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
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 decide, along with Carol, on appropriate management
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.
SELECT IMPORTANT SAFETY INFORMATION:
Risk for Image Misinterpretation and Other Errors
- Errors may occur in the Amyvid estimation of brain neuritic plaque density during image interpretation
- Amyvid scan results are indicative of the brain neuritic amyloid plaque content only at the time of image acquisition and a negative scan result does not preclude the development of brain amyloid in the future
Amyvid PET Scan Imaging Report
- Indicates presence of significant (moderate to frequent) amyloid neuritic plaques1
- Consistent with a neuropathological diagnosis of AD1
- Neuropathological examination has shown this amount of amyloid neuritic plaque is present in patients with AD, but may also be present in patients with other types of neurologic conditions as well as older people with normal cognition1
- Amyvid is an adjunct to other diagnostic evaluations. A positive Amyvid scan does not establish a diagnosis of AD or other cognitive disorder. The safety and effectiveness of Amyvid have not been established for predicting the development of dementia or other neurologic condition, or for monitoring responses to therapies1
PROCEDURE: BRAIN AMYLOID PET/CT SCAN
HISTORY: Cognitive impairment
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.
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