[18F]Florbetapir PET/MR imaging to assess demyelination in multiple sclerosis

• Published in: European journal of nuclear medicine and molecular imaging Vol. 47; no. 2; pp. 366 - 378
• Main Authors: Carotenuto, Antonio, Giordano, Beniamino, Dervenoulas, George, Wilson, Heather, Veronese, Mattia, Chappell, Zachary, Polychronis, Sotirios, Pagano, Gennaro, Mackewn, Jane, Turkheimer, Federico E., Williams, Steven C. R., Hammers, Alexander, Silber, Eli, Brex, Peter, Politis, Marios
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2020; Springer Nature B.V
• Subjects: Aniline Compounds; Anisotropy; Blood flow; Brain - diagnostic imaging; Cardiology; Central nervous system; Cerebral blood flow; Cluster analysis; Cognitive ability; Correlation analysis; Damage; Demyelination; Diffusion Tensor Imaging; Ethylene Glycols; Evaluation; Fluorine isotopes; Humans; Imaging; Lesions; Longitudinal studies; Magnetic Resonance Imaging; Medical imaging; Medicine; Medicine & Public Health; Multiple sclerosis; Multiple Sclerosis - diagnostic imaging; Multiple Sclerosis, Relapsing-Remitting; Myelin; Neurology; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Positron emission; Positron-Emission Tomography; Radiology; Spin labeling; Substantia alba; Tensors; Tomography; White Matter - diagnostic imaging; Pathology; Multiple sclerosis; [; Demyelination; PET; F]florbetapir; [18F]florbetapir
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-019-04533-y

Purpose We evaluated myelin changes throughout the central nervous system in Multiple Sclerosis (MS) patients by using hybrid [ 18 F]florbetapir PET-MR imaging. Methods We included 18 relapsing-remitting MS patients and 12 healthy controls. Each subject performed a hybrid [ 18 F]florbetapir PET-MR and both a clinical and cognitive assessment. [ 18 F]florbetapir binding was measured as distribution volume ratio (DVR), through the Logan graphical reference method and the supervised cluster analysis to extract a reference region, and standard uptake value (SUV) in the 70–90 min interval after injection. The two quantification approaches were compared. We also evaluated changes in the measures derived from diffusion tensor imaging and arterial spin labeling. Results [ 18 F]florbetapir DVRs decreased from normal-appearing white matter to the centre of T2 lesion ( P  < 0.001), correlated with fractional anisotropy and with mean, axial and radial diffusivity within T2 lesions ( coeff. = −0.15, P  < 0.001, coeff. = −0.12, P < 0.001 and coeff. = −0.16, P < 0.001, respectively). Cerebral blood flow was reduced in white matter damaged areas compared to white matter in healthy controls (−10.9%, P  = 0.005). SUV 70–90 and DVR are equally able to discriminate between intact and damaged myelin (area under the curve 0.76 and 0.66, respectively; P  = 0.26). Conclusion Our findings demonstrate that [ 18 F]florbetapir PET imaging can measure in-vivo myelin damage in patients with MS. Demyelination in MS is not restricted to lesions detected through conventional MRI but also involves the normal appearing white matter. Although longitudinal studies are needed, [ 18 F]florbetapir PET imaging may have a role in clinical settings in the management of MS patients.