Brain [18F]FDG PET-CT imaging in posterior cortical atrophy

Imagem cerebral por [18F]FDG-PET-CT na atrofia cortical posterior

A 68-year-old woman presented with a four-year history of progressive difficulty performing daily activities like dressing, and sometimes colliding with objects when walking. An ophthalmology consultant excluded primary visual changes. Evaluation revealed apperceptive visual agnosia, simultanagnosia, optic ataxia, oculomotor, dressing and constructive apraxia. Other cognitive domains were relatively spared. Brain [18F]FDG-PET-CT showed bilateral temporoparietal hypometabolism with occipital cortex extension (Figure), compatible with the hypothesis of posterior cortical atrophy¹,², a neurodegenerative syndrome with an early and progressive decline in visuospatial and visuoperceptual skills, attributable to Alzheimer’s disease pathology in most patients³, that could be assessed by cerebrospinal fluid biomarkers, which were not available in this case.

Figure
Brain [18F]FDG-PET images showing bilateral temporoparietal hypometabolism with extension to the occipital cortex, including its superior parts and transition with the temporal and parietal lobes. Left column - 3D-SSP reconstructions of the brain metabolic map in the right lateral projection (A1) and projection of the Z-map comparison with a group of healthy individuals in the right lateral (A2) and posterior views (A3). Right column - [18F]FDG-PET transaxial views.

References

• ¹
  Whitwell JL, Graff-Radford J, Singh TD, Drubach DA, Senjem ML, Spychalla AJ, et al. 18F-FDG PET in posterior cortical atrophy and dementia with Lewy bodies. J Nucl Med. 2017 Apr;58(4):632-8. https://doi.org/10.2967/jnumed.116.179903
  » https://doi.org/10.2967/jnumed.116.179903
• ²
  Singh TD, Josephs KA, Machulda MM, Drubach DA, Apostolova LG, Lowe VJ, et al. Clinical, FDG and amyloid PET imaging in posterior cortical atrophy. J Neurol. 2015 Jun;262(6):1483-92. https://doi.org/10.1007/s00415-015-7732-5
  » https://doi.org/10.1007/s00415-015-7732-5
• ³
  Crutch SJ, Lehmann M, Schott JM, Rabinovici GD, Rossor MN, Fox NC. Posterior cortical atrophy. Lancet Neurol. 2012 Feb;11(2):170-8. https://doi.org/10.1016/S1474-4422(11)70289-7
  » https://doi.org/10.1016/S1474-4422(11)70289-7

Publication Dates

• Publication in this collection
  24 Oct 2019
• Date of issue
  Oct 2019

History

• Received
  12 Jan 2019
• Reviewed
  01 Apr 2019
• Accepted
  08 Apr 2019