PET in the Evaluation of Alzheimer's Disease and Related Disorders

Among all the clinical indications for which radiologists, nuclear medicine phy- cians, neurologists, neurosurgeons, psychiatrists (and others examining disorders of the brain) order and read brain PET scans, demand is greatest for those pertaining to dementia and related disorders. This demand is driven by the sheer prevalence of those conditions, coupled with the fact that the differential diagnosis for causes of cognitive impairment is wide and often difficult to distinguish clinically. The conceptual framework by which evaluation and management of dementia is guided has evolved considerably during the last decade. Although we still are far from having ideal tests or dramatic cures for any of the established causes of dementia, our options have expanded with respect to both the diagnostic and the- peutic tools now available. In the first chapter of this book, the contribution and limitations of different elements of the clinical examination for diagnosis of cog- tive symptoms are described, and the roles of structural and functional neuroim- ing in the clinical workup are given context. The high demand for brain PET scans in dementia and related disorders is driven by both the prevalence of these conditions and the difficulty of distinguishing the causes of cognitive impairment. The clinical utility of brain PET in such cases depends in part on how accurately and fully the information inherently represented in a scan is appreciated and relayed in the interpretation of the images. Since this can be challenging for even the most highly trained imaging specialists, PET in the Evaluation of Alzheimer's Disease and Related Disorders takes a ground-up look at PET as it relates to the evaluation of patients with cognitive impairment. Expert contributors weigh in on when and why to order brain PET scans, their clinical interpretation, FDG PET in the evaluation of mild cognitive impairment and early dementia, PET and SPECT for central motor disorders, microstructural imaging of neurodegenerative changes, and amyloid imaging. The book is illustrated throughout with color images and also includes an interpretive practice atlas for self-testing of skills.

This practical guide contains all the science and clinical information needed to help the reader make informed decisions about the applications of brain PET to improve the care of patients with symptoms of Alzheimer's disease and related disorders. Beginning with an introduction to goals and limitations of the clinical evaluation of dementia, Dr. Dan Silverman and his distinguished group of contributors cover the role of functional imaging, clinical interpretation of brain FDG-PET scans, FDG-PET in the evaluation of early dementia, microstructural imaging of neurodegenerative changes, amyloid imaging, imaging non-neurodegenerative causes of cognitive impairment, tools for assisting PET scan interpretation in the clinical setting, and PET evaluation of central motor disorders. There is also a complete collection of clinical cases that practitioners are likely to encounter in their daily practice. Enhanced with numerous PET brain scans throughout, this book fills a rapidly growing need in the medical imaging field.

Front Matter....Pages i-xiv Front Matter....Pages 1-1 Clinical Evaluation of Dementia and When to Perform PET....Pages 3-31 Clinical Interpretation of Brain PET Scans: Performing Visual Assessments, Providing Quantifying Data, and Generating Integrated Reports....Pages 33-48 FDG PET in the Evaluation of Mild Cognitive Impairment and Early Dementia....Pages 49-65 PET and SPECT in the Evaluation of Patients with Central Motor Disorders....Pages 67-92 Front Matter....Pages 1-1 Microstructural Imaging of Neurodegenerative Changes....Pages 95-117 Amyloid Imaging with PET in Alzheimer’s Disease, Mild Cognitive Impairment, and Clinically Unimpaired Subjects....Pages 119-147 Front Matter....Pages 1-1 Interpretive Practice Atlas....Pages 151-210 Back Matter....Pages 211-215 cover 1 front-matter 2 Part I - Imaging Applications in Current Clinical Practice 14 1 Clinical Evaluation of Dementia and When to Perform PET 14 2 Clinical Interpretation of Brain PET Scans- Performing Visual Assessments, Providing Quantifying Data, and Generating Integrated Reports 43 3 FDG PET in the Evaluation of Mild Cognitive Impairment and Early Dementia 59 4 PET and SPECT in the Evaluation of Patients with Central Motor Disorders 76 Part II - Emerging Approaches Using PET 102 5 Microstructural Imaging of Neurodegenerative Changes 102 6 Amyloid Imaging with PET in Alzheimer’s Disease, Mild Cognitive Impairment, and Clinically Unimpaired Subjects 125 Part III - Atlas 154 7 Interpretive Practice Atlas 154 back-matter 214