PET-Amyloid After Inconclusive Cerebrospinal Fluid Biomarkers in Clinical Practice. Is it Necessary to Duplicate Procedures?
| Autor: | Rosa Vilchez-Carrillo, Manuel Gómez-Río, E. Triviño-Ibáñez, Cristóbal Carnero-Pardo, Lucía Triguero-Cueva, Juan Carlos Romero-Fábrega, Ismael Carrera-Muñoz |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Concordance Amyloidogenic Proteins Sensitivity and Specificity Appropriate Use Criteria Therapeutic approach Cerebrospinal fluid Alzheimer Disease Internal medicine medicine Humans Cognitive impairment Aged Amyloid beta-Peptides business.industry Gold standard (test) Middle Aged medicine.disease Peptide Fragments Clinical Practice Neurology Positron-Emission Tomography Female Neurology (clinical) Alzheimer's disease business Biomarkers |
| Zdroj: | Current Alzheimer Research. 17:698-708 |
| ISSN: | 1567-2050 |
| Popis: | Introduction: In the absence of a gold standard for in vivo Alzheimer disease (AD) diagnosis, AD biomarkers such as cerebrospinal fluid biomarkers (CSF-B) and PET-Amyloid are considered diagnostically useful in clinical practice guidelines and have consensual appropriate use criteria (AUC). However, little evidence has been published on their utilization in the clinical setting or on approaches to mismatched results. The objective of this work was to evaluate the use of AD biomarkers in clinical practice, focusing on the implementation of PET-Amyloid in cases of inconclusive CSF-B. Methods: This naturalistic, ambispective case series included patients fulfilling AUC for CSF-B and PET-Amyloid whose CSF-B results were non-diagnostic (target population), analyzing the diagnostic certainty, the treatment approach, and the relationship between CSF-B and PET-Amyloid results. Results: Out of 2373 eligible patients, AD biomarkers were studied in 417 (17.6%), most frequently due to cognitive impairment in under 65-year-olds, using CSF-B in 311 patients and PET-Amyloid in 150. CSF-B results were non-diagnostic for 44 patients (52.3% male; aged 60.9±6.6 years), who then underwent PET-Amyloid study, which was positive in 31. A ‘k’ coefficient of 0.108 was obtained between CSF-B and PET-amyloid (54.5% concordance). In multivariate regression analysis, Aβ42 was the only significant predictor (p= 0.018) of a positive PET-Amyloid result. In the target population, PETAmyloid increased diagnostic confidence by 53.7% (p Conclusion: These findings support the duplication of AD biomarkers and demonstrate that the implementation of PET-Amyloid provides an early and certain diagnosis to guide appropriate treatment. |
| Databáze: | OpenAIRE |
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