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Lee H, Fu JF, Gaudet K, Bryant AG, Price JC, Bennett RE, Johnson KA, Hyman BT, Hedden T, Salat DH, Yen YF, Huang SY. Aberrant vascular architecture in the hippocampus correlates with tau burden in mild cognitive impairment and Alzheimer's disease. J Cereb Blood Flow Metab 2024; 44:787-800. [PMID: 38000018 PMCID: PMC11197134 DOI: 10.1177/0271678x231216144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/04/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023]
Abstract
Cerebrovascular dysfunction is a significant contributor to Alzheimer's disease (AD) progression. AD mouse models show altered capillary morphology, density, and diminished blood flow in areas of tau and beta-amyloid accumulation. The purpose of this study was to examine alterations in vascular structure and their contributions to perfusion deficits in the hippocampus in AD and mild cognitive impairment (MCI). Seven individuals with AD and MCI (1 AD/6 MCI), nine cognitively intact older healthy adults, and seven younger healthy adults underwent pseudo-continuous arterial spin labeling (PCASL) and gradient-echo/spin-echo (GESE) dynamic susceptibility contrast (DSC) MRI. Cerebral blood flow (CBF), cerebral blood volume, relative vessel size index (rVSI), and mean vessel density were calculated from model fitting. Lower CBF from PCASL and SE DSC MRI was observed in the hippocampus of AD/MCI group. rVSI in the hippocampus of the AD/MCI group was larger than that of the two healthy groups (FDR-P = 0.02). No difference in vessel density was detected between the groups. We also explored relationship of tau burden from 18F-flortaucipir positron emission tomography and vascular measures from MRI. Tau burden was associated with larger vessel size and lower CBF in the hippocampus. We postulate that larger vessel size may be associated with vascular alterations in AD/MCI.
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Affiliation(s)
- Hansol Lee
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Jessie Fanglu Fu
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Kyla Gaudet
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Annie G Bryant
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Julie C Price
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Rachel E Bennett
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Bradley T Hyman
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Trey Hedden
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David H Salat
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yi-Fen Yen
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
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Pavel DG, Henderson TA, DeBruin S. The Legacy of the TTASAAN Report-Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I. Front Neurol 2022; 12:749579. [PMID: 35450131 PMCID: PMC9017602 DOI: 10.3389/fneur.2021.749579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease-comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.
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Affiliation(s)
- Dan G Pavel
- Pathfinder Brain SPECT Imaging, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Columbia, SC, United States
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Gillen R, Firbank MJ, Lloyd J, O'Brien JT. CT-based attenuation and scatter correction compared with uniform attenuation correction in brain perfusion SPECT imaging for dementia. Phys Med Biol 2015; 60:6775-87. [PMID: 26296141 DOI: 10.1088/0031-9155/60/17/6775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigated if the appearance and diagnostic accuracy of HMPAO brain perfusion SPECT images could be improved by using CT-based attenuation and scatter correction compared with the uniform attenuation correction method. A cohort of subjects who were clinically categorized as Alzheimer's Disease (n = 38), Dementia with Lewy Bodies (n = 29) or healthy normal controls (n = 30), underwent SPECT imaging with Tc-99m HMPAO and a separate CT scan. The SPECT images were processed using: (a) correction map derived from the subject's CT scan or (b) the Chang uniform approximation for correction or (c) no attenuation correction. Images were visually inspected. The ratios between key regions of interest known to be affected or spared in each condition were calculated for each correction method, and the differences between these ratios were evaluated. The images produced using the different corrections were noted to be visually different. However, ROI analysis found similar statistically significant differences between control and dementia groups and between AD and DLB groups regardless of the correction map used.We did not identify an improvement in diagnostic accuracy in images which were corrected using CT-based attenuation and scatter correction, compared with those corrected using a uniform correction map.
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Affiliation(s)
- Rebecca Gillen
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, NE1 4LP, UK. South of Tyne Medical Physics Department, City Hospitals Sunderland NHS Foundation Trust, NE7 7DN, UK
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Lacalle-Aurioles M, Alemán-Gómez Y, Guzmán-De-Villoria JA, Cruz-Orduña I, Olazarán J, Mateos-Pérez JM, Martino ME, Desco M. Is the cerebellum the optimal reference region for intensity normalization of perfusion MR studies in early Alzheimer's disease? PLoS One 2013; 8:e81548. [PMID: 24386081 PMCID: PMC3873914 DOI: 10.1371/journal.pone.0081548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/22/2013] [Indexed: 01/08/2023] Open
Abstract
The cerebellum is the region most commonly used as a reference when normalizing the intensity of perfusion images acquired using magnetic resonance imaging (MRI) in Alzheimer's disease (AD) studies. In addition, the cerebellum provides unbiased estimations with nuclear medicine techniques. However, no reports confirm the cerebellum as an optimal reference region in MRI studies or evaluate the consequences of using different normalization regions. In this study, we address the effect of using the cerebellum, whole-brain white matter, and whole-brain cortical gray matter in the normalization of cerebral blood flow (CBF) parametric maps by comparing patients with stable mild cognitive impairment (MCI), patients with AD and healthy controls. According to our results, normalization by whole-brain cortical gray matter enables more sensitive detection of perfusion abnormalities in AD patients and reveals a larger number of affected regions than data normalized by the cerebellum or whole-brain white matter. Therefore, the cerebellum is not the most valid reference region in MRI studies for early stages of AD. After normalization by whole-brain cortical gray matter, we found a significant decrease in CBF in both parietal lobes and an increase in CBF in the right medial temporal lobe. We found no differences in perfusion between patients with stable MCI and healthy controls either before or after normalization.
