A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, MD, Part 1

Discussing the evolution of updating appropriate use criteria (AUC) for amyloid positron emission tomography (PET) from the originally issued AUC in 2013, Phillip Kuo, M.D., recalls vociferous debates, addressing new clinical scenarios and rescoring of recommendations.

In a recent interview, Dr. Kuo said the normally arduous undertaking of updating an AUC with a multidisciplinary panel was a dynamic four-year process marked by the challenges of incorporating tau PET into the new AUC and reflecting the emergence of the newly FDA-approved anti-amyloid antibody therapies lecanemab (Leqembi, Eisai/Biogen) and donanemab (Kisunla, Eli Lilly) upon updates for amyloid PET.

“Even within this short period of time, relatively speaking, (there were a lot) of changes in the therapeutic landscape that obviously would affect the AUC criteria,” explained Dr. Kuo, a professor and division chief of nuclear medicine in the Department of Diagnostic Radiology at the City of Hope Cancer Center in Duarte, Calif.

“Those scenarios were added and then had to be rescored to reflect the fact that we now know that these anti-amyloid antibodies can have a statistically significant slowing of cognitive decline in patients who are amyloid positive and have (mild cognitive impairment) or early dementia due to Alzheimer's disease.”

While the multidisciplinary panel was originally charged with updates to the AUC for amyloid PET, Dr. Kuo said there was fairly strong consensus that tau PET recommendations needed to be included in the new AUC as well.

“ … While (amyloid PET) is a very sensitive and accurate marker for amyloid deposition in your brain, it doesn’t necessarily track very well with the clinical symptoms or the functional decline. That is where tau (PET) really has its strength,” emphasized Dr. Kuo. “It is a much more dynamic biomarker and is far more reflective, generally speaking, … of clinical symptoms.”

(Editor’s note: For related content, see “SNMMI Issues New Appropriate Use Criteria for Amyloid PET and Tau PET Imaging,” “New PET and MRI Research Suggests that Visceral Fat Reduction May Prevent or Delay Alzheimer’s Disease” and “FDA Clears New Centiloid Scoring and Tau PET Quantification Tools.”)

For more insights from Dr. Kuo, watch the video below.