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Misch MR, Mitchell S, Francis PL, Sherborn K, Meradje K, McNeely AA, Honjo K, Zhao J, Scott CJ, Caldwell CB, Ehrlich L, Shammi P, MacIntosh BJ, Bilbao JM, Lang AE, Black SE, Masellis M. Differentiating between visual hallucination-free dementia with Lewy bodies and corticobasal syndrome on the basis of neuropsychology and perfusion single-photon emission computed tomography. ALZHEIMERS RESEARCH & THERAPY 2014; 6:71. [PMID: 25484929 PMCID: PMC4256921 DOI: 10.1186/s13195-014-0071-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/08/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) and Corticobasal Syndrome (CBS) are atypical parkinsonian disorders with fronto-subcortical and posterior cognitive dysfunction as common features. While visual hallucinations are a good predictor of Lewy body pathology and are rare in CBS, they are not exhibited in all cases of DLB. Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities. METHODS Prospectively recruited case-control cohorts of CBS (n =31) and visual hallucination-free DLB (n =30), completed neuropsychological and neuropsychiatric measures as well as brain perfusion single-photon emission computed tomography and structural magnetic resonance imaging (MRI). Perfusion data were available for forty-two controls. Behavioural, perfusion, and cortical volume and thickness measures were compared between the groups to identify features that serve to differentiate them. RESULTS The Lewy body with no hallucinations group performed more poorly on measures of episodic memory compared to the corticobasal group, including the delayed and cued recall portions of the California Verbal Learning Test (F (1, 42) =23.1, P <0.001 and F (1, 42) =14.0, P =0.001 respectively) and the delayed visual reproduction of the Wechsler Memory Scale-Revised (F (1, 36) =9.7, P =0.004). The Lewy body group also demonstrated reduced perfusion in the left occipital pole compared to the corticobasal group (F (1,57) =7.4, P =0.009). At autopsy, the Lewy body cases all demonstrated mixed dementia with Lewy bodies, Alzheimer's disease and small vessel arteriosclerosis, while the corticobasal cases demonstrated classical corticobasal degeneration in five, dementia with agyrophilic grains + corticobasal degeneration + cerebral amyloid angiopathy in one, Progressive Supranuclear Palsy in two, and Frontotemporal Lobar Degeneration-Ubiquitin/TAR DNA-binding protein 43 proteinopathy in one. MRI measures were not significantly different between the patient groups. CONCLUSIONS Reduced perfusion in the left occipital region and worse episodic memory performance may help to distinguish between DLB cases who have never manifested with visual hallucinations and CBS at earlier stages of the disease. Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.
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Affiliation(s)
- Michael R Misch
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Sara Mitchell
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Philip L Francis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kayla Sherborn
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Katayoun Meradje
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Alicia A McNeely
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kie Honjo
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Jiali Zhao
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Christopher Jm Scott
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Curtis B Caldwell
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Lisa Ehrlich
- Department of Nuclear Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Prathiba Shammi
- Neuropsychology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Juan M Bilbao
- Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Cognition & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Neurogenetics Section, Centre for Addiction and Mental Health, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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Grova C, Jannin P, Buvat I, Benali H, Bansard JY, Biraben A, Gibaud B. From anatomic standardization analysis of perfusion SPECT data to perfusion pattern modeling: evidence of functional networks in healthy subjects and temporal lobe epilepsy patients. Acad Radiol 2005; 12:554-65. [PMID: 15866127 PMCID: PMC1978216 DOI: 10.1016/j.acra.2004.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2004] [Accepted: 08/17/2004] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES In the general context of perfusion pattern modeling from single-photon emission computed tomographic (SPECT) data, the purpose of this study is to characterize interindividual functional variability and functional connectivity between anatomic structures in a set of SPECT data acquired from a homogeneous population of subjects. MATERIALS AND METHODS From volume of interest (VOI)-perfusion measurements performed on anatomically standardized SPECT data, we proposed to use correspondence analysis (CA) and hierarchical clustering (HC) to explore the structure of statistical dependencies among these measurements. The method was applied to study the perfusion pattern in two populations of subjects; namely, SPECT data from 27 healthy subjects and ictal SPECT data from 10 patients with mesio-temporal lobe epilepsy (MTLE). RESULTS For healthy subjects, anatomic structures showing statistically dependent perfusion patterns were classified into four groups; namely, temporomesial structures, internal structures, posterior structures, and remaining cortex. For patients with MTLE, they were classified as temporomesial structures, surrounding temporal structures, internal structures, and remaining cortex. Anatomic structures of each group showed similar perfusion behavior so that they may be functionally connected and may belong to the same network. Our main result is that the temporal pole and lenticular nucleus seemed to be highly relevant to characterize ictal perfusion in patients with MTLE. This exploratory analysis suggests that a network involving temporal structures, lenticular nucleus, brainstem, and cerebellum seems to be involved during MTLE seizures. CONCLUSION CA followed by HC is a promising approach to explore brain perfusion patterns from SPECT VOI measurements.
