Critical review of the Appropriate Use Criteria for amyloid imaging: Effect on diagnosis and patient care

Liana G Apostolova; Janelle M Haider; Naira Goukasian; Gil D Rabinovici; Gael Chételat; John M Ringman; Sarah Kremen; Joshua D Grill; Lucas Restrepo; Mario F Mendez; Daniel H Silverman

doi:10.1016/j.dadm.2016.12.001

Critical review of the Appropriate Use Criteria for amyloid imaging: Effect on diagnosis and patient care

Alzheimers Dement (Amst). 2016 Dec 18:5:15-22. doi: 10.1016/j.dadm.2016.12.001. eCollection 2016.

Authors

Affiliations

¹ Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Radiological Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.
² Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA.
³ Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.
⁴ Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
⁵ Inserm, EPHE, Université de Caen Basse-Normandie, Unité de Recherche 1077, Caen, France.
⁶ Department of Neurology, Keck School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.
⁷ Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA.
⁸ Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA.
⁹ Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Abstract

Introduction: The utility of the Appropriate Use Criteria (AUC) for amyloid imaging is not established.

Methods: Fifty-three cognitively impaired patients with clinical F¹⁸-florbetapir imaging were classified as early and late onset, as well as AUC-consistent or AUC-inconsistent. Chi-square statistics and t test were used to compare demographic characteristics and clinical outcomes as appropriate.

Results: Early-onset patients were more likely to be amyloid positive. Change in diagnosis was more frequent in late-onset cases. Change in therapy was more common in early-onset cases. AUC-consistent and AUC-inconsistent cases had comparable rates of amyloid positivity. We saw no difference in the rate of treatment changes in the AUC-consistent group as opposed to the AUC-inconsistent group.

Discussion: The primary role of amyloid imaging in the early-onset group was to confirm the clinically suspected etiology, and in the late-onset group in detecting amyloid-negative cases. The rate of therapeutic changes was significantly greater in the early-onset cases.

Keywords: Alzheimer's disease (AD); Amyloid; Appropriate use criteria (AUC); Mild cognitive impairment (MCI); Positron emission tomography (PET).

Abstract

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