Why Is Amyloid-β PET Requested After Performing CSF Biomarkers?

Juhan Reimand, Colin Groot, Charlotte E. Teunissen, Albert D. Windhorst, Ronald Boellaard, Frederik Barkhof, Sergei Nazarenko, Wiesje M. van der Flier, Bart N.M. van Berckel, Philip Scheltens, Rik Ossenkoppele, Femke Bouwman

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)


BACKGROUND: Amyloid-β positron emission tomography (PET) and cerebrospinal fluid (CSF) Aβ42 are considered interchangeable for clinical diagnosis of Alzheimer's disease. OBJECTIVE: To explore the clinical reasoning for requesting additional amyloid-β PET after performing CSF biomarkers. METHODS: We retrospectively identified 72 memory clinic patients who underwent amyloid-β PET after CSF biomarkers analysis for clinical diagnostic evaluation between 2011 and 2019. We performed patient chart reviews to identify factors which led to additional amyloid-β PET. Additionally, we assessed accordance with appropriate-use-criteria (AUC) for amyloid-β PET. RESULTS: Mean patient age was 62.0 (SD = 8.1) and mean Mini-Mental State Exam score was 23.6 (SD = 3.8). CSF analysis conflicting with the clinical diagnosis was the most frequent reason for requesting an amyloid-β PET scan (n = 53, 74%), followed by incongruent MRI (n = 16, 22%), unusual clinical presentation (n = 11, 15%) and young age (n = 8, 11%). An amyloid-β PET scan was rarely (n = 5, 7%) requested in patients with a CSF Aβ+/tau+ status. Fifteen (47%) patients with a post-PET diagnosis of AD had a predominantly non-amnestic presentation. In n = 11 (15%) cases, the reason that the clinician requested amyloid-β was not covered by AUC. This happened most often (n = 7) when previous CSF analysis did not support current clinical diagnosis, which led to requesting amyloid-β PET. CONCLUSION: In this single-center study, the main reason for requesting an amyloid-β PET scan after performing CSF biomarkers was the occurrence of a mismatch between the primary clinical diagnosis and CSF Aβ/tau results.

Original languageEnglish
Pages (from-to)559-569
Number of pages11
JournalJournal of Alzheimer's disease : JAD
Issue number2
Publication statusPublished - 2020 Jan 21

Subject classification (UKÄ)

  • Neurology


  • Alzheimer’s disease
  • amyloid
  • cerebrospinal fluid
  • positron emission tomography
  • tau proteins


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