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Purpose <p>Positron-emission tomography (PET) and single-photon emission computed tomography (SPECT) increasingly support early dementia diagnosis yet generate complex ethical and medicolegal questions. This review synthesises current evidence to guide responsible clinical and research use.</p> Methods <p>A narrative review was undertaken in accordance with SANRA guidance. PubMed (<i>n</i> = 286), Scopus (<i>n</i> = 201) and the first 200 Google Scholar records were searched for English-language publications dated January 2005–May 2025 using (“dementia” OR “Alzheimer disease”) AND (“PET” OR “SPECT” OR “positron emission tomography”) AND (“ethics” OR “medicolegal” OR “informed consent” OR “biomarker disclosure”). De-duplication reduced 687 hits to 622 unique citations. Titles, abstracts and full texts were screened against predefined criteria focused on ethical or legal aspects of PET/SPECT, retaining 53 papers. Targeted manual searches of guideline repositories, policy documents and reference lists added 49 further sources (professional guidelines, consensus statements, policy papers and systematic reviews). Altogether, 102 publications were narratively reviewed.</p> Results <p>Ethical themes centred on (i) obtaining valid consent from cognitively impaired persons, (ii) communicating probabilistic biomarker findings, and (iii) ensuring equitable access to costly imaging and downstream therapies. Major medicolegal issues included the evolving diagnostic standard of care, liability for misinterpretation, the influence of pre-clinical findings on legal-capacity determinations, and gaps in data-privacy regulation for neuroimaging biomarkers.</p> Conclusions <p>PET and SPECT provide clinical benefit yet impose substantive ethical and legal obligations. Capacity-sensitive consent, transparent result disclosure, strict adherence to appropriate-use criteria and stronger anti-discrimination and privacy statutes are recommended to protect patients while maximising the value of nuclear-medicine imaging in dementia.</p>

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Ethical dilemmas and medicolegal implications of nuclear medicine imaging in dementias

  • 期刊论文

  • 发表日期：

    2025年11月18日

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  • Joseph Kabunda,
  • Honest Ndlovu,
  • Kaoma Chimbabantu,
  • Zane Knoesen,
  • Khomotso Mashigoane,
  • Kgomotso Mokoala,
  • Mike Sathekge

摘要

Purpose

Positron-emission tomography (PET) and single-photon emission computed tomography (SPECT) increasingly support early dementia diagnosis yet generate complex ethical and medicolegal questions. This review synthesises current evidence to guide responsible clinical and research use.

Methods

A narrative review was undertaken in accordance with SANRA guidance. PubMed (n = 286), Scopus (n = 201) and the first 200 Google Scholar records were searched for English-language publications dated January 2005–May 2025 using (“dementia” OR “Alzheimer disease”) AND (“PET” OR “SPECT” OR “positron emission tomography”) AND (“ethics” OR “medicolegal” OR “informed consent” OR “biomarker disclosure”). De-duplication reduced 687 hits to 622 unique citations. Titles, abstracts and full texts were screened against predefined criteria focused on ethical or legal aspects of PET/SPECT, retaining 53 papers. Targeted manual searches of guideline repositories, policy documents and reference lists added 49 further sources (professional guidelines, consensus statements, policy papers and systematic reviews). Altogether, 102 publications were narratively reviewed.

Results

Ethical themes centred on (i) obtaining valid consent from cognitively impaired persons, (ii) communicating probabilistic biomarker findings, and (iii) ensuring equitable access to costly imaging and downstream therapies. Major medicolegal issues included the evolving diagnostic standard of care, liability for misinterpretation, the influence of pre-clinical findings on legal-capacity determinations, and gaps in data-privacy regulation for neuroimaging biomarkers.

Conclusions

PET and SPECT provide clinical benefit yet impose substantive ethical and legal obligations. Capacity-sensitive consent, transparent result disclosure, strict adherence to appropriate-use criteria and stronger anti-discrimination and privacy statutes are recommended to protect patients while maximising the value of nuclear-medicine imaging in dementia.