Critical review of the Appropriate Use Criteria for amyloid imaging: Effect on diagnosis and patient care

Alzheimers Dement (Amst). 2016 Dec 18:5:15-22. doi: 10.1016/j.dadm.2016.12.001. eCollection 2016.


Introduction: The utility of the Appropriate Use Criteria (AUC) for amyloid imaging is not established.

Methods: Fifty-three cognitively impaired patients with clinical F18-florbetapir imaging were classified as early and late onset, as well as AUC-consistent or AUC-inconsistent. Chi-square statistics and t test were used to compare demographic characteristics and clinical outcomes as appropriate.

Results: Early-onset patients were more likely to be amyloid positive. Change in diagnosis was more frequent in late-onset cases. Change in therapy was more common in early-onset cases. AUC-consistent and AUC-inconsistent cases had comparable rates of amyloid positivity. We saw no difference in the rate of treatment changes in the AUC-consistent group as opposed to the AUC-inconsistent group.

Discussion: The primary role of amyloid imaging in the early-onset group was to confirm the clinically suspected etiology, and in the late-onset group in detecting amyloid-negative cases. The rate of therapeutic changes was significantly greater in the early-onset cases.

Keywords: Alzheimer's disease (AD); Amyloid; Appropriate use criteria (AUC); Mild cognitive impairment (MCI); Positron emission tomography (PET).