PET imaging has profoundly changed our understanding of neurodegenerative conditions associated with dementia or cognitive impairment and their clinical management over the last decades. PET imaging with 2-[18F]fluoro-2-deoxy-d-glucose, assessing glucose metabolism, provides a measure of neurodegeneration and allows a precise differential diagnosis among the most common neurodegenerative disease, such as Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies. PET tracers targeting receptors and transporters can demonstrate the involvement of specific neurotransmission pathways, and PET imaging of dopaminergic neurotransmission, which is selectively and typically affected in Lewy body diseases, is one of the key diagnostic tool in these cases. PET tracers specific for the pathological deposits characteristics of different neurodegenerative processes, namely amyloid and tau deposits typical of Alzheimer's Disease, finally allow the visualization of these aggregates in vivo, allowing a precise assessment of the pathology associated with clinical symptoms observed. These imaging modalities have reached a high level of clinical validity and are included in the diagnostic algorithms proposed for different neurodegenerative conditions associated with cognitive impairment. PET imaging use will presumably increase with the development of novel specific markers, possibly in combination with other biological markers assessed in fluids, namely in blood. PET imaging has also relevantly contributed to the evaluation of experimental therapeutic strategies in these conditions, still under investigations. In conclusion, the diagnosis of cognitive disorders is an important issue in today's medicine: PET represents already a mainstay of the etiological diagnostic process and is susceptible to play an increasingly important role with the advent of personalized diagnostic and preventive strategies.
PET imaging in dementia
Morbelli S.
2022-01-01
Abstract
PET imaging has profoundly changed our understanding of neurodegenerative conditions associated with dementia or cognitive impairment and their clinical management over the last decades. PET imaging with 2-[18F]fluoro-2-deoxy-d-glucose, assessing glucose metabolism, provides a measure of neurodegeneration and allows a precise differential diagnosis among the most common neurodegenerative disease, such as Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies. PET tracers targeting receptors and transporters can demonstrate the involvement of specific neurotransmission pathways, and PET imaging of dopaminergic neurotransmission, which is selectively and typically affected in Lewy body diseases, is one of the key diagnostic tool in these cases. PET tracers specific for the pathological deposits characteristics of different neurodegenerative processes, namely amyloid and tau deposits typical of Alzheimer's Disease, finally allow the visualization of these aggregates in vivo, allowing a precise assessment of the pathology associated with clinical symptoms observed. These imaging modalities have reached a high level of clinical validity and are included in the diagnostic algorithms proposed for different neurodegenerative conditions associated with cognitive impairment. PET imaging use will presumably increase with the development of novel specific markers, possibly in combination with other biological markers assessed in fluids, namely in blood. PET imaging has also relevantly contributed to the evaluation of experimental therapeutic strategies in these conditions, still under investigations. In conclusion, the diagnosis of cognitive disorders is an important issue in today's medicine: PET represents already a mainstay of the etiological diagnostic process and is susceptible to play an increasingly important role with the advent of personalized diagnostic and preventive strategies.
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