Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

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Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors.

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.[1]

References

Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. Womack, K.B., Diaz-Arrastia, R., Aizenstein, H.J., Arnold, S.E., Barbas, N.R., Boeve, B.F., Clark, C.M., DeCarli, C.S., Jagust, W.J., Leverenz, J.B., Peskind, E.R., Turner, R.S., Zamrini, E.Y., Heidebrink, J.L., Burke, J.R., DeKosky, S.T., Farlow, M.R., Gabel, M.J., Higdon, R., Kawas, C.H., Koeppe, R.A., Lipton, A.M., Foster, N.L. Arch. Neurol. (2011) [Pubmed]

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