REVIEW   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2019 March;63(1):83-92

DOI: 10.23736/S1824-4785.18.03069-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Emerging topics and practical aspects for an appropriate use of amyloid PET in the current Italian context

Flavio NOBILI ¹ ✉, Annachiara CAGNIN ^{2, 3}, Maria L. CALCAGNI ^{4, 5}, Andrea CHINCARINI ⁶, Ugo P. GUERRA ⁷, Silvia MORBELLI ⁸, Alessandro PADOVANI ^{9, 10}, Barbara PAGHERA ¹¹, Sabina PAPPATÀ ¹², Lucilla PARNETTI ¹³, Stelvio SESTINI ¹⁴, Orazio SCHILLACI ^{15, 16}

¹ Department of Neuroscience (DINOGMI), University of Genoa and Neurology Clinic, San Martino Polyclinic Hospital, Genoa, Italy; ² Department of Neurosciences (DNS), University of Padua, Padua, Italy; ³ San Camillo IRCCS Hospital, Venice, Italy; ⁴ Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; ⁵ Università Cattolica del Sacro Cuore, Rome, Italy; ⁶ National Institute for Nuclear Physics (INFN), Genoa Section, Genoa, Italy; ⁷ Unit of Nuclear Medicine, Poliambulanza Fundation, Brescia, Italy; ⁸ Unit of Nuclear Medicine, Department of Health Sciences (DISSAL), Polyclinic San Martino Hospital, University of Genoa, Genoa, Italy; ⁹ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; ¹⁰ Neurology Clinic, Spedali Civili, Brescia, Italy; ¹¹ Unit of Nuclear Medicine, ASST-Spedali Civili, University of Brescia, Brescia, Italy; ¹² Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy; ¹³ Center for Memory Disorders, Laboratory of Clinical Neurochemistry, Neurology Clinic, University of Perugia, Perugia, Italy; ¹⁴ Unit of Nuclear Medicine, Department of Diagnostic Imaging, N.O.P. - S. Stefano, U.S.L. Toscana Centro, Prato, Italy; ¹⁵ Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; ¹⁶ IRCCS Neuromed, Rome, Italy

In May 2017 some representatives of the Italian nuclear medicine and neurological communities spontaneously met to discuss the issues emerged during the first two years of routine application of amyloid PET with fluorinated radiopharmaceuticals in the real world. The limitations of a binary classification of scans, the possibility to obtain early images as a surrogate marker of regional cerebral bloos flow, the need for (semi-)quantification and, thus, the opportunity of ranking brain amyloidosis, the correlation with Aβ42 levels in the cerebrospinal fluid, the occurrence and biological meaning of uncertain/boderline scans, the issue of incidental amyloidosis, the technical pittfalls leading to false negative/positive results, the position of the tool in the diagnostic flow-chart in the national reality, are the main topics that have been discussed. Also, a card to justify the examination to be filled by the dementia specialist and a card for the nuclear medicine physician to report the exam in detail have been approved and are available in the web, which should facilitate the creation of a national register, as previewed by the 2015 intersocietal recommendation on the use of amyloid PET in Italy. The content of this discussion could stimulate both public institutions and companies to support further research on these topics.

KEY WORDS: Amyloid - Positron-emission tomography - Alzheimer disease - Brain - Amyloidosis - Neurodegenerative diseases