Objective: This study aimed to determine the agreement of the visual-read interpretation and Centiloid (CL) based binary analysis in amyloid brain positron emission tomography (PET) scans among patients who underwent 18F-florbetaben amyloid brain PET at St. Luke’s Medical Center-Quezon City and St. Luke’s Medical Center-Bonifacio Global City from January 2022 to May 2025.

Methods: Amyloid brain PET scans were acquired using the vendor-specific standardized pipeline at two tertiary hospitals in the Philippines from 2022 to 2025. Two blinded nuclear medicine physicians independently re-interpreted the amyloid brain PET scans based on purely visual analysis. Disagreements were resolved by a third reader. The number of visually positive cortical regions was also collected. CL was derived from the mean neocortical Standard Uptake Value ratio (SUVr). A threshold of greater than 30 CL was used for amyloid positivity. Agreement between visual analysis and CL-based interpretation was analyzed using Cohen’s kappa.

Results: Visual assessment and CL-based interpretation demonstrated almost perfect concordance (κ = 0.91), with a direct positive correlation of CL and number of visually positive cortical regions (ρ = 0.803, p < 0.0001). There was a significant difference (U = 4.0, p < 0.001) in the CL of visually positive cases compared to visually negative cases. All of the 38 (100%) visually negative scans had CL below 30. Two of the 17 (11.7%) visually positive scans had CL below 30. These scans warrant further review, with CL below the cut-off possibly due to motion artifacts, atypical binding patterns, or focal amyloid deposition in an isolated region.

Conclusion: The study demonstrated almost perfect agreement between visual interpretation and Centiloid-based assessment of amyloid brain scans, with discordant interpretations observed in the borderline Centiloid range. This study emphasizes visual interpretation as the primary mode of assessment and supports the use of quantification as an adjunct in challenging amyloid brain PET scans.