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Affiliation(s)
- María Lacalle-Aurioles
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Yasser Alemán-Gómez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Isabel Cruz-Orduña
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Olazarán
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José María Mateos-Pérez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Manuel Desco
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Yeo JM, Lim X, Khan Z, Pal S. Systematic review of the diagnostic utility of SPECT imaging in dementia. Eur Arch Psychiatry Clin Neurosci 2013; 263:539-52. [PMID: 23917803 DOI: 10.1007/s00406-013-0426-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/08/2013] [Indexed: 12/20/2022]
Abstract
Single-photon emission-computed tomography (SPECT) may potentially contribute to the diagnostic work up of patients with neurodegenerative dementia. This systematic review aims to establish the diagnostic utility of 99mTc-hexamethylpropyleneamine (99mTc-HMPAO) and 99mTc-ethylcysteine dimer SPECT in distinguishing between Alzheimer's disease (AD) and frontotemporal dementia (FTD), AD and vascular dementia (VD), AD and dementia with Lewy bodies (DLB), and AD and normal controls (NC). We searched MEDLINE and Embase databases via OVID for articles from January 1985 to May 2012 and identified additional studies from reviews and references. Of 755 studies, 49 studies met the inclusion and exclusion criteria for this systematic review; AD versus FTD (n=13), AD versus VD (n=18), AD versus DLB (n=5), and AD versus NC (n=18). We compiled relevant data and graded the studies with an internal and external validity criteria checklist. We pooled the studies with a clinical diagnosis and those using 99mTc-HMPAO SPECT in a meta-analysis, calculating the pooled weighted sensitivity, specificity, likelihood ratios, and diagnostic odds ratios using DerSimonian-Laird random-effects model. The pooled weighted sensitivity and specificity of 99mTc-HMPAO-SPECT in distinguishing clinically diagnosed AD from FTD are 79.7 and 79.9%, respectively, AD from VD are 74.5 and 72.4%, AD from DLB are 70.2 and 76.2%, and AD from NC are 76.1 and 85.4%. SPECT does have diagnostic value, particularly in differentiating Alzheimer's disease from frontotemporal dementia and normal controls; however, it should not be used in isolation, rather as an adjunct, and interpreted in the context of clinical information and paraclinical test results.
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Affiliation(s)
- Jing Ming Yeo
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK,
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The diagnosis and evaluation of dementia and mild cognitive impairment with emphasis on SPECT perfusion neuroimaging. CNS Spectr 2012; 17:176-206. [PMID: 22929226 DOI: 10.1017/s1092852912000636] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As the world population ages, the incidence of dementing illnesses will dramatically increase. The number of people afflicted with dementia is expected to quadruple in the next 50 years. Since the neuropathology of the dementias precedes clinical symptoms often by several years, earlier detection and intervention could be key steps to mitigating the progression and burden of these diseases. This review will explore methods of evaluating, differentiating, and diagnosing the multiple forms of dementia. Particular emphasis will be placed on the diagnosis of mild cognitive impairment-the precursor to dementia. Anatomical imaging; cerebrospinal fluid markers; functional neuroimaging, such as positron emission tomography and single photon emission tomography; and molecular imaging, such as amyloid marker imaging, will be assessed in terms of sensitivity and specificity. Cost will also be a consideration, as the growing population afflicted with dementia represents an increasingly large financial encumbrance to the healthcare systems of every nation. In the face of expensive new markers and limited availability of cyclotrons, single photon emission computer tomography (SPECT) provides relatively high sensitivity and specificity at a comparatively low overall cost.
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Fayed N, Dávila J, Oliveros A, Medrano J, Castillo J. Correlation of findings in advanced MR techniques with global severity scales in patients with some grade of cognitive impairment. Neurol Res 2010; 32:157-65. [PMID: 20158954 DOI: 10.1179/174313209x405164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Some previous studies in patients with mild cognitive impairment and Alzheimer's disease have probed changes in the results of (1)H magnetic resonance spectroscopy and perfusion- and diffusion-weighted imaging. The purpose of this work was to correlate the results of perfusion- and diffusion-weighted imaging and magnetic resonance spectroscopy with the results of two global severity scales in cognitive impairment: the clinical dementia rating (CDR) and the global deterioration scale (GDS). PATIENTS AND METHODS We evaluated 87 patients with cognitive impairment of diverse grade (35 men and 52 women; mean age, 70.2 +/- 8.5 years old). All patients were evaluated by a neurological team in our hospital. They applied both global severity scales (CDR and GDS) and referred the patients to our diagnostic imaging department to make a cerebral magnetic resonance imaging study and studies of diffusion- and perfusion-weighted imaging and magnetic resonance spectroscopy. We excluded patients with history of Parkinson's disease, frontotemporal dementia, cerebrovascular disease, intracranial tumors, hydrocephaly, epilepsy, alcoholism and psychiatric disorders. Magnetic resonance spectroscopy was carried out in the left occipital cortex and in the posterior cingulate gyrus. The evaluated metabolites were N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (mI). After diffusion-weighted imaging, we calculated apparent diffusion coefficient values in the region of interest located in hippocampi, white matter of temporal lobes, occipital lobes, parietal lobes, frontal lobes and posterior cingulate gyrus of both hemispheres. In perfusion-weighted imaging, we calculated the relative cerebral blood volume in hippocampi, gray matter of frontal lobes, occipital lobes, temporoparietal regions, posterior cingulate gyri and somatic-sensorial cortex. We used Spearman coefficient to analyse the correlation among the different factors. Statistical analysis was made with SPSS 14 software. RESULTS We found 33 patients with Alzheimer's disease and 54 with mild cognitive impairment. The Spearman coefficient had statistical significance in the correlation of CDR and GDS (R(2)=0.596, p<0.001). Magnetic resonance spectroscopy showed a good correlation between ratios of NAA/Cr and NAA/mI with CDR and GDS in both evaluated regions and a weak correlation between Cho/Cr in the left occipital lobe and GDS. In diffusion-weighted imaging, we found a weak correlation between GDS and apparent diffusion coefficient values in hippocampi, temporal lobes, left frontal lobe and left occipital lobe. Finally, perfusion showed a weak correlation between GDS and relative cerebral blood volume in occipital lobes and posterior cingulate gyrus. CONCLUSION In patients with cognitive impairment, there is a good correlation between CDR and GDS. The tool that showed the closest correlation with the clinical scales (CDR and GDS) was magnetic resonance spectroscopy in the left occipital cortex and posterior cingulate gyrus. Perfusion- and diffusion-weighted imaging are tools with a weak correlation with clinical scales, GDS being unique that gave us significant statistical results; this could be explained by the major number of items considered for cognitive impairment (GDS 2 and 3) compared with CDR (CDR 0.5). Magnetic resonance spectroscopy can be used in the diagnostic, following and evaluation of the response to the treatment in patients with cognitive impairment (mild cognitive impairment and Alzheimer's disease), complementing the information obtained in the clinical evaluation.
