caucasian individuals was 5.8 ± 0.42 msv.

52 Searching.

53 Πυρηνική Ιατρική & πραγματικότητα στη Θεσσαλονίκη

54 Πυρηνική Ιατρική & πραγματικότητα στη Θεσσαλονίκη

55 99mTc- HMPAO SPECT HMPAO υδρόλυση γλουταθιόνη Αστροκύτταρα

56 99mTc- HMPAO SPECT Φυσιολογική απεικόνιση

57 Brain SPECT φυσιολογικό Alzheimer

58 Brain SPECT φυσιολογικό Frontal Lobe Dementia

59 τοπογραφικά...

60 ALZHEIMER s...

61 Απεικόνιση με SPECT dementia φυσιολογικό Alzheimer fronto-temporal

62 fronto-temporal

63 Alzheimer

64 δ.δ ήπιας AD και DLB με SPECT

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69 Η «πυρηνική απεικόνιση» στην κλινική πρακτική

70 Η «πυρηνική απεικόνιση» στην κλινική πρακτική

71 From whom?

72 How?

73 1

74 2

75 3

76 Σας ευχαριστώ..

77 Σας ευχαριστώ..