Quantitative evaluation of tau PET tracers 18 F-THK5351 and 18 F-AV-1451 in Alzheimer's disease with standardized uptake value peak-alignment (SUVP) normalization.

PURPOSE: Off-target binding in the reference region is a challenge for recent tau tracers 18 F-AV-1451 and 18 F-THK5351. The conventional standardized uptake value ratio (SUVR) method relies on the average uptake from an unaffected tissue sample, and therefore is susceptible to biases from off-target binding as well as variability among individuals in the reference region. We propose a new method, standardized uptake value peak-alignment (SUVP), to reduce the bias of the SUVR, and improve the quantitative assessment of tau deposition.

METHODS: The SUVP normalizes uptake values by their mode and standard deviation. Instead of using a reference region, the SUVP derives the contrast from unaffected voxels over the whole brain. Using SUVP and SUVR methods, we evaluated the global and regional tau binding of 18 F-THK5351 and 18 F-AV-1451 on two independent cohorts (N = 18 and 32, respectively), each with cognitively normal (NL) subjects and Alzheimer's disease (AD) subjects.

RESULTS: Both tracers showed significantly increased binding for AD in the targeted cortical areas. In the temporal cortex, SUVP had a higher classification success rate (CSR) than SUVR (0.96 vs 0.89 for 18 F-THK5351; 0.86 vs 0.75 for 18 F-AV-1451), as well as higher specificity under fixed sensitivity around 0.80 (0.70 vs 0.45 specificity for 18 F-THK5351; 1.00 vs 0.78 for 18 F-AV-1451). In the cerebellar cortex, an AD-NL group difference with effect size (Cohen's d) of 0.62 was observed for AV-1451, confirming the limitation of the SUVR approach using this region as a reference. A smaller cerebellar effect size (0.09) was observed for THK5351.

CONCLUSION: The SUVP method reduces the bias of the reference region and improves the NL-AD classification compared to the SUVR approach.