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Searching for a clearer picture of dementia imaging

The potential for PET-based amyloid imaging to advance care of Alzheimer’s patients has excited many in the field of neuroimaging for years, yet the role of such scans has been difficult to define.

In 2013, despite FDA approval of florbetapir (Amyvid, Eli Lilly/Avid Radiopharmaceuticals) as a diagnostic PET radiopharmaceutical for Alzheimer’s, CMS (Centers for Medicare & Medicaid Services) was not ready to spring for full coverage. CMS’ final decision was to cover one PET scan to exclude Alzheimer’s disease only for patients participating in a clinical study under the Coverage with Evidence Development program.

While CMS was not totally convinced that PET amyloid imaging improves outcomes, these scans have changed the way physicians manage their patients, according to a study presented this week at the Alzheimer’s Association International Conference in Washington, D.C. Read more.

Why diagnosing Alzheimer’s, while painful, has value

Dwaine Rieves retired in 2013 as director of the Food and Drug Administration’s Division of Medical Imaging Products, where he was part of a team that reviewed clinical data on amyloid-imaging PET scans.

A couple of generations back, two women in my family “lost their minds.” One started wandering in her 60s, the other became obsessed with dolls in her late teens. The wanderer died at home in 1945, and best I can now tell, the regressing teenager died in a sanitarium about the same year.

As a boy, I vaguely recall an occasional impolite question about one or the other woman. The answer was always delivered with a lowered voice: She lost her mind. That was it, end of conversation — she just lost her mind. Just as when it sometimes happened to other folks in town, maybe from bad well water, from poisoning, perhaps spite or sin. Read more.

Q & A: The prevalence of overdiagnosis in Alzheimer's Disease

Overdiagnosis is commonly discussed in areas like breast imaging, where screening is widely conducted and media interest is high. While it’s under the radar for other diseases, it’s a big enough topic in the medical world to warrant a dedicated issue in Academic Radiology. Its August 2015 issue was devoted to overdiagnosis, a term used for disease that’s correctly diagnosed, but at the earliest stages when treatment may not be necessary and might even be harmful to the patient. This is in contrast to false positives, when the diagnostic test incorrectly indicates the possible presence of disease.

Overdiagnosis is more prevalent in modern times because the definition of disease has expanded, said Saurabh Jha, MBBS, assistant professor of radiology at the Hospital of the University of Pennsylvania, and guest editor of the Academic Radiology issue. “The rationale is the very intuitive concept that if we catch disease early on, we’ll avoid morbidity and mortality, that prevention is better than cure.” Read more.

Progenics inks licensing pact with Johns Hopkins University for agent to image prostate cancer using PET scan

Progenics Pharmaceuticals, Inc., engaged in developing innovative medicines for oncology, has entered into an exclusive worldwide licensing agreement with Johns Hopkins University for [18F]DCFPyL (PyL), a clinical-stage prostate specific membrane antigen (PSMA)-targeted imaging agent for prostate cancer.

PyL was developed by a team led by Martin G. Pomper, M.D., Ph.D. at the Johns Hopkins University School of Medicine. An early stage clinical trial of PyL with PET imaging in men with prostate cancer demonstrated uptake of PyL in sites of putative metastatic disease and primary tumors not seen with currently approved imaging techniques, suggesting the potential for high sensitivity and specificity in detecting prostate cancer. Read more.

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