Appropriate Use Criteria for Amyloid and Tau PET Imaging
A workgroup convened by the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) updated the 2013 appropriate use criteria (AUC) for amyloid positron emission tomography (PET), and developed a new AUC for tau PET to aid in the diagnosis of people with suspected Alzheimer's disease. As PET scans have become more widely available to patients due to changes in Medicare policy, the updated AUC is designed to guide primary care physicians, neurologists and other clinicians to determine the most appropriate use of amyloid and tau PET scans, thereby improving patient outcomes.
The 2025 guidance for the most appropriate use of amyloid and tau PET imaging was published simultaneously in Alzheimer’s & Dementia®: The Journal of the Alzheimer’s Association and The Journal of Nuclear Medicine. This update integrates new data and reflects advancements in Alzheimer's diagnostics and therapies, particularly amyloid-lowering treatments and tau imaging.
Overview
With dramatic recent advances in diagnostic and therapeutic approaches to Alzheimer’s disease, the workgroup reviewed the current data and updated the 2013 appropriate use criteria for amyloid PET. This update is inclusive of both amyloid and tau brain imaging.
The global, multidisciplinary workgroup, co-chaired by Dr. Gil D. Rabinovici and Dr. Keith A. Johnson, was composed of clinicians and other health care professionals with relevant expertise including neurologists, radiology/nuclear medicine physicians, PET imaging methodologists, neuro-ethicists, and pathology and laboratory medicine biomarker researchers.
The workgroup evaluated available evidence on amyloid and tau PET, and developed a list of real-world scenarios in which clinicians might use a PET biomarker to help diagnose and manage patients who have or are at risk for cognitive decline. Each scenario was rated by the workgroup on a scale of 1 to 9 using a modified Delphi approach, and consensus ratings were achieved with each scenario: grouped as appropriate, uncertain or rarely appropriate.
Review the Criteria
Current and future recommended use of criteria
The updated criteria provide 17 real-world scenarios to help clinicians determine when an amyloid and tau PET scan should be considered as part of a comprehensive clinical assessment by dementia specialists who spend a significant proportion of their clinical effort caring for patients with cognitive complaints. These scenarios also serve as a general reference for a broader audience interested in implementation of amyloid and tau PET in clinical practice. Overall, the strongest evidence for their use includes:
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Assessment and prognosis for people with mild cognitive impairment.
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Assessment of people with dementia when the cause is not clearly known.
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Determining eligibility for treatment with new disease-modifying therapies, and monitoring response to these treatments.
In most cases, these tests should not be used for:
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People who do not have cognitive impairment, even if they carry the APOE4 risk-related gene for Alzheimer’s.
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Nonmedical use, e.g., for legal concerns, insurance coverage or employment screening.
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In place of genetic testing in patients suspected of carrying a disease-causing genetic mutation.
Amyloid and tau PET are part of an expanding field of Alzheimer’s biomarkers, including CSF and blood-based biomarkers. Future research and development of clinical practice guidelines will determine the specific role of PET within the larger landscape of these emerging biomarkers into diagnostic frameworks.
Much progress has been made in the clinical implementation of amyloid and tau PET. However, further research is needed to understand disease progression and patient response to amyloid-lowering (and possibly in the future tau-lowering) therapies. Studying longitudinal changes in PET, and the broader integration of imaging and fluid biomarkers in real world clinical settings, will help answer these questions. When patients are being evaluated for new anti-amyloid treatments and when — using this criteria — amyloid PET is considered appropriate to confirm diagnosis, there are tools now available to track their diagnostic and treatment outcomes in real world settings. The Alzheimer’s Association offers ALZ-NET, a voluntary network where health care providers collect real-world clinical and imaging data from patients who are being evaluated for or are receiving FDA-approved Alzheimer’s treatments. Learn more and join ALZ-NET.
Workgroup members, affiliations and disclosures
The multidisciplinary workgroup was composed of clinicians and other healthcare professionals with relevant expertise. Each member has published extensively on topics related to the key considerations around the use of amyloid and tau PET, such as dementia research, clinical practice and ethics, and biomarker test validation and clinical utilization.View each workgroup member's disclosures (PDF).
Javier Arbizu, M.D., Ph.D.
Professor and Chair, Department of Nuclear Medicine, University of Navarra Clinic
Tammie L.S. Benzinger, M.D., Ph.D.
Professor of Radiology and Neurological Surgery, Mallinckrodt Institute of Radiology
Maria C. Carrillo, Ph.D.
Chief Science Officer and Medical Affairs Lead, Alzheimer’s Association
Kevin Donohoe, M.D.
Assistant Professor of Radiology, Beth Israel Deaconess Medical Center
Oskar Hansson, M.D., Ph.D.
Professor of Neurology, Senior Consultant of Neurology, Lund University
Peter Herscovitch, M.D.
Director, PET Department, NIH Clinical Center
Keith Johnson, M.D.
Director, Molecular Neuroimaging, Massachusetts General Hospital
David Knopman, M.D.
Professor of Neuroscience, Department of Neuroscience, Mayo Clinic
Phillip H. Kuo, M.D., Ph.D.
Professor, Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona
Jennifer Hagerty Lingler, Ph.D.
Professor, Vice Chair for Research Health & Community Systems, University of Pittsburgh
Satoshi Minoshima, M.D., Ph.D.
Professor and Chair, Department of Radiology and Imaging Sciences, University of Utah
Melissa E. Murray, Ph.D.
Professor of Neuroscience, Department of Neuroscience, Mayo Clinic
Julie C. Price, Ph.D.
Professor of Radiology, Massachusetts General Hospital
Gil Rabinovici, M.D.
Professor, Departments of Neurology, Radiology & Biomedical Imaging, University of California, San Francisco
Stephen Salloway, M.D., M.S.
Professor of Neurology and Psychiatry at the Warren Alpert School of Medicine at Brown University and Founding Director of the Butler Hospital Memory and Aging Program
Christopher J. Weber, Ph.D.
Sr. Director, Global Science Initiatives, Alzheimer’s Association