The EANM Journal · Sep 29, 2026

European Association of Nuclear Medicine (EANM) Focus Meeting 7: Consensus on the role of molecular imaging and fluid biomarkers in diagnosis, treatment eligibility, and monitoring in Alzheimer's Disease

By Morbelli SD, Brendel M, Tolboom N et al.

Introduction Molecular imaging and fluid biomarkers have redefined Alzheimer’s disease (AD) as a biological entity and are implemented clinically in two related but distinct pathways: (1) establishing the underlying etiology of a patient's cognitive syndrome within a comprehensive differential diagnosis, and (2) detecting amyloid pathology to determine eligibility for amyloid-directed interventions, particularly as mixed pathologies are frequent in older adults. We provide expert consensus recommendations on how biomarkers should be integrated across diagnostic, therapeutic, and preventive contexts. Materials and Methods The EANM Focus meeting 7 used a consensus process: (1) a systematic review of systematic reviews and meta-analyses (2020-2025), appraised using AMSTAR; (2) a two-round modified Delphi survey involving 33 multidisciplinary experts, rating 143 statements using a nine-point Likert scale, analysed using the RAND/UCLA Appropriateness Method; (3) a face-to-face consensus meeting (Palma de Majorca, February 2026). Results and Discussion Consensus was reached on 127/143 (89%) statements, with between-round convergence. Key agreement areas: plasma biomarkers as first-line diagnostic tool with molecular imaging and CSF for confirmations; visual and quantitative amyloid PET interpretation for PET-based treatment eligibility and monitoring; centiloid-based amyloid PET as the only biological modality operationalized for anti-amyloid therapy discontinuation; tau PET as the preferred staging biomarker; the clinical relevance of vascular and alpha-synuclein co-pathology and their assessment by direct and indirect imaging biomarkers; FDG PET and dual-phase-phase amyloid PET alongside etiologic testing to assess downstream neurodegeneration and differential diagnosis; and the need for evidence generation before biomarker use in asymptomatic populations. Evidence gaps included the following: harmonisation of fluid biomarker platforms, specification of longitudinal protocols for treatment monitoring, diagnostic algorithms focused on co-pathology assessment and evidence-based prevention programs incorporating biomarkers. Conclusions This multidisciplinary consensus provides an integrated framework for biomarker-guided diagnosis, treatment eligibility, and monitoring in AD, while identifying key research priorities including biomarker harmonisation, co-pathology assessment, and prevention strategies.

doi.org/10.1016/j.eanmj.2026.100250 Open access Industry & policy