PET imaging for the evaluation of cerebral amyloid angiopathy: a systematic review

Purpose In the last years, the role of PET imaging in the assessment of cerebral amyloid angiopathy (CAA) is emerging. In this setting, some tracers have proven their utility for the evaluation of the disease (mainly C-11-Pittsburgh compound B [C-11-PIB]), however, the value of other radiotracers has to be clarified. The aim of this systematic review is, therefore, to assess the role of PET imaging in the evaluation of CAA. Methods A wide literature search of the PubMed/MEDLINE, Scopus, Embase, Web of Science and Cochrane library databases was made to find relevant published articles about the diagnostic performance of PET imaging for the evaluation of CAA. Quality assessment including the risk of bias and applicability concerns was carried out using QUADAS-2 evaluation. Results The comprehensive computer literature search revealed 651 articles. On reviewing the titles and abstracts, 622 articles were excluded because the reported data were not within the field of interest. Twenty-nine studies were included in the review. In general, PET imaging with amyloid tracers revealed its value for the assessment of CAA, for its differential diagnosis and a correlation with some clinico-pathological features. With less evidence, a role for 18F-fluorodeoxiglucose (F-18-FDG) and tau tracers is starting to emerge. Conclusion PET imaging demonstrated its utility for the assessment of CAA. In particular, amiloid tracers revealed higher retention in CAA patients, correlation with cerebral bleed, the ability to differentiate between CAA and other related conditions (such as Alzheimer's disease) and a correlation with some cerebrospinal fluid biomarkers.