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Affiliation(s)
- Nicolás Fayed
- Department of Radiology, Quiron Hospital, Paseo Mariano Renovales s/n, Zaragoza 50006, Spain
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Porto CS, Caramelli P, Nitrini R. The influence of schooling on performance in the Mattis Dementia Rating Scale (DRS). Dement Neuropsychol 2010; 4:126-130. [PMID: 29213675 PMCID: PMC5619171 DOI: 10.1590/s1980-57642010dn40200009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Studies have shown the influence of schooling on performance in the Dementia
Rating Scale (DRS), suggesting that a single cut-off score is not appropriate
for all groups of elderly people.
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Affiliation(s)
- Cláudia Sellitto Porto
- PhD, Behavioral and Cognitive Neurology Unit, Department of Neuroly of University São Paulo School of Medicine and Cognitive Disorders Reference Center (CEREDIC), Hospital das Clínicas of University São Paulo School of Medicine, São Paulo SP, Brazil
| | - Paulo Caramelli
- MD, PhD, Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Ricardo Nitrini
- MD, PhD, Behavioral and Cognitive Neurology Unit, Department of Neuroly of University São Paulo School of Medicine and Cognitive Disorders Reference Center (CEREDIC), Hospital das Clínicas of University São Paulo School of Medicine, São Paulo SP, Brazil
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Colloby SJ, Taylor JP, Firbank MJ, McKeith IG, Williams ED, O'Brien JT. Covariance 99mTc-exametazime SPECT patterns in Alzheimer's disease and dementia with Lewy bodies: utility in differential diagnosis. J Geriatr Psychiatry Neurol 2010; 23:54-62. [PMID: 20029055 DOI: 10.1177/0891988709355272] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(99m)Tc-exametazime single photon emission computed tomography (SPECT) scans of 36 patients with Alzheimer's disease (AD) and 30 with dementia with Lewy bodies (DLB) underwent region of interest (ROI) and principal component analysis (PCA). Principal component analysis was performed on the entire ROI data set. Principal components (PCs) were obtained, representing common intercorrelated regions in AD and DLB. Topographic expression that signified the extent to which a participant expressed the topographic covariance pattern was derived and used as a discriminatory variable. Principal components were identified, accounting for 77% of total data variance. Significant (PC x group) interaction was observed (P < .001). Topographic expression was significantly higher in DLB than AD (F(1,64) = 21.6, P < .001), and differentiated DLB from AD with sensitivity 73% specificity 72%. Calculating the topographic expression in an independent data set of 48 patients with AD and 23 with DLB gave sensitivity = 70%, specificity = 67%. Principal component analysis captures additional sources of variance and if perfusion SPECT is the only scan available, this procedure may offer extra information.
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Affiliation(s)
- Sean J Colloby
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne, United Kingdom.
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Uh J, Lewis-Amezcua K, Martin-Cook K, Cheng Y, Weiner M, Diaz-Arrastia R, Devous M, Shen D, Lu H. Cerebral blood volume in Alzheimer's disease and correlation with tissue structural integrity. Neurobiol Aging 2009; 31:2038-46. [PMID: 19200623 DOI: 10.1016/j.neurobiolaging.2008.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 11/25/2008] [Accepted: 12/22/2008] [Indexed: 11/15/2022]
Abstract
A vascular component is increasingly recognized as important in Alzheimer's disease (AD). We measured cerebral blood volume (CBV) in patients with probable AD or Mild Cognitive Impairment (MCI) and in elderly non-demented subjects using a recently developed Vascular-Space-Occupancy (VASO) MRI technique. While both gray and white matters were examined, significant CBV deficit regions were primarily located in white matter, specifically in frontal and parietal lobes, in which CBV was reduced by 20% in the AD/MCI group. The regions with CBV deficit also showed reduced tissue structural integrity as indicated by increased apparent diffusion coefficients, whereas in regions without CBV deficits no such correlation was found. Subjects with lower CBV tended to have more white matter lesions in FLAIR MRI images and showed slower psychomotor speed. These data suggest that the vascular contribution in AD is primarily localized to frontal/parietal white matter and is associated with brain tissue integrity.
