18F-FDG PET and Perfusion SPECT in the Diagnosis of Alzheimer and Lewy Body Dementias

Abstract

Brain imaging with glucose (¹⁸F-FDG) PET or blood flow (hexamethylpropyleneamine oxime) SPECT is widely used for the differential diagnosis of dementia, though direct comparisons to clearly establish superiority of one method have not been undertaken. Methods: Subjects with Alzheimer disease (AD; n = 38) and dementia with Lewy bodies (DLB; n = 30) and controls (n = 30) underwent ¹⁸F-FDG PET and SPECT in balanced order. The main outcome measure was area under the curve (AUC) of receiver-operating-characteristic analysis of visual scan rating. Results: Consensus diagnosis with ¹⁸F-FDG PET was superior to SPECT for both dementia vs. no-dementia (AUC = 0.93 vs. 0.72, P = 0.001) and AD vs. DLB (AUC = 0.80 vs. 0.58, P = 0.005) comparisons. The sensitivity and specificity for dementia/no-dementia was 85% and 90%, respectively, for ¹⁸F-FDG PET and 71% and 70%, respectively, for SPECT. Conclusion:¹⁸F-FDG PET was significantly superior to blood flow SPECT. We recommend ¹⁸F-FDG PET be performed instead of perfusion SPECT for the differential diagnosis of degenerative dementia if functional imaging is indicated.