Objective: To determine the diagnostic utility of regional subcortical [¹⁸F]AV-1451 tau-PET measurements to differentiate progressive supranuclear palsy (PSP) from age-matched controls and Alzheimer’s dementia patients.

Background: Tau-PET imaging using the [¹⁸F]AV-1451 ligand has shown promising results in PSP, with studies observing consistent patterns of increased uptake in subcortical regions, including midbrain, dentate nucleus of the cerebellum, globus pallidus, putamen and thalamus, compared to controls and patients with Alzheimer’s dementia. It is, however, unclear whether measurements from these subcortical regions could provide diagnostic biomarkers in PSP.

Methods: [¹⁸F]AV-1451 PET was performed in ten patients with probable PSP. These patients were age and gender-matched to 50 controls and ten Alzheimer’s dementia patients that had undergone identical [¹⁸F]AV-1451 imaging. Regional [¹⁸F]AV-1451 uptake was calculated for the dentate nucleus of the cerebellum, midbrain, globus pallidus, putamen and thalamus using atlas-based parcellation and a modified version of the automated anatomical labeling atlas. Median [¹⁸F]AV-1451 uptake in each region was divided by median uptake in cerebellar crus grey matter to create standard uptake ratios. Sensitivity and specificity to differentiate PSP from controls and Alzheimer’s dementia were calculated using an area under the research operator curve analysis.

Results: Optimum differentiation of PSP from controls was achieved with uptake in the globus pallidus, with sensitivity of 80% and specificity of 82%. Uptake in the midbrain, putamen and thalamus all had a sensitivity of 70% to differentiate PSP from controls, with the highest specificity obtained with the midbrain (86%). The dentate nucleus of the cerebellum had good specificity (76%) but average sensitivity (60%). Uptake in the globus pallidus also provided optimum differentiation of PSP from Alzheimer’s dementia, with sensitivity of 70% and specificity of 90%. The dentate nucleus of the cerebellum also performed well with sensitivity of 70% and specificity of 80%.

Conclusions: Automated [¹⁸F]AV-1451 measurements from subcortical brain structures provide good sensitivity and specificity to differentiate PSP from age-matched healthy controls and Alzheimer’s dementia patients, with measurements of uptake in the globus pallidus showing most promise as a potential diagnostic biomarker in PSP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-utility-of-regional-18fav-1451-tau-pet-measurements-in-psp/