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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Concordance between brain 18F-FDG PET and cerebrospinal fluid biomarkers in diag...
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Vol. 37. Issue 1.
Pages 3-8 (January - February 2018)
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Vol. 37. Issue 1.
Pages 3-8 (January - February 2018)
Original Article
Concordance between brain 18F-FDG PET and cerebrospinal fluid biomarkers in diagnosing Alzheimer's disease
Concordancia entre la PET cerebral con 18F-FDG y los biomarcadores en líquido cefalorraquídeo en el diagnóstico de enfermedad de Alzheimer
S. Rubía,f,
Corresponding author

Corresponding author.
, A. Noguerab, S. Tarongíc, M. Oportoa, A. Garcíac, H. Vicoc, A. Espinod, M.J. Picadoe, A. Mase, C. Peñaa,f, G. Amerc,f
a Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Palma, Spain
b Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Palma, Spain
c Servicio de Neurología, Hospital Universitari Son Espases, Palma, Spain
d Servicio de Neurología, Hospital Son Llàtzer, Palma, Spain
e Servicio de Radiodiagnóstico, Hospital Universitari Son Espases, Palma, Spain
f Instituto de Investigación Sanitaria de Palma (IdISPa), Palma, Spain
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Tables (1)
Table 1. The results of the brain FDG-PET and analysis of the CSF biomarkers in the 120 patients included in the study, separated by clinical syndrome.

Cortical posterior hypometabolism on PET imaging with 18F-FDG (FDG-PET), and altered levels of Aβ1-42 peptide, total Tau (tTau) and phosphorylated Tau (pTau) proteins in cerebrospinal fluid (CSF) are established diagnostic biomarkers in Alzheimer's disease (AD). An evaluation has been made of the concordance and relationship between the results of FDG-PET and CSF biomarkers in symptomatic patients with suspected AD.

Material and methods

A retrospective review was carried out on 120 patients with cognitive impairment referred to our Cognitive Neurology Unit, and who were evaluated by brain FDG-PET and a lumbar puncture for CSF biomarkers. In order to calculate their Kappa coefficient of concordance, the result of the FDG-PET and the set of the three CSF biomarkers in each patient was classified as normal, inconclusive, or AD-compatible. The relationship between the results of both methods was further assessed using logistic regression analysis, including the Aβ1-42, tTau and pTau levels as quantitative predictors, and the FDG-PET result as the dependent variable.


The weighted Kappa coefficient between FDG-PET and CSF biomarkers was 0.46 (95% CI: 0.35–0.57). Logistic regression analysis showed that the Aβ1-42 and tTau values together were capable of discriminating an FDG-PET result metabolically suggestive of AD from one non-suggestive of AD, with a 91% sensitivity and 93% specificity at the cut-off line Aβ1-42=44+1.3×tTau.


The level of concordance between FDG-PET and CSF biomarkers was moderate, indicating their complementary value in diagnosing AD. The Aβ1-42 and tTau levels in CSF help to predict the patient FDG-PET cortical metabolic status.

Alzheimer's disease
Cognitive impairment
Cerebrospinal fluid

El hipometabolismo cortical posterior por PET con 18F-FDG (PET-FDG) y la alteración de los niveles del péptido Aβ1-42 y las proteínas Tau total (tTau) y Tau fosforilada (pTau) en líquido cefalorraquídeo (LCR) son biomarcadores establecidos para el diagnóstico de la enfermedad de Alzheimer (EA). Evaluamos la concordancia y la relación entre los resultados de la PET-FDG y los biomarcadores en LCR en pacientes sintomáticos con sospecha de EA.

Material y métodos

Revisión retrospectiva de 120 pacientes con deterioro cognitivo admitidos en la Unidad de Neurología Cognitiva a los que se les ha realizado punción lumbar para la determinación de biomarcadores en LCR y una PET-FDG cerebral. Para el análisis de concordancia (coeficiente Kappa), el resultado de la PET-FDG y del conjunto de los biomarcadores-LCR se clasificó en cada paciente como normal, no-concluyente, o compatible-EA. Se efectuó además una regresión logística incluyendo las variables cuantitativas Aβ1-42, tTau y pTau como predictores y la PET-FDG como variable dependiente.


El coeficiente Kappa ponderado entre PET-FDG y biomarcadores-LCR fue de 0,46 (IC 95%: 0,35-0,57). En el análisis por regresión logística, la Aβ1-42 y la tTau fueron en conjunto capaces de discriminar un resultado PET metabólicamente sugestivo de EA de uno no sugestivo de EA, con una sensibilidad del 91% y una especificidad del 93% aplicando la recta de corte Aβ1-42=44+1,3×tTau.


La concordancia entre la PET-FDG cerebral y los biomarcadores-LCR es moderada, lo cual indica su valor complementario en el diagnóstico de EA. Los niveles de Aβ1-42 y tTau en LCR son buenos predictores del estatus metabólico característico de EA por PET-FDG cerebral.

Palabras clave:
Enfermedad de Alzheimer
Deterioro cognitivo
Líquido cefalorraquídeo


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