Prognostic value of Amyloid PET in Real-World Amnestic MCI: Influence of reader experience and interpretation method
- 1Neurology Department, University of Navarra Clinic, Pamplona, Spain
- 2Nuclear Medicine Department, University of Navarra Clinic, Pamplona, Spain
- 3Medical Physics. Nuclear Medicine Department, University of Navarra Clinic, Pamplona, Spain
Abstract
Purpose: This study assessed the prognostic value and inter-/intra-observer reliability of three amyloid PET interpretation methods—conventional visual reading, assisted visual interpretation and standardized uptake value ratio (SUVR)-based quantification—for predicting conversion to Alzheimer’s disease (AD).
Methods: This retrospective longitudinal study included 145 patients with amnestic mild cognitive impairment who underwent amyloid PET and were followed for up to 8 years at a single memory clinic. Two certified nuclear medicine physicians performed structured visual reads and assisted visual interpretations. Semiquantitative SUVR thresholds validated in prior studies were applied as a third method. Inter- and intra-observer agreement was assessed using Cohen’s kappa (κ). Cox regression models estimated the association of conversion to AD in PET-positive versus PET-negative patients for each method, adjusting for age, sex and education.
Results: Inter-observer agreement was excellent for structured visual reading (κ = 0.877) and assisted visual interpretation (κ = 0.904). Intra-observer reliability was also high (κ = 0.891 for Reader 1; κ = 0.859 for Reader 2). Consensus agreement for the assisted method reached κ = 0.936. Amyloid PET positivity was strongly associated with progression to AD across all methods. Hazard ratios were highest for assisted visual interpretation (HR = 3.23, 95% CI 1.94–5.38, p < 0.0001), followed by SUVR quantification (HR = 2.19, 95% CI 1.55–3.10, p < 0.0001) and structured visual reading (HR = 1.83, 95% CI 1.10–3.06, p = 0.02).
Conclusion: Amyloid PET positivity consistently predicted conversion to AD regardless of interpretation method. Assisted visual and semiquantitative approaches showed numerically higher prognostic discrimination, while expert structured visual reading remained clinically reliable.
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BibTeX
@article{echeveste2026prognostic,
title = {{Prognostic value of Amyloid PET in Real-World Amnestic MCI: Influence of reader experience and interpretation method}},
author = {Beatriz Echeveste and Edgar Fernando Guillén and Elena Prieto and Katharina C. E. Hirschmüller and Mario Riverol and Javier Arbizu},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
month = aug,
doi = {10.1007/s00259-026-08159-9},
url = {https://doi.org/10.1007/s00259-026-08159-9},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prognostic value of Amyloid PET in Real-World Amnestic MCI: Influence of reader experience and interpretation method
AU - Beatriz Echeveste
AU - Edgar Fernando Guillén
AU - Elena Prieto
AU - Katharina C. E. Hirschmüller
AU - Mario Riverol
AU - Javier Arbizu
PY - 2026
DA - 2026/08/28
JO - European Journal of Nuclear Medicine and Molecular Imaging
DO - 10.1007/s00259-026-08159-9
UR - https://doi.org/10.1007/s00259-026-08159-9
AB - Purpose: This study assessed the prognostic value and inter-/intra-observer reliability of three amyloid PET interpretation methods—conventional visual reading, assisted visual interpretation and standardized uptake value ratio (SUVR)-based quantification—for predicting conversion to Alzheimer’s disease (AD). Methods: This retrospective longitudinal study included 145 patients with amnestic mild cognitive impairment who underwent amyloid PET and were followed for up to 8 years at a single memory clinic. Two certified nuclear medicine physicians performed structured visual reads and assisted visual interpretations. Semiquantitative SUVR thresholds validated in prior studies were applied as a third method. Inter- and intra-observer agreement was assessed using Cohen’s kappa (κ). Cox regression models estimated the association of conversion to AD in PET-positive versus PET-negative patients for each method, adjusting for age, sex and education. Results: Inter-observer agreement was excellent for structured visual reading (κ = 0.877) and assisted visual interpretation (κ = 0.904). Intra-observer reliability was also high (κ = 0.891 for Reader 1; κ = 0.859 for Reader 2). Consensus agreement for the assisted method reached κ = 0.936. Amyloid PET positivity was strongly associated with progression to AD across all methods. Hazard ratios were highest for assisted visual interpretation (HR = 3.23, 95% CI 1.94–5.38, p < 0.0001), followed by SUVR quantification (HR = 2.19, 95% CI 1.55–3.10, p < 0.0001) and structured visual reading (HR = 1.83, 95% CI 1.10–3.06, p = 0.02). Conclusion: Amyloid PET positivity consistently predicted conversion to AD regardless of interpretation method. Assisted visual and semiquantitative approaches showed numerically higher prognostic discrimination, while expert structured visual reading remained clinically reliable.
SN - 1619-7070
SN - 1619-7089
ER -