Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment

Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.

1. SNMMI also has a link to their Amy loid Im aging Libr ary
•Full DICOM cases including PET, CT, and/or MRI images
to give physicians practice in interpreting amyloid tracers
•Workflow allows learners to manipulate images and review
history, findings, and conclusions for each case
sites.snmmi.org/SNMMI-MAIN/Topic_Area/
Brain_Imaging/SNMMIMAIN/Brain/
Registration-Amyloid-Imaging-Library.aspx
Reader Training Cour ses are availa ble at no cost from these providers
Training from GE Healthcare
for Flutemetamol
readvizamyl.com/
Training from Life Molecular
Imaging for Florbetaben
neuraceqreadertraining.com/learn
Training from Lilly
Diagnostics for Florbetapir
amyvid.lilly.com/hcp/reader-training
Training from Lilly
Diagnostics for Flortaucipir
tauvid.lilly.com/reader-training
Access Free Reader Training for FDA-Approved Amyloid and Tau PET Radiotracers
SNMMI Resources
SNMMI website has an Amyloid Portal page with many
educational resources (eg, appropriate use criteria, resources for
brain imaging technologists, brain imaging procedure standards,
live and on-demand webinars and continuing education)
sites.snmmi.org/SNMMIMAIN/Brain/
Amyloid_Portal_Resources.aspxAlzheimer’s Disease Resources for Radiology
and Nuclear Medicine Specialists
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40

2. ALZ-NET is a provider-enrolled network that launched
in 2022 to collect real-world clinical and imaging da ta
from patients being evalua ted for or being treate d
with novel FD A-approved AD therapies
PET and MRI Imaging Education,
Protocols, and Resources
Medicare and Billing Information for
FDA-approved therapies for AD and
for amyloid PET, including examples
of claims forms
Interested in becoming a participating
ALZ-NET site?
alznetproviders.org/
alznetproviders.org/Clinical-Care-Resources/
Imaging-Resources
alznetproviders.org/Clinical-Care-Resources/
Medicare-and-Billing-Information
alznetproviders.org/Getting-Started/Join-the-NetworkAlzheimer’s Disease Resources for Radiology
and Nuclear Medicine Specialists
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40

3. Amyloid PET Imaging
in Alzheimer?s Disease
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 Appropriate Use Recommendations for Amyloid PET
1
Flowchart of Amyloid PET Usage in Dementia Diagnosis and Its Impact
on Clinical Evaluation, Dementia Management, and Clinical Trials
2
Clinical Evaluation
(symptoms and
neuropsychological tests)
Structural MRI
(brain atrophy patterns)
Amyloid PET
Positive or
abnormal
Negative or
normal
• Progressive unexplained cognitive impairment
• Early progressive dementia (<65 years)
• Atypical structural MRI
• Suspected Alzheimer’s disease
Individualized management
• Use of drugs specific to Alzheimer’s disease
• Counseling about safety and future planning
Clinical trials
• Participant recruitment
• Stratification
• Monitoring anti-amyloid therapies
Improved clinical evaluation
• Progressive unexplained cognitive impairment
• Early progressive dementia (<65 years)
• Increased diagnostic confidence
1
Amyloid imaging is inappropriate
in the following situations
Amyloid imaging is appropriate in
the following situations
• Patients with core clinical criteria for probable AD with
typical age of onset
• To determine dementia severity
• Based solely on a positive family history of dementia or
presence of apolipoprotein E (APOE) ε4
• Patients with a cognitive complaint that is unconfirmed
on clinical examination
• In lieu of genotyping for suspected autosomal
mutation carriers
• In asymptomatic individuals
• Nonmedical use (eg, legal, insurance coverage, or
employment screening)
• Patients with persistent or progressive
unexplained MCI
• Patients satisfying core clinical criteria
for possible AD because of unclear
clinical presentation, either an atypical
clinical course or an etiologically
mixed presentation
• Patients with progressive dementia and
atypically early age of onset (usually
defined as 65 years or less in age)
2
3

