Role of ¹⁸F‐florzolotau PET in diagnostic and therapeutic decision‐making for cognitive impairment

The novel positron emission tomography (PET) tracer, 18F-florzolotau, enables in vivo visualization of tau pathology. We evaluated the diagnostic performance of disease-specific spatial patterns of 18F-florzolotau PET imaging by visual read for tauopathies and its added value in diagnostic and therapeutic decision-making in 1277 participants with cognitive complaints. The disease-specific spatial patterns of 18F-florzolotau PET imaging demonstrated high diagnostic accuracy in differentiating various tauopathies, with 96.0% for Alzheimer's disease, 94.4% for frontotemporal lobe degeneration, 93.7% for progressive supranuclear palsy, and 97.5% for corticobasal degeneration. Added to a standard diagnostic workup, 18F-florzolotau PET reading led to diagnostic revisions for 247 participants (19.3%), increased diagnostic confidence from 68.6% to 81.3%, and resulted in medication changes for 284 participants (22.2%). Our data advocate for the strategic implementation of 18F-florzolotau PET in memory clinics, offering transformative potential for patient care and management. 18F-Florzolotau PET imaging presented disease-specific spatial patterns for different tauopathies. The disease-specific spatial patterns of 18F-florzolotau positron emission tomography (PET) imaging exhibited high diagnostic accuracy in differentiating various tauopathies. Integration of 18F-florzolotau PET imaging modality to a standard diagnostic workup significantly enhanced diagnostic confidence, enabled diagnostic revisions, and informed adjustments to treatment strategies.