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Differential effects of global and cerebellar normalization on detection and differentiation of dementia in FDG-PET studies


Dukart, Juergen, Mueller, Karsten, Horstmann, Annette, Vogt, Barbara, Frisch, Stefan, Barthel, Henryk, Becker, Georg, Möller, Harald E., Villringer, Arno, Sabri, Osama, Schroeter, Matthias L.


Neuroimage, Volume: 49, No.: 2, Pages.: 1490-1495

Year of Publication



FDG-PET ([18F]fluorodeoxyglucose positron emission tomography) is frequently used to improve the differential diagnosis of dementia. However, a fundamental methodological issue of the reference area for the intensity normalization procedure is still unsolved. Here, we systematically compared the two most commonly used normalization methods to the cerebral and to the cerebellar metabolic rate for glucose with regard to detection and differentiation of dementia syndromes. FDG-PET imaging was performed on 19 subjects with early Alzheimer’s disease, 13 subjects with early frontotemporal lobar degeneration and 10 subjects complaining of memory impairment, which had not been confirmed by comprehensive clinical testing. Images were normalized to either the cerebral or the cerebellar metabolic rate for glucose. Differences in relative regional glucose metabolism were assessed by voxelwise comparison. Analysis using the two normalization procedures revealed remarkable differential effects. Whereas cerebellar normalization was superior in identifying dementia patients in comparison to control subjects, cerebral normalization showed better results for differential diagnosis between types of dementia. These effects were shown for both, Alzheimer’s disease and frontotemporal lobar degeneration. Relative hypermetabolism in comparison to the control group was only detected in both kinds of dementia using global normalization. The results indicate that normalization has a decisive impact on diagnostic accuracy in dementia. While cerebellar normalization seems to be more sensitive for early diagnosis, cerebral global normalization might be superior for differential diagnostic purposes in dementia syndromes.;

Bibtex Citation

@article{Dukart_2010, doi = {10.1016/j.neuroimage.2009.09.017}, url = {}, year = 2010, month = {jan}, publisher = {Elsevier {BV}}, volume = {49}, number = {2}, pages = {1490--1495}, author = {Juergen Dukart and Karsten Mueller and Annette Horstmann and Barbara Vogt and Stefan Frisch and Henryk Barthel and Georg Becker and Harald E. Möller and Arno Villringer and Osama Sabri and Matthias L. Schroeter}, title = {Differential effects of global and cerebellar normalization on detection and differentiation of dementia in {FDG}-{PET} studies}, journal = {{NeuroImage}} }


age factors, alzheimer disease, analysis of variance, brain, brain mapping, cerebellum, dementia, diagnosis, diagnosis, differential, diagnostic use, female, fluorodeoxyglucose f18, frontotemporal lobar degeneration, glucose, humans, male, memory disorders, metabolism, methods, middle aged, radionuclide imaging, radiopharmaceuticals, severity of illness index

Countries of Study


Types of Dementia

Alzheimer’s Disease, Fronto Temporal (also known as Pick’s Disease)

Types of Study

Before and After Study

Type of Interventions

Diagnostic Target Identification

Diagnostic Targets

Neuroimaging (e.g. MRI, PET, CAT etc.)