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

Publication ,  Journal Article
Womack, KB; Diaz-Arrastia, R; Aizenstein, HJ; Arnold, SE; Barbas, NR; Boeve, BF; Clark, CM; DeCarli, CS; Jagust, WJ; Leverenz, JB; Peskind, ER ...
Published in: Arch Neurol
March 2011

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.

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Published In

Arch Neurol

DOI

EISSN

1538-3687

Publication Date

March 2011

Volume

68

Issue

3

Start / End Page

329 / 337

Location

United States

Related Subject Headings

  • Temporal Lobe
  • Reproducibility of Results
  • Radiopharmaceuticals
  • Positron-Emission Tomography
  • Parietal Lobe
  • Observer Variation
  • Neuropsychological Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Womack, K. B., Diaz-Arrastia, R., Aizenstein, H. J., Arnold, S. E., Barbas, N. R., Boeve, B. F., … Foster, N. L. (2011). Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. Arch Neurol, 68(3), 329–337. https://doi.org/10.1001/archneurol.2010.295
Womack, Kyle B., Ramon Diaz-Arrastia, Howard J. Aizenstein, Steven E. Arnold, Nancy R. Barbas, Bradley F. Boeve, Christopher M. Clark, et al. “Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors.Arch Neurol 68, no. 3 (March 2011): 329–37. https://doi.org/10.1001/archneurol.2010.295.
Womack KB, Diaz-Arrastia R, Aizenstein HJ, Arnold SE, Barbas NR, Boeve BF, et al. Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. Arch Neurol. 2011 Mar;68(3):329–37.
Womack, Kyle B., et al. “Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors.Arch Neurol, vol. 68, no. 3, Mar. 2011, pp. 329–37. Pubmed, doi:10.1001/archneurol.2010.295.
Womack KB, Diaz-Arrastia R, Aizenstein HJ, Arnold SE, Barbas NR, Boeve BF, Clark CM, DeCarli CS, Jagust WJ, Leverenz JB, Peskind ER, Turner RS, Zamrini EY, Heidebrink JL, Burke JR, DeKosky ST, Farlow MR, Gabel MJ, Higdon R, Kawas CH, Koeppe RA, Lipton AM, Foster NL. Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. Arch Neurol. 2011 Mar;68(3):329–337.

Published In

Arch Neurol

DOI

EISSN

1538-3687

Publication Date

March 2011

Volume

68

Issue

3

Start / End Page

329 / 337

Location

United States

Related Subject Headings

  • Temporal Lobe
  • Reproducibility of Results
  • Radiopharmaceuticals
  • Positron-Emission Tomography
  • Parietal Lobe
  • Observer Variation
  • Neuropsychological Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Male