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Affiliation(s)
- Christophe Grova
- Integration de Donnees Multimedia en Anatomie et Physiologie Cerebrale Pour l'Aide a la Decision et l'Enseignement
INSERM : ERI1Université Rennes IFaculte de Medecine
2, Av du Professeur Leon Bernard
35043 RENNES CEDEX,FR
- Montreal Neurological Institute
McGill UniversityMontreal
Canada,CA
| | - Pierre Jannin
- Integration de Donnees Multimedia en Anatomie et Physiologie Cerebrale Pour l'Aide a la Decision et l'Enseignement
INSERM : ERI1Université Rennes IFaculte de Medecine
2, Av du Professeur Leon Bernard
35043 RENNES CEDEX,FR
| | - Irène Buvat
- Imagerie médicale et quantitative
INSERM : U494CHU Pitié Salpétrière
91 bd de l'Hopital
75634 Paris CEDEX 13,FR
| | - Habib Benali
- Imagerie médicale et quantitative
INSERM : U494CHU Pitié Salpétrière
91 bd de l'Hopital
75634 Paris CEDEX 13,FR
| | - Jean-Yves Bansard
- Laboratoire Traitement du Signal et de l'Image
INSERM : U642Université Rennes ILTSI, Campus de Beaulieu,
Université de Rennes 1,
263 Avenue du Général Leclerc - CS 74205 - 35042 Rennes Cedex,FR
| | - Arnaud Biraben
- Integration de Donnees Multimedia en Anatomie et Physiologie Cerebrale Pour l'Aide a la Decision et l'Enseignement
INSERM : ERI1Université Rennes IFaculte de Medecine
2, Av du Professeur Leon Bernard
35043 RENNES CEDEX,FR
| | - Bernard Gibaud
- Integration de Donnees Multimedia en Anatomie et Physiologie Cerebrale Pour l'Aide a la Decision et l'Enseignement
INSERM : ERI1Université Rennes IFaculte de Medecine
2, Av du Professeur Leon Bernard
35043 RENNES CEDEX,FR
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Grova C, Jannin P, Biraben A, Buvat I, Benali H, Bernard AM, Scarabin JM, Gibaud B. A methodology for generating normal and pathological brain perfusion SPECT images for evaluation of MRI/SPECT fusion methods: application in epilepsy. Phys Med Biol 2003; 48:4023-43. [PMID: 14727749 DOI: 10.1088/0031-9155/48/24/003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Quantitative evaluation of brain MRI/SPECT fusion methods for normal and in particular pathological datasets is difficult, due to the frequent lack of relevant ground truth. We propose a methodology to generate MRI and SPECT datasets dedicated to the evaluation of MRI/SPECT fusion methods and illustrate the method when dealing with ictal SPECT. The method consists in generating normal or pathological SPECT data perfectly aligned with a high-resolution 3D T1-weighted MRI using realistic Monte Carlo simulations that closely reproduce the response of a SPECT imaging system. Anatomical input data for the SPECT simulations are obtained from this 3D T1-weighted MRI, while functional input data result from an inter-individual analysis of anatomically standardized SPECT data. The method makes it possible to control the 'brain perfusion' function by proposing a theoretical model of brain perfusion from measurements performed on real SPECT images. Our method provides an absolute gold standard for assessing MRI/SPECT registration method accuracy since, by construction, the SPECT data are perfectly registered with the MRI data. The proposed methodology has been applied to create a theoretical model of normal brain perfusion and ictal brain perfusion characteristic of mesial temporal lobe epilepsy. To approach realistic and unbiased perfusion models, real SPECT data were corrected for uniform attenuation, scatter and partial volume effect. An anatomic standardization was used to account for anatomic variability between subjects. Realistic simulations of normal and ictal SPECT deduced from these perfusion models are presented. The comparison of real and simulated SPECT images showed relative differences in regional activity concentration of less than 20% in most anatomical structures, for both normal and ictal data, suggesting realistic models of perfusion distributions for evaluation purposes. Inter-hemispheric asymmetry coefficients measured on simulated data were found within the range of asymmetry coefficients measured on corresponding real data. The features of the proposed approach are compared with those of other methods previously described to obtain datasets appropriate for the assessment of fusion methods.
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Affiliation(s)
- C Grova
- Laboratoire IDM, Faculté de Médecine, Université de Rennes 1, Rennes, France.
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