71-year-old accountant with cognitive concerns
Accompanied to doctor’s office by his wife of 40 years
Wife describes his progressive change over the past 3 years
Gradually lost ability to work with numbers; his wife now manages their finances
Used to enjoy lively dinner conversation; now he is less talkative
His memory is worse, but he sometimes recalls nearly everything
George is frustrated by these changes
MOCA 24/30 with errors in recall, calculation, attention, and visuospatial skills
Clinical Assessment: Progressive MCI
Medical history is remarkable for hypertension, type 2 diabetes, and gout. No previous stroke symptoms
Normal physical and neurological exams
Routine lab tests normal, as well as B12, folate, and TSH
Structural MRI outcomes: small bilateral lacunar infarcts, small vessel ischemic changes, and age-appropriate atrophy
An Amyvid PET scan is ordered due to the progressive nature of George’s cognitive decline and uncertain diagnosis
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:
WARNINGS AND PRECAUTIONS
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 sparse to no neuritic plaques1
- The negative scan is inconsistent with a neuropathological diagnosis of AD at the time of image acquisition, and makes it unlikely that George’s cognitive impairment is due to AD1
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 no increased tracer uptake seen in the cortical cerebral gray matter. The brain shows normal gray-white contrast throughout. 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 midline shift or mass effect.
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