In vivo [¹⁸F]-AV-1451 tau-PET imaging in sporadic Creutzfeldt-Jakob disease

Objective To determine whether specific patterns of [¹⁸F]-AV-1451 tau-PET retention are observed in patients with autopsy-proven sporadic Creutzfeldt-Jakob disease (CJD). Methods In vivo [¹⁸F]-AV-1451 PET neuroimaging was performed in 5 patients with sporadic CJD (median age, 66 years [63-74]), and results were compared to cognitively normal (CN) persons (n = 44; median age, 68 years [63-74]) and to participants with very mild Alzheimer disease (AD) dementia (n = 8; median age, 77 years [63-90]). Autopsy was completed in all patients with CJD, confirming the clinical diagnosis and permitting characterization of AD neuropathologic change (ADNC). Results All patients with CJD presented with rapidly progressive dementia, typical magnetic resonance brain imaging changes, and elevated CSF total tau (median = 6,519; range = 1,528-13,240 pg/ mL). Death occurred within 9 months of symptom onset, with a median 1 month (0.2-3.3) interval from [¹⁸F]-AV-1451 PET to autopsy. No unique pattern of [¹⁸F]-AV-1451 retention was observed on visual inspection. Summary standardized uptake value ratios in patients with CJD (1.17, 1.08-1.36) were indistinguishable from CN persons (1.14, 0.84-1.54; p = 0.6), and well below those of participants with AD (2.23, 1.60-3.04; p ≤ 0.01). [¹⁸F]-AV-1451 retention in patients with CJD and CN persons was similar in brain areas frequently affected in AD and CJD. Neuropathologic analysis confirmed the clinical diagnosis in all patients with CJD. Four patients with CJD also had low-level ADNC (A1B1C0); one patient had intermediate-level ADNC (A2B2C1/2). Conclusion Increased [¹⁸F]-AV-1451 retention was not observed in patients with rapidly progressive dementia due to sporadic CJD. The [¹⁸F]-AV-1451 PET tracer maintains good specificity for paired helical tau filaments associated with AD dementia.