Diagnostic Accuracy of MRI and Additional [18F]FDG-PET for Behavioral Variant Frontotemporal Dementia in Patients with Late Onset Behavioral Changes.
BACKGROUND
Neuroimaging has a reasonable accuracy to differentiate behavioral variant frontotemporal dementia (bvFTD) from other neurodegenerative disorders, its value for the differentiation of bvFTD among subjects with acquired behavioral disturbances is unknown.


OBJECTIVE
To determine the diagnostic accuracy of MRI, additional [18F]FDG-PET, and their combination for bvFTD among subjects with late onset behavioral changes.


METHODS
Patients with late onset behavioral changes referred to a memory clinic or psychiatric services were included. At baseline, 111 patients had a brain MRI scan and 74 patients received an additional [18F]FDG-PET when the MRI was inconclusive. The consensus diagnosis after two-year-follow-up was used as the gold standard to calculate sensitivity and specificity for baseline neuroimaging.


RESULTS
27 patients had probable/definite bvFTD and 84 patients had a non-bvFTD diagnosis (primary psychiatric diagnosis or other neurological disorders). MRI had a sensitivity of 70% (95% CI 52-85%) with a specificity of 93% (95% CI 86-97%). Additional [18F]FDG-PET had a sensitivity of 90% (95% CI 66-100%) with a specificity of 68% (95% CI 56-79%). The sensitivity of combined neuroimaging was 96% (95% CI 85-100%) with a specificity of 73% (95% CI 63-81%). In 66% of the genetic FTD cases, MRI lacked typical frontotemporal atrophy. 40% of cases with a false positive [18F]FDG-PET scan had a primary psychiatric diagnosis.


CONCLUSION
A good diagnostic accuracy was found for MRI and additional [18F]FDG-PET for bvFTD in patients with late onset behavioral changes. Caution with the interpretation of neuroimaging results should especially be taken in cases with a genetic background and in cases with a primary psychiatric differential diagnosis where [18F]FDG-PET is the only abnormal investigation.
['Vijverberg|Everard G B|EG|', 'Wattjes|Mike P|MP|', 'Dols|Annemiek|A|', 'Krudop|Welmoed A|WA|', 'Möller|Christiane|C|', 'Peters|Anne|A|', 'Kerssens|Cora J|CJ|', 'Gossink|Flora|F|', 'Prins|Niels D|ND|', 'Stek|Max L|ML|', 'Scheltens|Philip|P|', 'van Berckel|Bart N M|BN|', 'Barkhof|Frederik|F|', 'Pijnenburg|Yolande A L|YA|']
D017668:Age of Onset D000368:Aged D001284:Atrophy D001921:Brain D005188:False Negative Reactions D005189:False Positive Reactions D005260:Female D019788:Fluorodeoxyglucose F18 D005500:Follow-Up Studies D057180:Frontotemporal Dementia D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D001523:Mental Disorders D008875:Middle Aged D059906:Neuroimaging D049268:Positron-Emission Tomography D011446:Prospective Studies D019275:Radiopharmaceuticals D012680:Sensitivity and Specificity
diagnostic accuracy MRI Behavior frontotemporal dementia neuropsychology psychiatric disorders