The case for FDG-PET and NaF-PET in risk stratification of mild cognitive impairment

According to a recent study, integrating amyloid-PET, structural MRI, carotid Doppler ultrasound, cognitive testing, and APOE genotyping improves estimation of dementia progression in patients with mild cognitive impairment, with carotid plaque burden emerging as a dominant predictor in amyloid-β–negative cases. We agree that vascular pathology is crucial but suggest that future models consider supplementing amyloid-PET with FDG-PET, a well-validated functional marker of neuronal injury, and carotid Doppler with 18 F-sodium fluoride (NaF)-PET which can detect and quantify early, active microcalcification. This could further improve risk stratification while facilitating detection of potentially modifiable disease processes.