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Affiliation(s)
- Jinsoo Uh
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
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O'Brien JT, Colloby SJ, Pakrasi S, Perry EK, Pimlott SL, Wyper DJ, McKeith IG, Williams ED. Alpha4beta2 nicotinic receptor status in Alzheimer's disease using 123I-5IA-85380 single-photon-emission computed tomography. J Neurol Neurosurg Psychiatry 2007; 78:356-62. [PMID: 17135460 PMCID: PMC2077777 DOI: 10.1136/jnnp.2006.108209] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Loss of the alpha4beta2 nicotinic receptor subtype is found at autopsy in Alzheimer's disease. OBJECTIVE To investigate in vivo changes in this receptor using single-photon-emission CT (SPECT) with 123I-5-iodo-3-[2(S)-2-azetidinylmethoxy] pyridine (5IA-85380), a novel nicotinic acetylcholine receptor ligand which binds predominantly to the alpha4beta2 receptor. METHODS 32 non-smoking subjects (16 with Alzheimer's disease and 16 normal elderly controls) underwent 123I-5IA-85380 and perfusion (99mTc-hexamethylenepropyleneamine oxime (HMPAO)) SPECT scanning. Region of interest analysis was performed with cerebellar normalisation. RESULTS Significant bilateral reductions in nicotinic receptor binding were identified in frontal (left, p = 0.004; right, p = 0.002), striatal (left, p = 0.004; right, p = 0.003), right medial temporal (p = 0.04) and pons (p<0.001) in patients with AD compared to controls. There were no significant correlations with clinical or cognitive measures. The pattern of nicotinic binding significantly differed from that of perfusion in both patients with AD and controls. Both 123I-5IA-85380 and 99mTc-HMPAO SPECT imaging demonstrated similar diagnostic performance in correctly classifying controls and patients with AD. CONCLUSION Using 123I-5IA-85380 SPECT we found changes consistent with significant reductions in the nicotinic alpha4beta2 receptor in cortical and striatal brain regions. This method could facilitate diagnosis and may be useful for monitoring progression of the disease and response to treatment in patients with AD and related diseases.
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Affiliation(s)
- J T O'Brien
- Institute for Ageing and Health, Newcastle University, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK
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Uchida Y, Minoshima S, Okada S, Kawata T, Ito H. Diagnosis of dementia using perfusion SPECT imaging at the patient's initial visit to a cognitive disorder clinic. Clin Nucl Med 2007; 31:764-73. [PMID: 17117070 DOI: 10.1097/01.rlu.0000246818.24566.54] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study was performed to evaluate the diagnostic accuracy of brain perfusion SPECT in patients visiting the cognitive disorder clinic for initial evaluation using 3D-SSP compared with using standard transaxial section. MATERIALS AND METHODS Standard transaxial section displays and 3D-SSP z-score maps obtained after administration of Tc-99m ECD or I-123 IMP were randomly interpreted in 315 patients who visited initially to the cognitive disorder clinic (age 46-88 years; 162 women, 153 men). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated and receiver operating characteristic (ROC) analysis was performed. RESULTS One hundred thirty-seven patients were clinically diagnosed with Alzheimer disease and 178 patients were diagnosed with other disorders and age-associated cognitive decline. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy calculated using standard transaxial display were 61%, 70%, 61%, 70%, and 66%, respectively, and using the 3D-SSP z-score map were 90%, 74%, 73%, 90%, and 81%, respectively. Particularly, the sensitivity value improved in mild cases compared with severe cases using 3D-SSP. Diagnostic performance with 3D-SSP was superior in both mild dementia (Az = 0.64 [section] vs 0.81 [3D-SSP], P = 0.001) and severe dementia (Az = 0.75 [section] vs 0.90 [3D-SSP], P = 0.002). CONCLUSIONS Brain perfusion SPECT was useful for diagnosis in patients who come to the cognitive disorder clinic for initial evaluation using 3D-SSP.
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Affiliation(s)
- Yoshitaka Uchida
- Department of Radiology, Chiba University School of Medicine, Chiba, Japan.
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Tang BNT, Minoshima S, George J, Robert A, Swine C, Laloux P, Borght TV. Diagnosis of suspected Alzheimer's disease is improved by automated analysis of regional cerebral blood flow. Eur J Nucl Med Mol Imaging 2004; 31:1487-94. [PMID: 15232656 DOI: 10.1007/s00259-004-1597-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 05/11/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Accurate diagnosis of Alzheimer's disease (AD), the most common form of dementia, remains difficult. In order to assess whether fully automated stereotactic surface projection (3D-SSP) presentation contributes to the diagnosis of AD by single-photon emission computed tomography (SPECT), we investigated the diagnostic accuracy of transaxial display with and without 3D-SSP analysis as well as the correlation between cerebral perfusion in different cortical areas and the mini mental score (MMS). METHODS Seventy-two patients referred because of cognitive impairment were included in the study. According to the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's disease and Related Disorders Association (ADRDA) criteria, 27 patients were diagnosed as having probable AD while 45 were classified as non-AD patients. 3D-SSP was used to quantify the regional cerebral blood flow (rCBF) acquired from SPECT imaging. RESULTS Compared with the transaxial section presentation alone, 3D-SSP presentation improved the area under the receiver operating curve (p<0.05) as well as intra-observer (k=0.73 vs 0.88) and inter-observer (k=0.50 vs 0.84) reproducibility. Upon normalisation of regional to thalamic activity, multiple regression analysis revealed a strong correlation between the MMS and rCBF in the right parietal cortex (p=0.002). CONCLUSION Addition of 3D-SSP to the transaxial section display of ECD-SPECT studies improves the reproducibility and the diagnostic performance in respect of AD in patients with cognitive impairment and provides a valid tool for assessment of the severity of cortical perfusion abnormalities in such patients.