4. Amyloid PET Imaging
in Alzheimer?s Disease
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40
1. Johnson KA et al. Alzheimers Dement. 2013;9:e-1-16. 2. Alzheimer?s Disease International. World Alzheimer Report 2021. https://www.alzint.org/u/World-Alzheimer-Report-2021-Chapter-10.pdf. 3. Images courtesy of Val J. Lowe, MD. 4. Images courtesy of Ilya Nasrallah, MD, PhD.
Amyloid PET Images Showing Increased Tracer Binding in
Gray Matter in Alzheimer’s Disease
3
Amyloid PET Images Showing Amyloid Clearance After Treatment
With an Anti-Amyloid Monoclonal Antibody
4
• The determination of cortical uptake of amyloid
PET tracers relies on inspection of the contrast
between gray matter and white matter
• Amyloid PET tracers are routinely visible in
white matter of all scans, regardless of AD
pathology, but binding in cortical gray matter is
very low or absent in patients without β-amyloid
plaques
• If β-amyloid plaques are moderate or frequent,
the amyloid image contrast between gray and
white matter is reduced, as seen in the lower
two images
White matter
contrast
Negative
amyloid PET
scans
Positive
amyloid PET
scans
Before Treatment After Treatment

5. Appropriate Use of Anti-Af Monoclonal Antibodies in 
Clinical Practice: Baseline Radiographic Exclusion Criteria
1,2
 
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40
1. Cummings J et al. J Prev Alzheimers Dis. 2023;10:362-377. 2. Cummings J et al. J Prev Alzheimers Dis. 2022;2:221-230.f •>4 microhemorrhages (defned as ≤10 mm at the greatest diameter)
•A single macrohemorrhage >10 mm at greatest diameter
•An area of superfcial siderosis
•Evidence of vasogenic edema
•>2 lacunar infarcts or stroke involving a major vascular territory
•Severe subcortical hyperintensities consistent with a Fazekas score of 3
•Evidence of ABRA
•Evidence of CAA-ri
•Any other major intracranial pathology that may cause cognitive impairment (eg, cerebral contusion,
      encephalomalacia, brain aneurysms or other vascular malformations, CNS infection, and brain tumors
      other than meningioma or arachnoid cysts)
•MRI evidence of a non-AD dementia
Baseline MRI-Based Exclusion Criteria

6. Detecting, Monitoring, and Managing Amyloid-Related 
Imaging Abnormalities (ARIA) 
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 3T scanner (recommended)
1.5T scanner (minimal)
High feld strength scanners have greater sensitivity but limited availability
The use of 1.5T scanner is endorsed as a minimum standard
Slice thickness: ≤5 mm Thinner slices increase resolution, but decrease signal-to-noise ratio
TE: ≥20 ms Longer TE increases sensitivity to detection
2D T2* GRE or SWI
(for ARIA-H)
MRI sequences used to improve the detection, visualization, and monitoring of 
microhemorrhages and superfcial siderosis (ARIA-H)
T2-FLAIR (for ARIA-E) MRI sequences used to detect and monitor brain edema or sulcal efusion (ARIA-E)
Difusion-weighted imaging
An MRI method used to diferentiate between ARIA and cytotoxic processes (eg, infarcts)
Recommended for diferential diagnosis
Visit the American Society for Neuroradiology (ASNR) website to access ARIA resources,
including links to standardized protocols for 3T and 1.5T scanners via this QR code or URL:
https://www.asnr.org/education-resources/alzheimers-webinar-series
MRI Acquisition Protocols to Detect and Monitor ARIA
1-3

7. Detecting, Monitoring, and Managing Amyloid-Related
Imaging Abnormalities (ARIA)
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 ARIA Type
ARIA-E
ARIA-H
microhemorrhage
ARIA-H superfcial
siderosis
FLAIR hyperintensity
confned to sulcus and/or
cortex/subcortical white
matter in one location <5 cm
Mild Moderate
Radiographic Severity
Severe
≤4 new incident
microhemorrhages
One focal area
of superfcial siderosis
FLAIR hyperintensity 5-10 cm,
or more than one site
of involvement, each
measuring <10 cm
5-9 new incident
microhemorrhages
Two focal areas
of superfcial siderosis
FLAIR hyperintensity measures
>10 cm, often with signifcant
subcortical white matter
and/or sulcal involvement;
≥1 separate sites of
involvement might be noted
≥10 new incident
microhemorrhages
>2 focal areas
of superfcial siderosis
Classifying ARIA by Radiographic Severity
4,5

