Improved power for characterizing longitudinal amyloid-β PET changes and evaluating amyloid-modifying treatments with a cerebral white matter reference region

J Nucl Med. 2015 Apr;56(4):560-6. doi: 10.2967/jnumed.114.149732. Epub 2015 Mar 5.


In this article, we describe an image analysis strategy with improved power for tracking longitudinal amyloid-β (Aβ) PET changes and evaluating Aβ-modifying treatments.

Methods: Our aims were to compare the power of template-based cerebellar, pontine, and cerebral white matter reference regions to track 24-mo florbetapir standardized uptake value (SUV) ratio (SUVR) changes; to relate those changes to 24-mo clinical declines; and to evaluate Aβ-modifying treatments in Aβ-positive (Aβ+) and Aβ-negative (Aβ-) patients with probable Alzheimer dementia (pAD), in patients with mild cognitive impairment (MCI), in cognitively normal controls (NCs), and in cognitively normal apolipoprotein E4 (APOE4) carriers and noncarriers. We used baseline and follow-up (∼24 mo) florbetapir PET scans from 332 Aβ+ and Aβ- subjects participating in the multicenter Alzheimer's Disease Neuroimaging Initiative. Each of the proposed analyses included 31 pAD patients, 187 MCI patients, and 114 NCs. Cerebral-to-white matter, cerebellar, and pontine SUVRs were characterized in terms of their longitudinal variability; their power to track longitudinal fibrillar Aβ increases in Aβ+ and Aβ- subgroups and cognitively normal APOE4 carriers and noncarriers; the sample sizes needed to detect attenuated accumulation of or clearance of fibrillar Aβ accumulation in randomized clinical trials; and their ability to relate 24-mo fibrillar Aβ increases to clinical declines.

Results: As predicted, cerebral-to-white matter SUVR changes were significantly less variable and had significantly greater power to detect 24-mo fibrillar Aβ increases and evaluate Aβ-modifying treatment effects in Aβ+ pAD, MCI, and NC subjects and cognitively normal APOE4 carriers. They were also distinguished by the ability to detect significant associations between 24-mo Aβ increases and clinical declines.

Conclusion: A cerebral white matter reference region may improve the power to track longitudinal fibrillar Aβ increases, to characterize their relationship to longitudinal clinical declines, and to evaluate Aβ-modifying treatments in randomized clinical trials.

Keywords: Alzheimer disease; biomarkers; clinical trial sample size; florbetapir PET; image analysis; statistical power.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / diagnosis
  • Alzheimer Disease / diagnostic imaging
  • Amyloid beta-Peptides / chemistry*
  • Aniline Compounds*
  • Apolipoprotein E4 / genetics
  • Brain / diagnostic imaging
  • Brain / pathology
  • Brain Mapping / methods
  • Cerebellum / diagnostic imaging
  • Cerebrum / diagnostic imaging
  • Cognition Disorders / diagnosis
  • Cognition Disorders / diagnostic imaging
  • Ethylene Glycols*
  • Female
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pons / diagnostic imaging
  • Positron-Emission Tomography / methods*
  • Randomized Controlled Trials as Topic
  • Reference Values
  • Sample Size
  • Time Factors
  • White Matter / diagnostic imaging*


  • Amyloid beta-Peptides
  • Aniline Compounds
  • Apolipoprotein E4
  • Ethylene Glycols
  • florbetapir