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Affiliation(s)
- Bich-Ngoc-Thanh Tang
- Department of Nuclear Medicine, Mont-Godinne University Hospital, UCL-Université Catholique de Louvain, Yvoir, Belgium.
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15
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Infeld B, Davis SM. Single-Photon Emission Computed Tomography. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:339-45. [PMID: 12894264 DOI: 10.1590/s0004-282x2003000300004] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To verify the diagnostic accuracy of the Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of patients with mild dementia in Alzheimer's disease (AD); to verify the interference of the variables age and schooling on the performance of the DRS. METHOD The DRS was administered to 41 patients with mild AD and to 60 controls. In order to analyze the effects of age and schooling on the performance of the tests, patients and controls were separated into three age groups and three levels of schooling. RESULTS The cutoff score of 122 showed a sensitivity of 91.7 % and specificity of 87.8 %. Age and schooling interfered in the DRS total score and in the scores of its subscales. CONCLUSION The DRS showed good diagnostic accuracy in the discrimination of patients with mild AD from the control individuals. In the sample examined, the effects of schooling were more marked than age.
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Affiliation(s)
- Cláudia S Porto
- Behavioral and Cognitive Neurology Unit, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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17
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Zakzanis KK, Graham SJ, Campbell Z. A meta-analysis of structural and functional brain imaging in dementia of the Alzheimer's type: a neuroimaging profile. Neuropsychol Rev 2003; 13:1-18. [PMID: 12691498 DOI: 10.1023/a:1022318921994] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We conducted a quantitative review of the imaging literature using meta-analytic methodology to characterize further the magnitude of hippocampal deficit in probable Alzheimer's disease (AD) and to determine whether other neuroanatomic structures in AD can better discriminate the disease from normal aging. Additionally, we parceled the discriminability of neuroanatomic structures by duration of disease to determine those structures most sensitive to AD in its early and late stages. One hundred twenty-one studies published between 1984 and 2000 met criteria for inclusion in the present analysis. In total, structural (i.e., CT and MRI) and functional (i.e., SPECT and PET) neuroimaging results from 3511 patients with AD, and 1632 normal healthy controls were recorded across meta-analyses. Our results include neuroimaging profiles for both early onset and longer duration patients with AD. In sum, these profiles yield a signature of diagnostic markers in both cortical and subcortical neuroanatomic areas. This signature is consistent with the clinical phenomenology of Alzheimer's dementia and should aid in the positive identification of AD.
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18
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Miyazawa N, Aoki S, Toyama K, Arbab AS, Hori M, Umeda T, Araki T, Nukui H. Velocity-coded colour magnetic resonance angiography and perfusion-weighted magnetic resonance imaging for the evaluation of extracranial-to-intracranial arterial bypass surgery. Clin Neurol Neurosurg 2002; 105:48-59. [PMID: 12445925 DOI: 10.1016/s0303-8467(02)00102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Velocity-coded colour magnetic resonance angiography (VCCMRA) and perfusion magnetic resonance imaging (pMRI) were evaluated as methods for investigating the efficacy of extracranial-to-intracranial arterial bypass (EC-IC bypass) by comparing the findings of VCCMRA and those of cerebral angiography and by measuring the improvement ratio after EC-IC bypass by pMRI compared to that by single photon emission computed tomography (SPECT) using the autoradiographic technique. METHODS Thirteen patients who underwent VCCMRA, angiography, SPECT, and pMRI before and after surgery were analyzed. Findings of VCCMRA were compared to those of angiography. Improvement ratio was calculated compared to the cerebellum for cerebral blood volume, mean transit time (MTT), and regional cerebral blood flow (rCBF) as measured by pMRI and quantitative SPECT. RESULTS Findings of VCCMRA were in good agreement with those of angiography and clearly showed the direction of bypass flow. No statistically significant correlation was observed between the improvement ratios in CBF in the hemisphere and middle cerebral artery territory on the surgical and non-surgical sides and in rCBF in the same regions of interest (ROIs) (r=-0.574, 0.09). However, a statistically significant correlation was observed between the cerebrovascular reserve capacity (CVRC) in the hemisphere on the surgical side and in MTT in the same ROIs (r=0.955, P<0.001). CONCLUSION VCCMRA may clearly show the direction of flow in the EC-IC bypass. MIT measured by pMRI may indicate the postoperative state of CVRC. These techniques could replace angiography and positron emission tomography or SPECT in patients undergoing EC-IC bypass.
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Affiliation(s)
- Nobuhiko Miyazawa
- Department of Neurosurgery, Yamanashi Medical University, 1110 Shimokato, Tamaho-cho, Nakakoma-gun, Yamanashi 409-3898, Japan.
