Gandolfo, F. (Federica)

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    Diagnostic utility of FDG-PET in the differential diagnosis between different forms of primary progressive aphasia
    (Springer, 2018) Arbizu, J. (Javier); Agosta, F. (Federica); Nobili, F. (Flavio); Drzezga, A. (Alexander); Altomare, D. (Daniele); Nestor, P. (Peter); Morbelli, S. (Silvia); Bouwman, F. (Femke); Boccardi, M. (Marina); Walker, Z. (Zuzana); Orini, S. (Stefania); Gandolfo, F. (Federica); Festari, C. (Cristina)
    Purpose A joint effort of the European Association of Nuclear Medicine (EANM) and the European Academy of Neurology (EAN) aims at clinical guidance for the use of FDG-PET in neurodegenerative diseases. This paper addresses the diagnostic utility of FDG-PET over clinical/neuropsychological assessment in the differentiation of the three forms of primary progressive aphasia (PPA). Methods Seven panelists were appointed by the EANM and EAN and a literature search was performed by using harmonized PICO (Population, Intervention, Comparison, Outcome) question keywords. The studies were screened for eligibility, and data extracted to assess their methodological quality. Critical outcomes were accuracy indices in differentiating different PPA clinical forms. Subsequently Delphi rounds were held with the extracted data and quality assessment to reach a consensus based on both literature and expert opinion. Results Critical outcomes for this PICO were available in four of the examined papers. The level of formal evidence supporting clinical utility of FDG-PET in differentiating among PPA variants was considered as poor. However, the consensual recommendation was defined on Delphi round I, with six out of seven panelists supporting clinical use. Conclusions Quantitative evidence demonstrating utility or lack thereof is still missing. Panelists decided consistently to provide interim support for clinical use based on the fact that a typical atrophy or metabolic pattern is needed for PPA according to the diagnostic criteria, and the synaptic failure detected by FDG-PET is an earlier phenomenon than atrophy. Also, a normal FDGPET points to a non-neurodegenerative cause.
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    Clinical utility of FDG PET in Parkinson's disease and atypical parkinsonism associated with dementia
    (Springer Nature, 2018) Arbizu, J. (Javier); Agosta, F. (Federica); Nobili, F. (Flavio); Garibotto, V. (V.); Drzezga, A. (Alexander); Altomare, D. (Daniele); Nestor, P. (Peter); Bouwman, F. (Femke); Boccardi, M. (Marina); Walker, Z. (Zuzana); Orini, S. (Stefania); Gandolfo, F. (Federica); Festari, C. (Cristina)
    Purpose There are no comprehensive guidelines for the use of FDG PET in the following three clinical scenarios: (1) diagnostic work-up of patients with idiopathic Parkinson’s disease (PD) at risk of future cognitive decline, (2) discriminating idiopathic PD from progressive supranuclear palsy, and (3) identifying the underlying neuropathology in corticobasal syndrome. Methods We therefore performed three literature searches and evaluated the selected studies for quality of design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were the sensitivity, specificity, accuracy, positive/ negative predictive value, area under the receiving operating characteristic curve, and positive/negative likelihood ratio of FDG PET in detecting the target condition. Using the Delphi method, a panel of seven experts voted for or against the use of FDG PET based on published evidence and expert opinion. Results Of 91 studies selected from the three literature searches, only four included an adequate quantitative assessment of the performance of FDG PET. The majority of studies lacked robust methodology due to lack of critical outcomes, inadequate gold standard and no head-to-head comparison with an appropriate reference standard. The panel recommended the use of FDG PET for all three clinical scenarios based on nonquantitative evidence of clinical utility. Conclusion Despite widespread use of FDG PET in clinical practice and extensive research, there is still very limited good quality evidence for the use of FDG PET. However, in the opinion of the majority of the panellists, FDG PET is a clinically useful imaging biomarker for idiopathic PD and atypical parkinsonism associated with dementia.