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FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease
Foster NL, Heidebrink JL, Clark CM, Jagust WJ, Arnold SE, Barbas NR, DeCarli CS, Turner RS et al.. Brain : a journal of neurology, 2007-08-18
Topic: Amyloid, tau and blood-test diagnosis
Distinguishing Alzheimer's disease (AD) and frontotemporal dementia (FTD) currently relies on a clinical history and examination, but positron emission tomography with [(18)F] fluorodeoxyglucose (FDG-PET) shows different patterns of hypometabolism in these disorders that might aid differential diagnosis. Six dementia experts with variable FDG-PET experience made independent, forced choice, diagnostic decisions in 45 patients with pathologically confirmed AD (n = 31) or FTD (n = 14) using five separate methods: (1) review of clinical summaries, (2) a diagnostic checklist alone, (3) summary and checklist, (4) transaxial FDG-PET scans and (5) FDG-PET stereotactic surface projection (SSP) metabolic and statistical maps. In addition, we evaluated the effect of the sequential review of a clinical summary followed by SSP. Visual interpretation of SSP images was superior to clinical assessment and had the best inter-rater reliability (mean kappa = 0.78) and diagnostic accuracy (89.6%). It also had the highest specificity (97.6%) and sensitivity (86%), and positive likelihood ratio for FTD (36.5). The addition of FDG-PET to clinical summaries increased diagnostic accuracy and confidence for both AD and FTD. It was particularly helpful when raters were uncertain in their clinical diagnosis. Visual interpretation of FDG-PET after brief training is more reliable and accurate in distinguishing FTD from AD than clinical methods alone. FDG-PET adds important information that appropriately increases diagnostic confidence, even among experienced dementia specialists.
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APA 7th
Foster, N. L., Heidebrink, J. L., Clark, C. M., Jagust, W. J., Arnold, S. E., Barbas, N. R., et al. (2007). FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease. Brain : a journal of neurology. https://doi.org/10.1093/brain/awm177
Vancouver
Foster NL, Heidebrink JL, Clark CM, Jagust WJ, Arnold SE, Barbas NR, et al. FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease. Brain : a journal of neurology. 2007. doi:10.1093/brain/awm177. PMID: 17704526.
BibTeX
@article{foster2007-17704526,
author = {Foster, N. L. and Heidebrink, J. L. and Clark, C. M. and Jagust, W. J. and Arnold, S. E. and Barbas, N. R. and DeCarli, C. S. and Turner, R. S. and others},
title = {{FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease}},
journal = {Brain : a journal of neurology},
year = {2007},
doi = {10.1093/brain/awm177},
pmid = {17704526},
url = {https://doi.org/10.1093/brain/awm177}
}
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Key findings
- It also had the highest specificity (97.6%) and sensitivity (86%), and positive likelihood ratio for FTD (36.5).
- The addition of FDG-PET to clinical summaries increased diagnostic accuracy and confidence for both AD and FTD.
- It was particularly helpful when raters were uncertain in their clinical diagnosis.
- Visual interpretation of FDG-PET after brief training is more reliable and accurate in distinguishing FTD from AD than clinical methods alone.
- FDG-PET adds important information that appropriately increases diagnostic confidence, even among experienced dementia specialists.
Why it matters
In 45 patients whose diagnosis was later confirmed by brain tissue (31 Alzheimer's, 14 frontotemporal dementia), six dementia experts chose between the two diagnoses more reliably and accurately from FDG-PET brain-metabolism maps (89.6% accuracy) than from clinical information alone, and adding the scan to a clinical summary helped most when they were unsure. The study only compared these two diagnoses, used expert readers and a small FTD group, and is a diagnostic aid — it does not treat, cure or prevent Alzheimer's disease.
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Study details
- Participants31
- Effect size89.6%; 97.6%
- Evidence strengthLow
How this study scored 63/100
Published in a leading specialty journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Brain : a journal of neurology) |
| Journal's citation record | 4 / 4 | Brain: journal h-index 503 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2007 — within 20 year(s) of the newest study here |
| Sample size | 1 / 4 | 31 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 612 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 29.1 citations a year over 21 year(s) since 2007 |
| Impact for its field and year | 5 / 6 | Cited 23.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 40 other studies in this library |
| Still being cited | 3 / 4 | Cited 57 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Satoshi Minoshima: h-index 89 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 17704526) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 63 / 100 | — |
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