The Reading Room Podcast: Current Perspectives on the Updated Appropriate Use Criteria for Brain PET

For Satoshi Minoshima, M.D., Ph.D., the approval of new anti-amyloid treatments and emerging research on the use of blood-based biomarkers were key developments that fueled the recently updated appropriate use criteria (AUC) for brain positron emission tomography (PET) in patients with mild cognitive impairment (MCI)

In a new podcast, Dr. Minoshima noted that amyloid PET wasn’t recommended 10 years ago for patients who had an established diagnosis of Alzheimer’s disease. However, with the approvals of the anti-amyloid therapies lecanemab (Leqembi, Eisai/Biogen) and donanemab (Kisunia, Eli Lilly), Dr. Minoshima said amyoid PET enables clinicians to confirm target expression within the brain in these patients prior to treatment.

Additionally, in light of emerging evidence on the use of blood-based biomarkers, Dr. Minoshima notes the utility of amyloid PET imaging if cerebrospinal fluid (CSF) or other fluid biomarker results are uncertain or incongruent with the clinical diagnosis.

“I think maybe that’s a great opportunity to do amyloid PET imaging,” posited Dr. Minoshima, a past president and current chair of value initiative at the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

The updated AUC also incorporated the use of tau PET imaging, which could enhance assessment of neuronal injury and possibly assist in differentiating Alzheimer’s disease and other neurodegenerative conditions, according to Dr. Minoshima.

“This clinical distinction between progressive supranuclear palsy (PSP) and Alzheimer’s disease is actually quite difficult, so hopefully the availability of tau pet in the future is going to give us a better differential diagnosis so combining (tau PET) with amyloid PET, we can guide the patient to the right treatment,” noted Dr. Minoshima, the Anne G. Osborn Chair and professor in the Department of Radiology and Imaging Sciences at the University of Utah.

In the podcast, James Williams, the chief executive officer for Siemens Healthcare Molecular Imaging, also noted that the availability of low-cost, easily to perform blood tests in the future may lead to a broader population of patients being tested for neurodegenerative diseases due to family history or genetic predisposition.

“In those cases, I think the imaging gets even more critical because certainly you wouldn't want to … subject someone to the therapy until you're very sure what's going to happen, but they're going to be a different patient population too. (These are) not the images we've seen in the clinical trials or for a large part of the research up to (now),” added Williams.

(Editor’s note: For related content, see “SNMMI Issues New Appropriate Use Criteria for Amyloid PET and Tau PET Imaging,” “A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, MD, Part 1” and “A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, Part 2.”)

For more insights from Dr. Minoshima and Dr. Williams, listen below or subscribe on your favorite podcast platform.