Chet Mathis Bill Klunk		Are you confused about the various forms of PET and MRI that are used to image the brain? Do you know which protocol is more suited to detecting plaques and which can measure brain activity? Are you concerned when you see images of shrinking brains? Do you know what needs to be done to improve brain imaging?
Whether you are a clinician, a molecular biologist, a caregiver or a master of magnetic resonance, join Alzforum and five imaging experts to discuss what we know, what we don't know and what we need to know in order to make imaging technology easier, more informative and routinely available. Chet Mathis and Bill Klunk, with Julie Price, Cliff Jack, and Eric Reiman, led this live discussion on 27 April 2005. Readers are invited to submit additional comments by using our Comments form at the bottom of the page.

View Transcript of Live Discussion — Posted 22 August 2006

Background Text
By Bill Klunk

Imaging is currently the most promising tool for the early diagnosis and monitoring of Alzheimer disease (AD). PET (positron emission tomography) can build high-resolution maps of brain activity and amyloidbeta plaques, while magnetic resonance imaging (MRI) can be used to detect subtle changes in tissue composition. Four relatively recent developments have focused much attention on the capabilities and roles of neuroimaging in AD research.

• The Centers for Medicare and Medicaid Services (CMS) has just given limited approval for the reimbursement of FDG-PET in the diagnosis and treatment of mild cognitive impairment (MCI) and early dementia in elderly patients for whom the differential diagnosis includes neurodegenerative diseases.

• The launch of the "Alzheimer's Disease Neuroimaging Initiative" (ADNI), a $60 million multi-center effort jointly funded by NIH and the pharmaceutical industry. Details of this large initiative can be found on the ADNI website. See ARF related news story.

• Reports from research groups at University of California, Los Angeles (See ARF related news); University of Pittsburgh, Pennsylvania and Uppsala University (See ARF related news); and the University of Toronto and University of Pennsylvania (Verhoeff et al. 2004) demonstrating that PET radiotracers are capable of imaging amyloid pathology (and possibly neurofibrillary tangle pathology) in living subjects.

• The unexpected finding of increased brain atrophy in subjects treated with Elan's AN-1792 Aβ vaccine (Fox NC, et al. Epub ahead of print ).

What do these developments mean for the clinician, the basic researcher, the patient? This discussion will focus on these latest developments and the current state of affairs of AD imaging. For example, which imaging protocol is best suited to AD? Should we be focusing on PET imaging of Aβ, or is MRI likely to be more informative? What questions will ADNI be able to answer? Will it deliver an imaging standard that will be widely accepted? Are there new potential biomarkers out there or new Aβ ligands that can be imaged? And how do we go about finding them?

References

Shoghi-Jadid K, Small GW, Agdeppa ED, Kepe V, Ercoli LM, Siddarth P, Read S, Satyamurthy N, Petric A, Huang SC, Barrio JR. Localization of neurofibrillary tangles and beta-amyloid plaques in the brains of living patients with Alzheimer disease. Am J Geriatr Psychiatry. 2002 Jan-Feb ; 10(1):24-35. Abstract See Related News

Klunk WE, Engler H, Nordberg A, Wang Y, Blomqvist G, Holt DP, Bergström M, Savitcheva I, Huang GF, Estrada S, Ausén B, Debnath ML, Barletta J, Price JC, Sandell J, Lopresti BJ, Wall A, Koivisto P, Antoni G, Mathis CA, Långström B. Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B. Ann Neurol. 2004 Mar ; 55(3):306-19. Abstract

Verhoeff NP, Wilson AA, Takeshita S, Trop L, Hussey D, Singh K, Kung HF, Kung MP, Houle S. In-vivo imaging of Alzheimer disease beta-amyloid with [11C]SB-13 PET. Am J Geriatr Psychiatry. 2004 Nov-Dec ; 12(6):584-95. Abstract

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