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A Case of F-18 Florbetapir PET CT in the Differentiation of Normal Pressure Hydrocephalus From Early Alzheimer’s Disease
Poster Title: A Case of F-18 Florbetapir PET CT in the Differentiation of Normal Pressure Hydrocephalus From Early Alzheimer’s Disease
Submitted on 29 Sep 2015
Author(s): Dr Sairah R Khan, Dr Soumitra Mukerji, Laura Perry, Bamidele Williams, Dr Zarni Win
Affiliations: Imperial College NHS Healthcare Trust, Radiological Sciences Unit- Imperial College Healthcare NHS Trust
Poster Views: 2,242
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Poster Information
Abstract: A 77-year-old man presented with a 1-year history of progressive memory decline whilst remaining otherwise cognitively intact. Blood sampling revealed normal thyroid function, B12 and folate levels. Cranial MRI demonstrated some imaging features suggestive of normal-pressure hydrocephalus (NPH). Namely prominence of the lateral and third ventricles as well as the sylvian fissures with some crowding of the gyri at the vertex. There was, however, preservation of the mesial temporal lobes and no evidence of significant associated small vessel disease. Although the MRI findings were suggestive of NPH, clinically the symptoms were felt to be more consistent with atrophy and possibly early Alzheimer’s disease. A F-18 Florbetapir (Amyvid) brain PET CT was requested for further evaluation and planning of future patient management.
F-18 Florbetapir PET CT imaging of the brain demonstrated low tracer uptake within the cerebellar grey matter with good cerebellar grey-white differentiation, but generalised patchy increased grey matter uptake, in more than two lobes in the cerebrum. Most notably, there was loss of grey-white differentiation in both occipital lobes, the left temporal lobe, the left posterior parietal cortex and the precuneus consistent with a positive scan. A positive scan indicating moderate or severe levels of amyloid plaque deposition, which is compatible with a clinical diagnosis of Alzheimer's disease.
The positive Amyvid scan supported the clinical working diagnosis of early Alzheimer’s and as a result the patient avoided CSF shunting as a treatment for NPH which would have proved futile and carries risk of complications both at insertion and thereafter.
Summary: A Case of F-18 Florbetapir PET CT in the Differentiation of Normal Pressure Hydrocephalus From Early Alzheimer’s Disease. Amyvid brain PET is a powerful, accurate, and consistently reproducible new tool in the investigation of suspected AD in vivo.

References: 1. Clark CM, Schneider JA, Bedell BJ et al. Use of florbetapir-PET for imaging –amyloid pathology. JAMA 2011; 305: 275-283. 2. Clark CM, Pontecorvo MJ, Beach TG et al. Cerebral PET with florbetapir compared with neuropathology at autopsy for detection of neuritic
amyloid- plaques: a prospective cohort study. Lancet Neurology 2012; 11: 669-678. 3. Wong DF, Rosenberg PB, Zhou Y et al. In vivo imaging of amyloid depoisiton in Alzheimer disease using the radioligand 18F-AV-45 (florbetapir F-18). J Nucl Med 2010; 51: 913-920. 4. Johnson KA, Minoshima S, Bohnen NI et al. Appropriate use criteria for amyloid PET: A report of the AmyloidImaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association. J Nucl Med 2013; 54: 476-490.
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