Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors

Kyle B. Womack, Ramon Diaz-Arrastia, Howard J. Aizenstein, Steven E. Arnold, Nancy R. Barbas, Bradley F Boeve, Christopher M. Clark, Charles S. DeCarli, William J. Jagust, James B. Leverenz, Elaine R. Peskind, R. Scott Turner, Edward Y. Zamrini, Judith L. Heidebrink, James R. Burke, Steven T. DeKosky, Martin R. Farlow, Matthew J. Gabel, Roger Higdon, Claudia H. KawasRobert A. Koeppe, Anne M. Lipton, Norman L. Foster

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)329-337
Number of pages9
JournalArchives of Neurology
Volume68
Issue number3
DOIs
StatePublished - Mar 2011

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Frontotemporal Lobar Degeneration
Diagnostic Errors
Gyrus Cinguli
Alzheimer Disease
Positron-Emission Tomography
Temporal Lobe
Diagnostics
Imaging
Degeneration
Fluorodeoxyglucose F18
Brain
Frontal Lobe
Dementia
Alzheimer's Disease
Autopsy

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

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. Archives of Neurology, 68(3), 329-337. https://doi.org/10.1001/archneurol.2010.295

Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. / Womack, Kyle B.; Diaz-Arrastia, Ramon; Aizenstein, Howard J.; Arnold, Steven E.; Barbas, Nancy R.; Boeve, Bradley F; Clark, Christopher M.; DeCarli, Charles S.; Jagust, William J.; Leverenz, James B.; Peskind, Elaine R.; Turner, R. Scott; Zamrini, Edward Y.; Heidebrink, Judith L.; Burke, James R.; DeKosky, Steven T.; Farlow, Martin R.; Gabel, Matthew J.; Higdon, Roger; Kawas, Claudia H.; Koeppe, Robert A.; Lipton, Anne M.; Foster, Norman L.

In: Archives of Neurology, Vol. 68, No. 3, 03.2011, p. 329-337.

Research output: Contribution to journalArticle

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 2011, 'Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors', Archives of Neurology, vol. 68, no. 3, pp. 329-337. https://doi.org/10.1001/archneurol.2010.295
Womack, Kyle B. ; Diaz-Arrastia, Ramon ; Aizenstein, Howard J. ; Arnold, Steven E. ; Barbas, Nancy R. ; Boeve, Bradley F ; Clark, Christopher M. ; DeCarli, Charles S. ; Jagust, William J. ; Leverenz, James B. ; Peskind, Elaine R. ; Turner, R. Scott ; Zamrini, Edward Y. ; Heidebrink, Judith L. ; Burke, James R. ; DeKosky, Steven T. ; Farlow, Martin R. ; Gabel, Matthew J. ; Higdon, Roger ; Kawas, Claudia H. ; Koeppe, Robert A. ; Lipton, Anne M. ; Foster, Norman L. / Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors. In: Archives of Neurology. 2011 ; Vol. 68, No. 3. pp. 329-337.
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T1 - Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors

AU - Womack, Kyle B.

AU - Diaz-Arrastia, Ramon

AU - Aizenstein, Howard J.

AU - Arnold, Steven E.

AU - Barbas, Nancy R.

AU - Boeve, Bradley F

AU - Clark, Christopher M.

AU - DeCarli, Charles S.

AU - Jagust, William J.

AU - Leverenz, James B.

AU - Peskind, Elaine R.

AU - Turner, R. Scott

AU - Zamrini, Edward Y.

AU - Heidebrink, Judith L.

AU - Burke, James R.

AU - DeKosky, Steven T.

AU - Farlow, Martin R.

AU - Gabel, Matthew J.

AU - Higdon, Roger

AU - Kawas, Claudia H.

AU - Koeppe, Robert A.

AU - Lipton, Anne M.

AU - Foster, Norman L.

PY - 2011/3

Y1 - 2011/3

N2 - 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.

AB - 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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