Overviewing Updating Amyloid and Tau PET Criteria to Enhance Alzheimer Diagnostic Precision: Phillip Kuo, MD, PhD, FACR

WATCH TIME: 5 minutes

“Amyloid is necessary but not sufficient for diagnosing Alzheimer disease. In these challenging or uncertain cases, tau PET may potentially help.”

A multidisciplinary workgroup recently released updated guidance for the use of amyloid and tau PET imaging in Alzheimer disease (AD) and related dementia, expanding on the initial appropriate use criteria established in 2013. Published in Alzheimer’s & Dementia and the Journal of Nuclear Medicine, the revised criteria aimed to help clinicians identify when these imaging tools can effectively support diagnosis and management of cognitive decline and also highlighted scenarios where PET scans are unlikely to provide significant clinical benefit.¹

The updated AUC emphasized the strongest evidence for amyloid and tau PET imaging in specific contexts, such as evaluating mild cognitive impairment, as well as clarifying the cause of dementia when uncertain, and determining eligibility for emerging disease-modifying therapies or monitoring treatment response. In the guidance revision, these tests were generally discouraged for individuals without cognitive impairment, even those with the APOE4 gene linked to AD risk, as well as for nonmedical purposes like legal disputes, insurance evaluations, or employment screening, and should not replace genetic testing in patients suspected of having a hereditary disease.^2,3

To delve deeper into the evolving landscape of AD diagnostics, NeurologyLive^® turned to Phillip Kuo, MD, PhD, FACR, professor in the department of diagnostic radiology at City of Hope. In a recent interview, Kuo shared his insights on key developments shaping the field, including the impact of anti-amyloid antibody therapies on amyloid PET criteria, the growing role of tau PET in staging AD, and the critical importance of multidisciplinary collaboration in refining diagnostic frameworks for neurodegenerative conditions. His expertise offered a valuable perspective on these advancements and their implications for clinical practice.

REFERENCES
1. Rabinovici GD, Knopman DS, Arbizu J, et al. Updated Appropriate Use Criteria for Amyloid and Tau PET: A Report from the Alzheimer's Association and Society for Nuclear Medicine and Molecular Imaging Workgroup. J Nucl Med. Published online January 8, 2025. doi:10.2967/jnumed.124.268756
2. New Guidance for Gold-Standard Imaging Tests Assists Clinicians in Diagnosis and Management of Alzheimer’s and Other Dementia. News Release. Published January 8, 2024. Accessed January 10, 2024. https://www.alz.org/news/2025/updated-appropriate-use-criteria-amyloid-tau-pet
3. SNMMI and the Alzheimer’s Association Release Updated Appropriate Use Criteria for Amyloid and Tau PET Imaging. News Release. SNMMI. Published January 8, 2024. Accessed January 10, 2024. https://snmmi.org/Web/News/Articles/SNMMI-and-the-Alzheimer-s-Association-Release-Updated-Appropriate-Use-Criteria-for-Amyloid-and-Tau-P

Editor’s Note: Kuo has disclosed that he is a consultant and/or speaker for Attralus, Blue Earth Diagnostics, Chimerix, dGenThera, Eli Lilly, Fusion Pharma, General Electric Healthcare, Invicro, Life Molecular Imaging, Navidea, Novartis, Radionetics, Telix Pharmaceuticals, and United Imaging. He is on the scientific advisory board for dGenThera. He has been a recipient of research grants from Blue Earth Diagnostics and General Electric Healthcare.