Morbelli, S. (Silvia)
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- EANM practice guideline/SNMMI procedure standard for dopaminergic imaging in Parkinsonian syndromes 1.0(2020) Herscovitch, P. (Peter); Arbizu, J. (Javier); Law, I. (Ian); Wanner, M. (Michele); Dickson, J.C. (John C.); Varrone, A. (Andrea); Douglas, D. (David); Peñuelas-Sanchez, I. (Ivan); Esposito, G. (Giuseppe); Boellaard, R. (Ronald); Drzezga, A. (Alexander); Morbelli, S. (Silvia); Garibotto, V. (Valentina); Dubroff, J. (Jacob); Ekmekcioglu, O. (Ozgul); Brooks, D.J. (David J.); Seibyl, J. (John); Tossici-Bolt, L. (Livia); Darcourt, J. (Jacques); Bohnen, N. (Nico); Semah, F. (Franck); Barthel, H. (Henryk); Kuo, P. (Phillip); Lammertsma, A. (Adriaan); Pappata, S. (Sabina); Van-Laere, K. (Koen); Zubal, G. (George); Van-de-Giessen, E. (Elsmarieke)Purpose This joint practice guideline or procedure standard was developed collaboratively by the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The goal of this guideline is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of dopaminergic imaging in parkinsonian syndromes. Methods Currently nuclear medicine investigations can assess both presynaptic and postsynaptic function of dopaminergic synapses. To date both EANM and SNMMI have published procedural guidelines for dopamine transporter imaging with single photon emission computed tomography (SPECT) (in 2009 and 2011, respectively). An EANM guideline for D2 SPECT imaging is also available (2009). Since the publication of these previous guidelines, new lines of evidence have been made available on semiquantification, harmonization, comparison with normal datasets, and longitudinal analyses of dopamine transporter imaging with SPECT. Similarly, details on acquisition protocols and simplified quantification methods are now available for dopamine transporter imaging with PET, including recently developed fluorinated tracers. Finally, [18F]fluorodopa PET is now used in some centers for the differential diagnosis of parkinsonism, although procedural guidelines aiming to define standard procedures for [18F]fluorodopa imaging in this setting are still lacking. Conclusion All these emerging issues are addressed in the present procedural guidelines for dopaminergic imaging in parkinsonian syndromes.
- 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.
- Abnormal pattern of brain glucose metabolism in parkinson’s disease: replication in three european cohorts(Springer, 2020) Leenders, K.L. (Klaus L.); Pagani, M. (Marco); Nobili, F. (Flavio); Renken, R.J. (Remco J.); Obeso, J.A. (José A.); Teune, L.K. (L. K.); Arnaldi, D. (Dario); Morbelli, S. (Silvia); van-Laar, T. (Teus); Meles, S.K. (Sanne K.); Rodriguez-Oroz, M.C. (María Cruz)Rationale In Parkinson’s disease (PD), spatial covariance analysis of 18F-FDG PET data has consistently revealed a characteristic PD-related brain pattern (PDRP). By quantifying PDRP expression on a scan-by-scan basis, this technique allows objective assessment of disease activity in individual subjects. We provide a further validation of the PDRP by applying spatial covariance analysis to PD cohorts from the Netherlands (NL), Italy (IT), and Spain (SP). Methods The PDRPNL was previously identified (17 controls, 19 PD) and its expression was determined in 19 healthy controls and 20 PD patients from the Netherlands. The PDRPIT was identified in 20 controls and 20 “de-novo” PD patients from an Italian cohort. A further 24 controls and 18 “de-novo” Italian patients were used for validation. The PDRPSP was identified in 19 controls and 19 PD patients from a Spanish cohort with late-stage PD. Thirty Spanish PD patients were used for validation. Patterns of the three centers were visually compared and then cross-validated. Furthermore, PDRP expression was determined in 8 patients with multiple system atrophy. Results A PDRP could be identified in each cohort. Each PDRP was characterized by relative hypermetabolism in the thalamus, putamen/pallidum, pons, cerebellum, and motor cortex. These changes co-varied with variable degrees of hypometabolism in posterior parietal, occipital, and frontal cortices. Frontal hypometabolism was less pronounced in “de-novo” PD subjects (Italian cohort). Occipital hypometabolism was more pronounced in late-stage PD subjects (Spanish cohort). PDRPIT, PDRPNL, and PDRPSP were significantly expressed in PD patients compared with controls in validation cohorts from the same center (P < 0.0001), and maintained significance on cross-validation (P < 0.005). PDRP expression was absent in MSA.
- Semi-quantification and grading of amyloid PET: A project of the European Alzheimer's Disease Consortium (EADC)(Elsevier BV, 2019) Nobili, F. (Flavio); Pardini, M. (M.); Garibotto, V. (V.); Morbelli, S. (Silvia); Hausner, L. (L.); Guerra, U.P. (U. P.); Mendonça, A. (A.) de; Musarra, M. (M.); Santana, I. (I.); Mecocci, P. (P.); Engelborghs, S. (S.); Dottorini, M. (M.); Chincarini, A. (A.); Büsing, K.A. (K. A.); Queneau, M. (M.); Ferrarese, C. (C.); Verhaeghe, J. (J.); Bauckneht, M. (M.); Hugon, J. (J.); Riverol, M. (Mario); Peira, E. (E.); Didic, M. (M.); Arbizu, J. (Javier); Castelo-Branco, M. (M.); Guedj, E. (E.); Frisoni, G.B. (G. B.)Background amyloid-PET reading has been classically implemented as a binary assessment, although the clinical experience has shown that the number of borderline cases is non negligible not only in epidemiological studies of asymptomatic subjects but also in naturalistic groups of symptomatic patients attending memory clinics. In this work we develop a model to compare and integrate visual reading with two independent semi-quantification methods in order to obtain a tracer-independent multi-parametric evaluation. Methods We retrospectively enrolled three cohorts of cognitively impaired patients submitted to 18F-florbetaben (53 subjects), 18F-flutemetamol (62 subjects), 18F-florbetapir (60 subjects) PET/CT respectively, in 6 European centres belonging to the EADC. The 175 scans were visually classified as positive/negative following approved criteria and further classified with a 5-step grading as negative, mild negative, borderline, mild positive, positive by 5 independent readers, blind to clinical data. Scan quality was also visually assessed and recorded. Semi-quantification was based on two quantifiers: the standardized uptake value (SUVr) and the ELBA method. We used a sigmoid model to relate the grading with the quantifiers. We measured the readers accord and inconsistencies in the visual assessment as well as the relationship between discrepancies on the grading and semi-quantifications. Conclusion It is possible to construct a map between different tracers and different quantification methods without resorting to ad-hoc acquired cases. We used a 5-level visual scale which, together with a mathematical model, delivered cut-offs and transition regions on tracers that are (largely) independent from the population. All fluorinated tracers appeared to have the same contrast and discrimination ability with respect to the negative-to-positive grading. We validated the integration of both visual reading and different quantifiers in a more robust framework thus bridging the gap between a binary and a user-independent continuous scale.