8. Detecting, Monitoring, and Managing Amyloid-Related
Imaging Abnormalities (ARIA)
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 Headache
Confusion and
dizziness
Neuropsychiatric
symptoms
Nausea
Gait
disturbance
Visual
disturbance/
blurred vision
Seizure
Less frequent Uncommon
Symptom Severity
Mild
Discomfort noted;
no disruption of
daily activity
Moderate
Discomfort sufcient
to reduce or afect
normal daily activity
Severe
Incapacitating,
with inability to perform
normal daily activity
Symptoms Consistent With ARIA That Should Trigger Out-of-Sequence MRI
6-8

9. Detecting, Monitoring, and Managing Amyloid-Related 
Imaging Abnormalities (ARIA) 
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 Baseline MRI has no exclusion factors
MRI routine or conducted because of symptoms suggestive of ARIA
ARIA-E or ARIA-H detected
Symptomatic Asymptomatic
Radiographically mild ARIA-E
or mild ARIA-H
Continue treatment with
anti-Aβ antibody; monthly MRI
Continue treatment;
discontinue monthly MRI if ARIA-E
resolves or ARIA-H stabilizes
Resume treatment with anti-Aβ antibody
Suspend treatment; clinical assessment;
repeat MRI monthly
Radiographically
moderate/severe ARIA-E
or moderate/severe ARIA-H
MRI shows resolution of ARIA-E or
stabilization of ARIA-H; symptoms
resolve; patient wishes to continue
Stop anti-Aβ antibody therapy for any of the following
•Any macrohemorrhage
•>1 area of superfcial siderosis
•>10 microhemorrhages since treatment initiation
•>2 episodes of ARIA
•Severe symptoms of ARIA
•Patient requires treatment with an anticoagulant
Severity of Changes Observed on MRI
Radiographic ARIA-E: Mild
Radiographic ARIA-E: Moderate
Radiographic ARIA-E: Severe
Radiographic ARIA-H: Mild
Radiographic ARIA-H: Moderate
Radiographic ARIA-H: Severe
Symptom Description
No Symptoms Mild Symptoms Moderate Symptoms Severe Symptoms
Discontinue dosing
Discontinue dosing
Discontinue dosing
Discontinue dosing
Discontinue dosing
Discontinue dosingDiscontinue dosingDiscontinue dosingDiscontinue dosing
Discontinue dosing
Suspend dosing
Suspend dosing Suspend dosing
Suspend dosing
Suspend dosing
Suspend dosing
Suspend dosing
Suspend dosing
Suspend dosing
Suspend dosing
Discontinue dosing Discontinue dosing
Continue dosing
Continue dosing
ARIA Management Algorithm
6-8
1. Cogswell PM et al. AJNR Am J Neuroradiol. 2022;43:E19-E35. 2. Sperling RA et al. Alzheimers Dement. 2011;7:367-385. 3. Barakos J et al. J Prev Alzheimers Dis. 2022;9:211-220.
4. Aduhelm (aducanumab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/761178s007lbl.pdf. 5. Leqembi (lecanemab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/761269s000lbl.pdf.
6. Cummings J et al. J Prev Alzheimers Dis. 2023;10:362-377. 7. Cummings J et al. J Prev Alzheimers Dis. 2022;2:221-230. 8. Cummings J et al. J Prev Alzheimers Dis. 2021;4:398-410.

10. Selected Images of Amyloid-Related Imaging 
Abnormalities (ARIA) and Its Mimics 
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 Parenchymal Edema
New T2-FLAIR hyperintense signal with mild local 
mass efect and sulcal efacement measuring <5 cm 
(mild ARIA-E)
New multifocal, patchy T2-FLAIR hyperintense 
signal, each region measuring <5 cm (moderate 
ARIA-E); multiple ARIA-E yields a classifcation of 
moderate, as long as each region is <10 cm
Extensive T2-FLAIR hyperintense signal throughout the 
right frontal and parietal lobes measuring >10 cm 
(severe ARIA-E); associated mass efect and sulcal 
efacement throughout much of the right hemisphere
Baseline Baseline BaselinePost-treatment Post-treatment Post-treatment
Mild Moderate Severe
New sulcal T2-FLAIR hyperintense signal measuring
<5 cm in transverse dimensions (mild ARIA-E)
New T2-FLAIR sulcal efusion involving the right 
posterior temporal and parietal lobes measuring
5-10 cm (moderate ARIA-E)
Extensive T2-FLAIR sulcal efusion involving the 
bilateral temporal and occipital lobes measuring
≥10 cm in extent (severe ARIA-E)
Baseline Post-treatment
Mild
Sulcal Efusion
Baseline Post-treatment
Moderate
Baseline Post-treatment
Severe
ARIA-E Examples (Detected With T2-FLAIR Sequence)
1