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Radau PE, Slomka PJ, Julin P, Svensson L, Wahlund LO. Evaluation of linear registration algorithms for brain SPECT and the errors due to hypoperfusion lesions. Med Phys 2001; 28:1660-8. [PMID: 11548935 DOI: 10.1118/1.1388894] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The semiquantitative analysis of perfusion single-photon emission computed tomography (SPECT) images requires a reproducible, objective method. Automated spatial standardization (registration) of images is a prerequisite to this goal. A source of registration error is the presence of hypoperfusion defects, which was evaluated in this study with simulated lesions. The brain perfusion images measured by 99mTc-HMPAO SPECT from 21 patients with probable Alzheimer's disease and 35 control subjects were retrospectively analyzed. An automatic segmentation method was developed to remove external activity. Three registration methods, robust least squares, normalized mutual information (NMI), and count difference were implemented and the effects of simulated defects were compared. The tested registration methods required segmentation of the cerebrum from external activity, and the automatic and manual methods differed by a three-dimensional displacement of 1.4+/-1.1 mm. NMI registration proved to be least adversely effected by simulated defects with 3 mm average displacement caused by severe defects. The error in quantifying the patient-template parietal ratio due to misregistration was 2.0% for large defects (70% hypoperfusion) and 0.5% for smaller defects (85% hypoperfusion).
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Affiliation(s)
- P E Radau
- Department of Medical Biophysics, University of Western Ontario, London, Canada
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20
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Stamatakis EA, Glabus MF, Wyper DJ, Barnes A, Wilson JT. Validation of statistical parametric mapping (SPM) in assessing cerebral lesions: A simulation study. Neuroimage 1999; 10:397-407. [PMID: 10493898 DOI: 10.1006/nimg.1999.0477] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Simulated abnormalities were introduced in a normal SPECT with known and controllable characteristics (abnormality size and depth) in an attempt to provide validation for the analysis of SPECT lesion studies using SPM. Two simulations were carried out. The first determined the minimum hypoperfusion depth detectable using SPM by altering mean local intensity while keeping the size of the lesion constant. This was done by changing the mean local intensity in percentile increments of 10 down to -100 and up to 50. The second simulation determined the cluster size that SPM can detect by keeping the mean intensity of the lesion constant while altering its size from 4 voxels to 63,000 voxels in a total brain volume of 300, 000 voxels. Both simulations determined which method of normalization is most appropriate, what level of grey matter thresholding should be used, and at what statistical probability peak threshold (u) the results should be determined. Proportional scaling was found to be the most appropriate normalization method. ANCOVA was useful where very large abnormalities were present and normalization external to SPM was not available. In those cases, ANCOVA was used in conjunction with measurement of an unaffected part of the brain (in this case medial occipital lobe). For better results statistical probability peak threshold was set to p(u) = 0. 01 and grey matter threshold was set to a value below 0.5. SPM produced best results when the abnormality represented a decrease of about -50% from the normal or more and detected other decreases in an acceptable manner.
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Affiliation(s)
- E A Stamatakis
- Department of Psychology, University of Stirling, Stirling, Scotland
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21
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Varrone A, Soricelli A, Postiglione A, Salvatore M. Comparison between cortical distribution of I-123 iomazenil and Tc-99m HMPAO in patients with Alzheimer's disease using SPECT. Clin Nucl Med 1999; 24:660-5. [PMID: 10478740 DOI: 10.1097/00003072-199909000-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare brain perfusion and synaptic density in Alzheimer's disease assessed using I-123 iomazenil SPECT with brain perfusion assessed using Tc-99m HMPAO SPECT. MATERIALS AND METHODS Early and delayed I-123 iomazenil SPECT images acquired 20 and 180 minutes after injection were compared with Tc-99m HMPAO SPECT studies acquired 15 to 20 minutes after injection in five patients with Alzheimer's disease. RESULTS Visual analysis of I-123 iomazenil images showed more severe (n = 4) and extensive (n = 3) defects than did Tc-99m HMPAO. Semiquantitative analysis was performed by normalizing the uptake of Tc-99m HMPAO and I-123 iomazenil in individual brain regions in the cerebellum and expressing these values as a ratio of the occipital regions. The analysis of brain regional ratios in Tc-99m HMPAO studies showed a low but significant correlation with ratios of delayed (r = 0.325, P < 0.05) images in the I-123 iomazenil studies. Furthermore, when compared with Tc-99m HMPAO, early (P < 0.01) and delayed mean ratios (P < 0.05) were significantly less in the frontal regions; early mean ratios were significantly less in the temporal regions (P < 0.05), and delayed (P < 0.05) mean ratios were significantly less in the parietal regions. CONCLUSIONS Tc-99m HMPAO images were better correlated with I-123 iomazenil images, indicating cortical synaptic density (delayed images). I-123 iomazenil SPECT in patients with Alzheimer's disease provided more sensitive information than Tc-99m HMPAO, allowing evaluation of brain perfusion and synaptic density.
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Affiliation(s)
- A Varrone
- The Center for Nuclear Medicine of The National Research Council, University Federico II, Naples, Italy
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22
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Stodilka RZ, Kemp BJ, Msaki P, Prato FS, Nicholson RL. The relative contributions of scatter and attenuation corrections toward improved brain SPECT quantification. Phys Med Biol 1998; 43:2991-3008. [PMID: 9814531 DOI: 10.1088/0031-9155/43/10/022] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mounting evidence indicates that scatter and attenuation are major confounds to objective diagnosis of brain disease by quantitative SPECT. There is considerable debate, however, as to the relative importance of scatter correction (SC) and attenuation correction (AC), and how they should be implemented. The efficacy of SC and AC for 99mTc brain SPECT was evaluated using a two-compartment fully tissue-equivalent anthropomorphic head phantom. Four correction schemes were implemented: uniform broad-beam AC, non-uniform broad-beam AC, uniform SC + AC, and non-uniform SC + AC. SC was based on non-stationary deconvolution scatter subtraction, modified to incorporate a priori knowledge of either the head contour (uniform SC) or transmission map (non-uniform SC). The quantitative accuracy of the correction schemes was evaluated in terms of contrast recovery, relative quantification (cortical:cerebellar activity), uniformity ((coefficient of variation of 230 macro-voxels) x 100%), and bias (relative to a calibration scan). Our results were: uniform broad-beam (mu = 0.12 cm(-1)) AC (the most popular correction): 71% contrast recovery, 112% relative quantification, 7.0% uniformity, +23% bias. Non-uniform broad-beam (soft tissue mu = 0.12 cm(-1)) AC: 73%, 114%, 6.0%, +21%, respectively. Uniform SC + AC: 90%, 99%, 4.9%, +12%, respectively. Non-uniform SC + AC: 93%, 101%, 4.0%, +10%, respectively. SC and AC achieved the best quantification; however, non-uniform corrections produce only small improvements over their uniform counterparts. SC + AC was found to be superior to AC; this advantage is distinct and consistent across all four quantification indices.
