Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia

For the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders, Marina Boccardi, Cristina Festari, Daniele Altomare, Federica Gandolfo, Stefania Orini, Flavio Nobili, Giovanni B. Frisoni, Federica Agosta, Javier Arbizu, Femke Bouwman, Alexander Drzezga, Peter Nestor, Zuzana Walker

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Background: FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use. Methods: Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use. Results: Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold−/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24% of the examined papers; 38% used an acceptable reference-standard (clinical follow-up); and 38% compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence. Discussion: An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations.

Original languageEnglish
Pages (from-to)1470-1486
Number of pages17
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume45
Issue number9
DOIs
Publication statusPublished - 1 Jul 2018

Cite this

For the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders, Boccardi, M., Festari, C., Altomare, D., Gandolfo, F., Orini, S., ... Walker, Z. (2018). Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia. European Journal of Nuclear Medicine and Molecular Imaging, 45(9), 1470-1486. https://doi.org/10.1007/s00259-018-4024-1
For the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders ; Boccardi, Marina ; Festari, Cristina ; Altomare, Daniele ; Gandolfo, Federica ; Orini, Stefania ; Nobili, Flavio ; Frisoni, Giovanni B. ; Agosta, Federica ; Arbizu, Javier ; Bouwman, Femke ; Drzezga, Alexander ; Nestor, Peter ; Walker, Zuzana. / Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia. In: European Journal of Nuclear Medicine and Molecular Imaging. 2018 ; Vol. 45, No. 9. pp. 1470-1486.
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abstract = "Background: FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use. Methods: Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use. Results: Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold−/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24{\%} of the examined papers; 38{\%} used an acceptable reference-standard (clinical follow-up); and 38{\%} compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence. Discussion: An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations.",
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For the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders, Boccardi, M, Festari, C, Altomare, D, Gandolfo, F, Orini, S, Nobili, F, Frisoni, GB, Agosta, F, Arbizu, J, Bouwman, F, Drzezga, A, Nestor, P & Walker, Z 2018, 'Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia' European Journal of Nuclear Medicine and Molecular Imaging, vol. 45, no. 9, pp. 1470-1486. https://doi.org/10.1007/s00259-018-4024-1

Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia. / For the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders; Boccardi, Marina; Festari, Cristina; Altomare, Daniele; Gandolfo, Federica; Orini, Stefania; Nobili, Flavio; Frisoni, Giovanni B.; Agosta, Federica; Arbizu, Javier; Bouwman, Femke; Drzezga, Alexander; Nestor, Peter; Walker, Zuzana.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 45, No. 9, 01.07.2018, p. 1470-1486.

Research output: Contribution to journalReview articleAcademicpeer-review

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T1 - Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia

AU - For the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders

AU - Boccardi, Marina

AU - Festari, Cristina

AU - Altomare, Daniele

AU - Gandolfo, Federica

AU - Orini, Stefania

AU - Nobili, Flavio

AU - Frisoni, Giovanni B.

AU - Agosta, Federica

AU - Arbizu, Javier

AU - Bouwman, Femke

AU - Drzezga, Alexander

AU - Nestor, Peter

AU - Walker, Zuzana

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N2 - Background: FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use. Methods: Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use. Results: Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold−/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24% of the examined papers; 38% used an acceptable reference-standard (clinical follow-up); and 38% compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence. Discussion: An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations.

AB - Background: FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use. Methods: Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use. Results: Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold−/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24% of the examined papers; 38% used an acceptable reference-standard (clinical follow-up); and 38% compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence. Discussion: An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations.

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KW - Alzheimer

KW - Biomarker

KW - Dementia

KW - Diagnosis

KW - Evidence assessment

KW - FDG-PET

KW - Fluorodeoxyglucose metabolism

KW - Positron emission tomography

KW - Quality of evidence

KW - Recommendations

KW - Validation

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DO - 10.1007/s00259-018-4024-1

M3 - Review article

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EP - 1486

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

SN - 1619-7070

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For the EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders, Boccardi M, Festari C, Altomare D, Gandolfo F, Orini S et al. Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia. European Journal of Nuclear Medicine and Molecular Imaging. 2018 Jul 1;45(9):1470-1486. https://doi.org/10.1007/s00259-018-4024-1