11. Selected Images of Amyloid-Related Imaging 
Abnormalities (ARIA) and Its Mimics 
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 Microhemorrhage
Postdosing, ≥10 new microhemorrhages
(severe ARIA-H)
Baseline Post-treatment
Severe
Postdosing, 5 treatment-emergent 
microhemorrhages (moderate ARIA-H)
Baseline Post-treatment
Moderate
Postdosing, few (<5) new peripheral left frontal 
microhemorrhages (mild ARIA-H)
Baseline Post-treatment
Mild
Superfcial Siderosis
Postdosing, new right temporal superfcial siderosis, which involves 
contiguous sulci when viewed over multiple slices (mild ARIA-H, 
siderosis); this patient also had two treatment-emergent 
microhemorrhages (mild ARIA-H, microhemorrhage)
Two regions of treatment-emergent superfcial siderosis in the 
right greater-than-left frontal lobes (moderate ARIA-H)
Baseline Post-treatment
Mild
Baseline Post-treatment
Moderate
ARIA-H Examples (Detected With T2-GRE or SWI Sequence)
1

12. Selected Images of Amyloid-Related Imaging
Abnormalities (ARIA) and Its Mimics
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 Infarct (Early Subacute)
FLAIR+ (hyperintensity)
•In addition to FLAIR and GRE/SWI sequences, a trace DWI 
sequence should be included as routine protocol in ARIA 
monitoring examinations to help with the diferential 
diagnosis of new signal abnormalities 
•For example, the DWI sequence plays an important role in 
helping to diferentiate ARIA-E from potential cytotoxic 
edema caused by an incidental infarct
•In classic cases of ARIA, the difusion restriction will be 
absent, because intense difusion restriction associated 
with an infarct is not a characteristic of ARIA
•The DWI sequence helped to identify the underlying 
etiology of this patient’s radiographic fndings
•Difusion restriction was identifed, which indicated that it 
was not ARIA
•However, the difusion restriction was located in the sulci, 
which is not a typical pattern seen with acute or subacute 
infarcts 
•This patient was diagnosed with bacterial meningitis 
following confrmatory lab testing
Infection (Bacterial Meningitis)
FLAIR+ (vasogenic edema
and sulcal efusions)
GRE/SWI+ (microhemorrhages
and superfcial siderosis)
DWI+ (with restricted
difusion in the sulci)
DWI+ (with restricted difusion)GRE/SWI+ (microhemorrhage)
ARIA Mimics
2

13. Selected Images of Amyloid-Related Imaging
Abnormalities (ARIA) and Its Mimics
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40
1. Cogswell PM et al. Am J Neuroradiol. 2022;43:E19-E35. 2. Images courtesy of Tammie L.S. Benzinger, MD, PhD.  ARIA Mimics
2
Brain Metastasis
FLAIR+ (hyperintensity)
•New signal abnormalities detected in ARIA monitoring 
examinations may require T1-weighted gadolinium-enhanced 
imaging to diferentiate between ARIA and brain metastases
•Contrast-enhanced imaging should be considered based on 
the patient’s medical history and/or any clinical fndings that 
may suggest the possibility of a metastatic etiology
•ARIA and PRES are usually indistinguishable based on MRI (eg, both 
will typically have FLAIR hyperintensities and no restricted 
difusion)
•Therefore, the clinical context is critical to diferentiate between 
ARIA and PRES
•This patient presented to the emergency department with 
confusion, headache, and very high blood pressure (which is a 
classic presentation for PRES)
•They were treated for their hypertension, which resolved their 
clinical symptoms and their edema
Posterior Reversible Encephalopathy Syndrome (PRES)
FLAIR+ (hyperintensities) GRE/SWI negative DWI negative
(no difusion restriction)
T1 postcontrast + enhancementGRE/SWI+ (microhemorrhage)
T1 postcontrast

