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18F-flortaucipir tau positron emission tomography distinguishes established progressive supranuclear palsy from controls and Parkinson disease: A multicenter study

  • Author(s): Schonhaut, DR
  • McMillan, CT
  • Spina, S
  • Dickerson, BC
  • Siderowf, A
  • Devous, MD
  • Tsai, R
  • Winer, J
  • Russell, DS
  • Litvan, I
  • Roberson, ED
  • Seeley, WW
  • Grinberg, LT
  • Kramer, JH
  • Miller, BL
  • Pressman, P
  • Nasrallah, I
  • Baker, SL
  • Gomperts, SN
  • Johnson, KA
  • Grossman, M
  • Jagust, WJ
  • Boxer, AL
  • Rabinovici, GD
  • et al.

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© 2017 American Neurological Association Objective: 18F-flortaucipir (formerly 18F-AV1451 or 18F-T807) binds to neurofibrillary tangles in Alzheimer disease, but tissue studies assessing binding to tau aggregates in progressive supranuclear palsy (PSP) have yielded mixed results. We compared in vivo 18F-flortaucipir uptake in patients meeting clinical research criteria for PSP (n = 33) to normal controls (n = 46) and patients meeting criteria for Parkinson disease (PD; n = 26). Methods: Participants underwent magnetic resonance imaging and positron emission tomography for amyloid-β (11C-PiB or 18F-florbetapir) and tau (18F-flortaucipir). 18F-flortaucipir standardized uptake value ratios were calculated (t = 80–100 minutes, cerebellum gray matter reference). Voxelwise and region-of-interest group comparisons were performed in template space, with receiver operating characteristic curve analyses to assess single-subject discrimination. Qualitative comparisons with postmortem tau are reported in 1 patient who died 9 months after 18F-flortaucipir. Results: Clinical PSP patients showed bilaterally elevated 18F-flortaucipir uptake in globus pallidus, putamen, subthalamic nucleus, midbrain, and dentate nucleus relative to controls and PD patients (voxelwise p < 0.05 family wise error corrected). Globus pallidus binding best distinguished PSP patients from controls and PD (area under the curve [AUC] = 0.872 vs controls, AUC = 0.893 vs PD). PSP clinical severity did not correlate with 18F-flortaucipir in any region. A patient with clinical PSP and pathological diagnosis of corticobasal degeneration had severe tau pathology in PSP-related brain structures with good correspondence between in vivo 18F-flortaucipir and postmortem tau neuropathology. Interpretation: 18F-flortaucipir uptake was elevated in PSP versus controls and PD patients in a pattern consistent with the expected distribution of tau pathology. Ann Neurol 2017;82:622–634.

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