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Affiliation(s)
- R Z Stodilka
- Department of Nuclear Medicine and Magnetic Resonance, St Joseph's Health Centre, Lawson Research Institute, University of Western Ontario, London, Canada.
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23
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Zimmer R, Leucht S, Rädler T, Schmauss F, Gebhardt U, Lauter H. Variability of cerebral blood flow deficits in 99mTc-HMPAO SPECT in patients with Alzheimer's disease. J Neural Transm (Vienna) 1998; 104:689-701. [PMID: 9444568 DOI: 10.1007/bf01291886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to analyse the frequency of the different pathological perfusion patterns in SPECT in a clinical, unselected population of patients with Alzheimer's disease. In 91 patients and 16 control subjects regional cerebral blood flow (rCBF) was measured with Single Photon Emission Computed Tomography (SPECT) using 99mTc-hexa-methyl-propyleneamine oxime (HMPAO). 95% confidence intervals obtained from the perfusion values of the control subjects were used to define normal perfusion ranges. The frequency of perfusion deficits in the left frontal, temporal, parietal and occipital lobes were 62.2%, 60.4%. 70.3% and 23.1%, respectively. In the right hemisphere the corresponding values were 60.4%, 58.2%, 63.7% and 9.9%. With the exception of the occipital lobes these frequencies were not significantly different. The analysis of the perfusion pattern of each patient revealed 35 different combinations of lobes with perfusion deficits. The temporo-parietal perfusion deficits were not more frequent than the temporofrontal perfusion deficits. These results suggest that in the clinical routine a high variety of heterogeneous rCBF patterns have to be expected.
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Affiliation(s)
- R Zimmer
- Department of Psychiatry, Technische Universität München, Federal Republic of Germany
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24
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Wada M, Kato T, Yuki N, Hosoya T, Moriai S, Kurita K, Yamaguchi K, Sasaki H. Gadolinium-enhancement of the spinal posterior roots in acute sensory ataxic neuropathy. Neurology 1997; 49:1470-1. [PMID: 9371949 DOI: 10.1212/wnl.49.5.1470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- M Wada
- Third Department of Internal Medicine, Yamagata University School of Medicine, Japan
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25
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Lyoo IK, Satlin A, Lee CK, Renshaw PF. Regional atrophy of the corpus callosum in subjects with Alzheimer's disease and multi-infarct dementia. Psychiatry Res 1997; 74:63-72. [PMID: 9204509 DOI: 10.1016/s0925-4927(97)00009-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Regional areas of the corpus callosum (CC) were evaluated in subjects with dementia. The area of the CC and seven distinct subdivisions were measured in subjects with Alzheimer's disease (AD) (n = 162), multi-infarct dementia (MID) (n = 28), and in a healthy comparison group (n = 36). There were significant differences in the regional areas of the CC for both the AD and MID patients relative to values for the comparison subjects. When mildly demented (MMSE > or = 21), subjects with AD had significantly smaller posterior midbody, isthmus, and splenium and subjects with MID had significantly smaller genu relative to comparison subjects. This study reports different patterns of regional CC area loss in subjects with AD and MID.
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Affiliation(s)
- I K Lyoo
- McLean Hospital Brain Imaging Center, Belmont, MA, USA.
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26
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Mattman A, Feldman H, Forster B, Li D, Szasz I, Beattie BL, Schulzer M. Regional HmPAO SPECT and CT measurements in the diagnosis of Alzheimer's disease. Neurol Sci 1997; 24:22-8. [PMID: 9043743 DOI: 10.1017/s0317167100021041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study investigated the hypothesis that the combination of regional CT brain atrophy measurements and semiquantitative SPECT regional blood flow ratios could produce a diagnostic test for Alzheimer's disease (AD) with an accuracy comparable to that achieved with the present clinical gold standard of the NINCDS-ADRDA criteria. METHODS Single proton emission computed tomography (SPECT) and CT head scans were performed on 122 subjects referred an UBC Alzheimer clinic and diagnosed as either 'not demented' (ND-37) or 'possible/probable AD' (AD-85) by the NINCDS-ADRDA criteria. Stepwise discriminant analysis (SDA) was performed on the bilateral SPECT regions of interest and compared to bilateral CT qualitative/quantitative assessment in the frontal, parietal and temporal lobes to determine which were most accurate at ND/AD distinction. Receiver operating curves (ROC) were then constructed for these variables individually and for their combined discriminant function. RESULTS The left temporal qualitative cortical atrophy score (CT) and left temporal perfusion ratio (SPECT) were selected in the SDA. The combined discriminant function was more specific at AD/ND distinction than either of CT or SPECT alone. The accuracy of AD/ND distinction with the combined discriminant function was below that achieved by clinical diagnosis according to the NINCDS-ADRDA criteria and was not significantly different from that achieved with SPECT or CT alone as defined by ROC curve analysis. CONCLUSION The measurements of left temporal cortical atrophy and regional cerebral blood flow were most indicative of AD; however they lacked the sensitivity and specificity to recommend their use as a diagnostic test for AD.