14. Use the following pages as reporting templates
to document baseline screening MRI prior to initiating
anti-amyloid therapy (page 1) and follow-up MRI
to monitor ARIA in patients undergoing
treatment with anti-amyloid therapy (pages 2-3).
Printable Resource ARIA Reporting Templates
Full abbreviations, accreditation, and disclosure information available at
PeerView.com/PVA40

15. Baseline MRI for Screening Prior to Initiating Anti-Amyloid Therapy (page 1 of 1)
Scan Information (fill in or circle response as needed)
DWI
Gadolinium
Contrast
ARIA–H
Sequence
ARIA–E
Sequence
Slice
Gap
Slice Thickness
(mm)
Field
Strength
ModelManufacturer
Y
N
Y
N
SWI
GRE/T2*
3D T2-FLAIR1.5T
3T
Hyperintensities/Infarcts Summary
Location
(eg, frontal, parietal, occipital, temporal,
brainstem, cerebellum)
L/R
Type
(eg, parenchymal; sulcal)
Max Diameter
(cm)
Lesion 1
Lesion 2
Lesion 3
Lesion 4
Microhemorrhages/Superficial Siderosis Summary
BrainstemDeep GrayCerebellumTemporalFrontalParietalOccipitalTotal
MCH count
SS count
Findings
Total FLAIR hyperintensities: ______________
Describe locations and measure longest size in 1 dimension for each: _________________________________________________________________

Total microhemorrhages: ________________
Describe locations in general, deep vs lobar: ____________________________________________________________________________________

Total areas of superficial siderosis: __________________
Describe locations: _________________________________________________________________________________________________________
General description of other acute or chronic findings (eg, macrohemorrhage >10 mm; vasogenic edema; >2 lacunar infarcts or stroke involving a major
vascular territory; severe subcortical hyperintensities consistent with a Fazekas score of 3; evidence of ABRA; evidence of CAA-ri; evidence of non-AD
dementia; any other major intracranial pathology that may cause cognitive impairment):
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
IMPRESSION
Total microhemorrhages (circle one): 0-4 5-9 ≥10
Superficial siderosis (circle one): is not detected is present
Note any other EXCLUSION CRITERIA for initiating treatment with anti-amyloid therapy:
____________________________________________________________________________________________________________________
Restricted Diffusion
(circle correct response)
Contrast Enhancement
(circle correct response)
Yes No N/AYes No N/A
Patient Information
Patient Name:____________________________ Age:________ Sex:_______
Patient ID:___________________ Referring MD:________________________
Report Information
Scan Date:_________________________________
Site Location:_______________________________
Updated findings were conveyed to _____________________________ by _______________________________
(referring physician) (radiologist)

16. Follow-Up MRI to Monitor for ARIA in Patients Undergoing
Treatment With an Anti-Amyloid Therapy (page 1 of 2)
Patient Information
Patient Name:____________________________ Age: _________
Sex:_______ Patient ID:___________________
Referring MD:___________________________________________
Purpose of scan (circle correct response): scheduled/asymptomatic monitoring for ARIA
OR unscheduled/safety MRI in response to symptoms
Report Information
Scan Date: ________________________________
Site Location: ______________________________
Scan Information (fill in or circle response as needed)DWI
Gadolinium
Contrast
ARIA–H
Sequence
ARIA–E
Sequence
Slice
Gap
Slice
Thickness
(mm)
Field
Strength
ModelManufacturer
Y
N
Y
N
SWI
GRE/T2*
3D T2-FLAIR1.5T
3T
ARIA-E Summary
Location
(eg, frontal, parietal,
occipital, temporal,
brainstem, cerebellum)
L/R
Type
(eg, parenchymal;
sulcal)
Change
From
Baseline
(cm)
Lesion Dynamics
(eg, new, enlarging,
shrinking, stable
Max
Diameter
(cm)
Lesion 1
Lesion 2
Lesion 3
Lesion 4
Treatment History
Anti-Amyloid Agent: ________________________________ Number of doses received: ____________
Date of last dose: _______________________ Suspected ARIA Symptoms (if present): ______________________
Restricted Diffusion
(circle correct response)
Contrast Enhancement
(circle correct response)
Yes No N/AYes No N/A

