Salloway S.
Improving Evaluation of Patients With Cognitive Impairment With Amyloid Positron Emission Tomography.
JAMA Neurol. 2018 Sep 1;75(9):1045-1046.
PubMed.
From my perspective, de Wilde et al. provides important, novel and high-level evidence for the clinical utility of amyloid PET imaging.
Our current knowledge in this regard was so far based on a number of smaller, sometimes retrospective or observational studies in selected patient cohorts. It is, thus, extremely valuable, not only for discussing potential reimbursement of amyloid PET with payers, to confirm these previous data by a prospective study and in an unselected population as achieved by de Wilde et al.
It is important to stress, however, that a change of diagnosis, diagnostic confidence, and management is, while encouraging based on our knowledge on amyloid PET imaging accurately reflecting histopathology, per se not attributable to an improved outcome. As a control group without amyloid imaging is, understandably, not available in this ABIDE project, the ultimate questions of whether, and to which degree, amyloid imaging improves patient outcome cannot be addressed here. In this regard, the community will, thus, need to wait for the results of the ongoing IDEAS and AMYPAD studies.
I agree with the comment made on the somewhat limited generalizability of the study results to the “real clinical world.” This refers, in my eyes, to both the scenarios in which amyloid imaging was carried out, and in which the clinical diagnosis was established. For the amyloid imaging, as the nuclear physician performing the PET scan is bound to collect all patient information beforehand, the information on the pretest clinical diagnosis and on that of the CSF/APOE testing results (where available) are includable in clinical routine (other than in this study) into the amyloid image read. For establishing the pre-PET clinical diagnosis, the same holds true for CSF/APOE testing results.
However, it would definitely be interesting to, in a comparative design, investigate in future studies how amyloid imaging compares to CSF sampling in regard to clinical utility/outcome effects/cost-efficiency. Such research should definitely also consider the frequency of borderline/inconsistent results, the frequency of side effects, and the interlab reproducibility for both modalities.
Regardless, the ABIDE study results provide one important missing link for establishing amyloid imaging in a wider clinical routine scenario. This PET approach to accurately detect/exclude amyloid pathology in cognitively impaired patients in a noninvasive manner can, already by today, be considered without doubt a valuable addition to the diagnostic toolbox in dementia.
Comments
From my perspective, de Wilde et al. provides important, novel and high-level evidence for the clinical utility of amyloid PET imaging.
Our current knowledge in this regard was so far based on a number of smaller, sometimes retrospective or observational studies in selected patient cohorts. It is, thus, extremely valuable, not only for discussing potential reimbursement of amyloid PET with payers, to confirm these previous data by a prospective study and in an unselected population as achieved by de Wilde et al.
It is important to stress, however, that a change of diagnosis, diagnostic confidence, and management is, while encouraging based on our knowledge on amyloid PET imaging accurately reflecting histopathology, per se not attributable to an improved outcome. As a control group without amyloid imaging is, understandably, not available in this ABIDE project, the ultimate questions of whether, and to which degree, amyloid imaging improves patient outcome cannot be addressed here. In this regard, the community will, thus, need to wait for the results of the ongoing IDEAS and AMYPAD studies.
I agree with the comment made on the somewhat limited generalizability of the study results to the “real clinical world.” This refers, in my eyes, to both the scenarios in which amyloid imaging was carried out, and in which the clinical diagnosis was established. For the amyloid imaging, as the nuclear physician performing the PET scan is bound to collect all patient information beforehand, the information on the pretest clinical diagnosis and on that of the CSF/APOE testing results (where available) are includable in clinical routine (other than in this study) into the amyloid image read. For establishing the pre-PET clinical diagnosis, the same holds true for CSF/APOE testing results.
However, it would definitely be interesting to, in a comparative design, investigate in future studies how amyloid imaging compares to CSF sampling in regard to clinical utility/outcome effects/cost-efficiency. Such research should definitely also consider the frequency of borderline/inconsistent results, the frequency of side effects, and the interlab reproducibility for both modalities.
Regardless, the ABIDE study results provide one important missing link for establishing amyloid imaging in a wider clinical routine scenario. This PET approach to accurately detect/exclude amyloid pathology in cognitively impaired patients in a noninvasive manner can, already by today, be considered without doubt a valuable addition to the diagnostic toolbox in dementia.
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