Temporoparietal hypometabolism in frontotemporal lobar degeneration and associated imaging diagnostic errors
Open accessAbstract
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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- Authors
- Womack, K. B., Diaz-Arrastia, R., Aizenstein, H. J., Arnold, S. E., Barbas, N. R., Boeve, B. F., Clark, C. M., DeCarli, C. S., Jagust, W. J., Leverenz, J. B., Peskind, E. R., Turner, R. S., Zamrini, E. Y., Heidebrink, J. L., Burke, J. R., DeKosky, S. T., Farlow, M. R., Gabel, M. J., Higdon, R., Kawas, C. H., Koeppe, R. A., Lipton, A. M., & Foster, N. L.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Seattle Children's Hospital (US)
- ORCID
- Womack, Kyle B.
- Diaz-Arrastia, Ramon
- Aizenstein, Howard J.
- Arnold, Steven E.
- 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.
- Kawas, Claudia H.
- Koeppe, Robert A.
- Foster, Norman L.
- Venue
- Archives of Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2011-03-01
- Volume
- 68
- Issue
- 3
- Pages
- 329-37
- ISSN
- 0003-9942 (ISSN-L)
- PMC
- PMC3058918
- OpenAlex
- W2119315037
- Cited by
- 85
- References
- 52
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 6 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 5 · 2015: 5 · 2014: 9 · 2013: 7 · 2012: 9
- FWCI
- 5.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institute on Aging (AG 10133, P30AG010129, P30AG010133, AG 05-133, AG 08671, AG22394, P30AG012300, P50AG005133, AG 16573, P30AG028377, U01AG016976, P30AG010124, P50AG016573, AG-10124, AG028377, AG-10129, K23AG030006, AG-16976, AG30006, R01AG022394, P50AG008671, AG 12300)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Keywords
- frontotemporal lobar degeneration, Alzheimer's disease, FDG-PET, diagnostic errors, interobserver agreement, anterior cingulate cortex, anterior temporal cortex, posterior cingulate cortex, differential diagnosis of dementia, brain metabolism
- MeSH terms
- Adult, Aged, Alzheimer Disease, Brain, Diagnosis, Differential, Diagnostic Errors, Female, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Neuropsychological Tests, Parietal Lobe, Temporal Lobe, Reproducibility of Results, Observer Variation, Age of Onset, Radiopharmaceuticals, Fluorodeoxyglucose F18, Positron-Emission Tomography, Frontotemporal Lobar Degeneration
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