17. ARIA-H Summary
BrainstemDeep GrayCerebellumTemporalFrontalParietalOccipitalTotal
Current
MCH count
Baseline
MCH count
Change from
baseline
MCH count
Current SS
count
Baseline SS
count
Change from
baseline SS
count
Radiographic Severity (circle response)
ARIA Type
SevereModerateMild
≥1 location, >10 cm
1 location, 5-10 cm
OR
>1 location, each <10 cm
1 location, <5 cmARIA-E
≥105-90-4
ARIA-H
(MCH)
>2 focal areas2 focal areas1 focal area
ARIA-H
(SS)
Note other acute or chronic findings: _________________________________________________________________
_________________________________________________________________________________________________
Updated findings were conveyed to _____________________________ by _______________________________
(referring physician) (radiologist)
Follow-Up MRI to Monitor for ARIA in Patients Undergoing
Treatment With an Anti-Amyloid Therapy (page 2 of 2)

18. ARIA Standardized Reporting Template for PowerScribe
Full abbreviations, accreditation, and disclosure information available at PeerView.com/PVA40 Download the XML code for a standardized and automated ARIA reporting
template in PowerScribe by scanning the QR code or visiting the provided URL:
www.PeerView.com/ARIA24-PowerScribeXML
Once the file is downloaded, the code will need to be updated for your radiology department.

19. Use the following page as a tool to report and
communicate results of amyloid PET scans
to other members of the care team.
Printable Resource Amyloid PET Reporting Template
1,2

Full abbreviations, accreditation, and disclosure information available at
PeerView.com/PVA40
1. https://www.ideas-study.org/-/media/Ideas/Files/Forms/PET-Imaging-Facility-Case-Report-Form-Packet.pdf. 2. Minoshima S et al. J Nuc Med. 2016;57:1316 -1322.

20. Additional Findings (include brief descriptions of the following):
 Pattern of radiotracer uptake in the cerebellum: _________________________________________________________________________________
 Degree and location of cerebral atrophy (if present): _____________________________________________________________________________
 Lobes with loss of gray/white matter differentiation (if present): _____________________________________________________________________
 Areas with cerebral cortical uptake more intense than white matter uptake: ___________________________________________________________
Patient Information
Patient Name:____________________________ Age:________ Sex:_______
Patient ID:___________________ Referring MD:________________________
Report Information
Scan Date:_________________________________
Site Location:_______________________________
Indications for Scan
Clinical Symptoms (select one)
 Mild cognitive impairment
 Dementia (circle one): Mild Moderate Severe
 Other:
____________________________________________
Reason for Amyloid PET (select one)
 Assessment to determine whether patient has amyloid pathology
prior to initiating treatment with an amyloid-targeting therapy
 Other:
______________________________________________
Updated findings were conveyed to_______________________________ by_____________________________________________
(referring physician)
Amyloid PET Scan Administration
Scan Duration
(minutes)
Scan Start Time (AM/PM)
Time of
Radiopharmaceutical
Injection (AM/PM)
Dose
(mCi)
RadiopharmaceuticalScan Type
__________________ : ______ AM / PM
(circle one)
______ : ______ AM / PM
(circle one)
________
 F-18 florbetaben (Neuraceq
TM
)
 F-18 florbetapir (Amyvid
TM
)
 F-18 flutametamol (Vizamyl
TM
)
 PET
 PET-CT
 PET-MRI
Amyloid PET Scan Interpretation and Quality Assessment
Was image quantification used to assist in interpretation? (circle one)
Yes No
Was comparison with prior brain imaging studies used to assist in interpretation? (circle one)
Yes No
If yes, select one or more of the following and provide date for each selected:
 Other
Date of Other: _______________ FDG
Date of FDG: ________________  MRI
Date of MRI: ________________  CT
Date of CT: ________________
If uninterpretable/technically inadequate study, specify reason(s): Scan Quality Assessment
 Patient motion
 Image too noisy
 Image artifact
 Other, specify: ____________________________________________________
 Adequate
 Suboptimal, but interpretable
 Uninterpretable/technically inadequate
Amyloid PET Scan Findings
If positive or negative, provide confidence level of interpretation (circle one)Global Scan Result
Low Intermediate High
 Positive for cortical beta-amyloid
 Negative for cortical beta-amyloid
(nuclear medicine physician/radiologist)