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Affiliation(s)
- A Mattman
- Clinic for Alzheimer's Disease and Related Disorders, Vancouver Hospital and Health Sciences Center-UBC Site, Canada
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Ryding E. SPECT measurements of brain function in dementia; a review. ACTA NEUROLOGICA SCANDINAVICA. SUPPLEMENTUM 1996; 168:54-8. [PMID: 8997421 DOI: 10.1111/j.1600-0404.1996.tb00374.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A brief review of the role of SPECT (single photon emission computed tomography) in the diagnosis of dementing brain disease is given. Between 1990 and 1995 some 100 original articles deal with SPECT measurements with radioactive tracers of brain function in demented patients. The main field is measurement of regional cerebral blood flow (rCBF) but there is an increasing number of studies concerning receptor functions in the demented brain.
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Affiliation(s)
- E Ryding
- Department of Clinical Neurophysiology, University Hospital of Lund, Sweden
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Gorson KC, Ropper AH, Muriello MA, Blair R. Prospective evaluation of MRI lumbosacral nerve root enhancement in acute Guillain-Barré syndrome. Neurology 1996; 47:813-7. [PMID: 8797486 DOI: 10.1212/wnl.47.3.813] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Nerve root enhancement of the cauda equina occurs in Guillain-Barré syndrome (GBS), but the frequency, diagnostic value, and meaning of this finding is unknown. We prospectively obtained gadolinium-enhanced lumbosacral spine MRIs in 24 consecutive patients with acute GBS and blindly rated nerve root enhancement as absent, mild, or prominent. The MRIs were obtained 13 days, mean, after onset of symptoms (range 2 to 42 days). Twenty of 24 patients had cauda equina nerve root enhancement, which was mild in 6 and prominent in 14. Eighteen of 19 with "typical" GBS had enhancement, compared with 2 of 5 with a variant presentation. Sixty percent of patients with prominent enhancement had severe back or leg pain in contrast to 10% of patients with mild or no enhancement. The GBS disability grade (0 to 5 scale) was higher in patients with prominent enhancement, and significantly fewer patients with prominent nerve root enhancement could walk independently by 2 months. There was no relationship between nerve root enhancement and the timing of the MRI, CSF protein, any of several EMG abnormalities, duration of hospitalization, mean disability grade at 2 months, or the time required for patients to improve to grade 2. In two patients, the EMGs at 11 and 20 days, respectively, were normal except for slightly prolonged F-responses and neurogenic recruitment, but there were prominent nerve root enhancement and an elevated CSF protein. Enhancement of the cauda equina nerve roots with gadolinium on lumbosacral MRI is 83% sensitive of acute GBS and was present in 95% of typical cases. This finding may be useful when electrophysiologic abnormalities are equivocal. In addition, conspicuous nerve root enhancement correlates with pain, GBS disability grade, and duration of recovery.
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Affiliation(s)
- K C Gorson
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA
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Ishii K, Mori E, Kitagaki H, Sakamoto S, Yamaji S, Imamura T, Ikejiri Y, Kono M. The clinical utility of visual evaluation of scintigraphic perfusion patterns for Alzheimer's disease using I-123 IMP SPECT. Clin Nucl Med 1996; 21:106-10. [PMID: 8697677 DOI: 10.1097/00003072-199602000-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors examined the role of SPECT perfusion pattern in the diagnosis of Alzheimer's disease (AD) using I-123 IMP. They studied 93 patients who had memory and cognitive disorders, including 42 patients with a diagnosis of probable AD, classifying SPECT images into determined perfusion patterns. The probability of AD was 54% with bilateral temporal and/or parietal defects, 69% with bilateral temporoparietal defects with additional defects, 17% with no defects, and 11% with frontal defects only. The sensitivity of bilateral temporoparietal perfusion defects for AD was 95.2%, whereas the specificity was 56.9%. In the absence of bilateral temporal and/or parietal defects on visual evaluation of SPECT, the diagnosis of AD was unlikely, although it is not pathognomonic for AD, because this sign would be seen in various neuropsychiatric diseases causing memory and cognitive impairments. Visual evaluation of SPECT is of value in the diagnosis of AD among patients with dementia.
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Affiliation(s)
- K Ishii
- Divisions of Neuroimaging Research, Hyogo Institute for Aging Brain and Cognitive Disorders, Himeji, Japan
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Krausz Y, Bonne O, Marciano R, Yaffe S, Lerer B, Chisin R. Brain SPECT imaging of neuropsychiatric disorders. Eur J Radiol 1996; 21:183-7. [PMID: 8777908 DOI: 10.1016/0720-048x(95)00725-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Brain imaging has become an integral part of the evaluation of neurological and psychiatric disorders. Functional imaging techniques, SPECT and PET, together with structural modalities, CT and MRI, are widely employed. Functional imaging studies are routinely used in the diagnostic workup of patients with well-characterized neurological disorders, such as epilepsy and brain tumors, and have a growing role in research on psychiatric disorders without known mechanisms such as depression and schizophrenia. Furthermore, many well-defined neurological disorders manifest prominent psychiatric symptomatology which may pose difficulties in differential diagnosis. This review addresses the current knowledge of SPECT findings in patients who present with psychiatric phenomena, associated with disorders at the interface of neurology and psychiatry.
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Affiliation(s)
- Y Krausz
- Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
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