Amyloid PET
Amyloid PET/CT for Referring Physicians
Ordering, Coverage & Eligibility for Anti-Amyloid Treatments
Ordering Form
For providers looking for ordering information for neurology PET/CT exams, including amyloid PET/CT, NCPIC has created a fillable form that can be found here.
General Exam Questions and Answers
To learn more about how PET/CT imaging relates to anti-amyloid treatments, review NCPIC’s brief .pdf on this topic here.
Sample Report Preview
Click here to view a sample NCPIC Amyloid PET Neuro Report.
Medicare & Insurance Coverage
As of February 2025, amyloid PET/CT imaging is covered by Medicare and many private insurers. However, coverage may be limited for some PPOs and Federal Employee Plans (FEP). (Please contact NCPIC for specific insurance questions).
How Many Amyloid PET/CT Exams Can My Patient Receive?
In 2025, Noridian’s CMO team provided NCPIC with a clinical opinion stating that patients are eligible for up to three amyloid PET/CT imaging exams: Pre-treatment, During treatment and Post-treatment evaluation.
Specific timing recommendations were not commented on specifically by Noridian’s M.D. clinical opinion experts.
Referring Physician Eligibility
Medicare does not require a referring physician to be a neurologist. Any qualified provider can order an Amyloid PET/CT if the patient meets appropriate use criteria.
Patient Eligibility Criteria for Anti-Amyloid Treatments
Referring providers should confirm appropriate use criteria for amyloid PET/CT:
- MMSE Score: 22 or greater
- Diagnosis: Mild Alzheimer’s or mild cognitive impairment (MCI)
- Amyloid Biomarker: Positive PET scan or spinal tap
- Exclusions: Microhemorrhage & patients on anticoagulants
How NCPIC Interprets Amyloid PET/CT for Anti-Amyloid Therapy
NCPIC provides expert PET/CT interpretation with neuro quantification and centiloid scoring for precise amyloid burden analysis.
What other SUV brain structure scores does NCPIC report? What are the normal ranges?
| Brain Structure | Normal Values/Mean (range) |
|---|---|
| Anterior Cingulate Gyrus | 0.84 – 1.14 |
| Inferior Medial Frontal Gyrus | 0.81 – 1.01 |
| Lateral Temporal Lobe | 0.88 – 1.11 |
| Posterior Cingulate Gyrus | 0.82 – 1.05 |
| Precuneus | 0.91 – 1.10 |
| Superior Parietal Lobule | 0.86 – 1.09 |
| Occipital Lobe | 0.89 – 1.21 |
| Centiloid Value | 0 – 24 |
Centiloid Value Scores
Ordering providers receive quantification values for each PET/CT exam, including the standardized centiloid score. The threshold for amyloid positivity is generally 24 centiloids, with values ranging from 0 to over 100. For clinical understanding, centiloid values are derived from global SUVr which provide a standardized measure of amyloid burden.
Anti-Amyloid Treatment Clinical Trial Insights
Recent clinical trials have demonstrated significant findings regarding amyloid clearance in Alzheimer’s disease treatments:
- Decline in Amyloid Levels Among Low-Tau Populations: In the TRAILBLAZER-ALZ 2 study, donanemab treatment slowed clinical decline by 35% compared to placebo and resulted in 40% less decline in the ability to perform activities of daily living.
- Amyloid Clearance at 18 Months: In the Clarity AD clinical trial, treatment with lecanemab reduced clinical decline on the Clinical Dementia Rating-Sum of Boxes (CDR-SB) by 27% at 18 months compared to placebo.
ARIA Screening MRIs
Care teams should be familiar with the term “ARIA”, which stands for Amyloid-Related Imaging Abnormalities. ARIA is associated with anti-amyloid therapies and can present as brain edema (ARIA-E) or microhemorrhages (ARIA-H). To screen for ARIA, patients typically undergo a series of MRI exams, starting with a baseline MRI before initiating anti-amyloid therapy. Follow-up MRIs are conducted at specified intervals during treatment to monitor for ARIA, particularly after infusions.
NCPIC exclusively performs PET/CT only, so please reach your radiology provider for MRI access.
Typical imaging:
- Baseline MRI: Required before PET/CT
- Follow-up MRIs: Conducted at screening intervals to assess for ARIA
- Treatment Adjustment: If microhemorrhage occurs, treatment is typically stopped
This information is for reference only.
Locations
Sacramento
Rocklin