0:00

Dr. Laser,

0:01

I want to talk a little bit about the role of PET

0:03

or Positron Emission Tomography in Pick's disease.

0:06

You and I were discussing earlier that when the frontal

0:10

lobe gets basically obliterated over time,

0:13

the patients lose their filter.

0:15

They get what's known as a dysexecutive syndrome.

0:17

They behave very badly.

0:19

They have no inhibitions.

0:20

They may also have some nasal-type symptoms.

0:24

They sniff because the olfactory region is affected.

0:27

And we said before that sometimes the left side is more

0:31

affected than the right.

0:32

It is an asymmetric disease.

0:33

When the left side is more affected,

0:34

they may have semantic aphasia, right side more affected,

0:37

they present a little later

0:39

with facial recognition problems.

0:41

And look at how much sparing of the parietal lobe we have.

0:44

And we said earlier in vignettes that the entorhinal cortex

0:48

and hippocampus proper is often spared or less involved.

0:52

Now with fluorodeoxyglucose,

0:53

remember, we are not using amyloid markers here,

0:56

which we would use in ALZ.

0:58

You would see accumulation of amyloid,

1:00

although it's not specific.

1:02

The absence of amyloid uptake on a specific PET,

1:06

almost excludes ALZ.

1:09

On the other hand, when we do an FDG study,

1:12

you tend to have temporoparietal hypometabolism in ALZ.

1:16

You have frontotemporal hypometabolism in PET.

1:21

And here's just one cut in the frontal region.

1:23

Look at the profound hypometabolism anteriorly and

1:27

the sparing of the parietal region posteriorly.

1:30

This is a very typical pattern with fluorodeoxy

1:34

glucose PET showing frontal involvement.

1:36

Do you care to make any additional comments about this?

1:39

Sure.

1:40

So, I think one of the most important things is when

1:42

you have someone that has cognitive symptoms,

1:45

one of the things that the PET will do could be an early

1:48

indicator of hypometabolism in a certain region.

1:51

In this case, the frontal lobe,

1:52

left greater than right,

1:53

indicates that there's hypometabolism

1:56

involving the frontal lobe,

1:57

which would lead you to the diagnosis

1:58

of frontotemporal dementia.

1:59

So what you're saying is

2:00

before the morphologic changes occur,

2:02

the metabolic changes occur.

2:03

So you might pick up Pick's disease

2:05

or frontotemporal lobar dementia

2:07

earlier with a PET, even an FDG PET,

2:09

than you would with MR.

2:11

Correct.

2:11

All right, let's move on.

2:13

Pomeranz and Laser out.

2:14

Out.