70-year-old art teacher—widowed since 2012
Enjoys painting and being with her 3 grandchildren
- Arrives 30 minutes late for her visit, seems anxious
- Describes her morning as “chaos” trying to get her grandchildren to school
- Reports more difficulty with memory for the past 2 years and asks, “This is just normal for my age, right?”
- Repeated the same story about her morning twice
- MMSE 26/30
*Hypothetical patient.
Clinical Assessment: MCI
Complete history and physical are normal, including neurological exam—reveals no focal deficits
Routine lab tests normal, as well as TSH, B12, and folate
Structural MRI is read as "age-appropriate atrophy"
Diagnosis is MCI: Follow-up scheduled in 3 months—family member is requested to attend
An Amyvid PET scan is ordered to differentiate diagnosis and help determine, along with Carol, on appropriate management
Amyvid PET Scan Imaging Report
POSITIVE SCAN†
SELECT IMPORTANT SAFETY INFORMATION:
Risk for Image Misinterpretation and Other Errors
Errors may occur during Amyvid image interpretation. Image interpretation should be performed independently of the patient’s clinical information. Amyvid scan results are indicative of plaque content only at the time of image acquisition and a negative scan does not preclude the development of brain amyloid in the future.1
PROCEDURE: BRAIN AMYLOID PET/CT SCAN
HISTORY: Cognitive impairment
COMPARISON: None
RADIOPHARMACEUTICAL: 10mCi Amyvid (florbetapir F 18)
TECHNIQUE: PET/CT imaging was performed 30-50 minutes following the intravenous administration of 10mCi Amyvid (florbetapir F 18). Images were obtained from the level of the vertex to the base of the skull. Axial, sagittal, and coronal PET reconstructions were acquired.
Corresponding CT images were reviewed in axial, coronal, and sagittal planes. CT scan was a limited noncontrast study and used for anatomical correlation and attenuation correction.
COMMENT: There is diffusely increased tracer uptake throughout the cortical cerebral gray matter. Most intense uptake is seen in the prefrontal, lateral temporal, and parietal areas, with these areas showing clear loss of the normal gray-white contrast. The cerebellum has no evidence of abnormal uptake.
Tracer distribution is otherwise unremarkable.
CT (NONDIAGNOSTIC, PERTINENT FINDINGS ONLY): There is mild cerebral volume loss without mass effect or midline shift.
IMPRESSION: Positive scan, indicating moderate to frequent beta-amyloid neuritic plaques
NOTE: Amyvid is a radioactive diagnostic agent for Positron Emission Tomography (PET) imaging of the brain to estimate beta-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease and other causes of cognitive decline. A negative Amyvid scan indicates sparse to no neuritic plaques and is inconsistent with a neuropathological diagnosis of Alzheimer’s disease at the time of image acquisition; a negative scan result reduces likelihood that a patient’s cognitive impairment is due to Alzheimer’s disease. A positive Amyvid scan indicates moderate to frequent amyloid neuritic plaques; neuropathological examination has shown this amount of amyloid neuritic plaque is present in patients with Alzheimer’s disease, but may be also present in patients with other types of neurologic conditions as well as older patients with normal cognition. Amyvid is an adjunct to other diagnostic evaluations.
LIMITATIONS OF USE:
- A positive Amyvid scan does not establish a diagnosis of Alzheimer’s disease or other cognitive disorder
-
Safety and effectiveness of Amyvid have not been established
for:
- Predicting development of dementia or other neurologic condition
- Monitoring response to therapies
Example of a positive Amyvid PET scan imaging report.
CT=computed tomography; MCI=mild cognitive impairment; MMSE=Mini-Mental State Examination; PET=positron emission tomography; TSH=thyroid-stimulating hormone
†Amyvid PET scans are interpreted independently of the patient’s clinical information.
The objective of Amyvid image interpretation is to provide an estimate of the brain beta-amyloid neuritic plaque density, not to make a clinical diagnosis. Image interpretation is performed independently of a patient’s clinical features and relies upon the recognition of unique image features. Image interpretation should be performed independently of the patient’s clinical information. The use of clinical information in the interpretation of Amyvid images has not been evaluated and may lead to errors.
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Meet GeorgeReferences:
- Amyvid (florbetapir F 18 injection) Prescribing Information. Lilly USA, LLC.