Garibotto, V. (V.)

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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.
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    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.