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Razek AAKA, Elsebaie NA. Imaging of vascular cognitive impairment. Clin Imaging 2021; 74:45-54. [PMID: 33434866 DOI: 10.1016/j.clinimag.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Vascular cognitive impairment (VCI) is a major health challenge and represents the second most common cause of dementia. We review the updated imaging classification and imaging findings of different subtypes of VCI. We will focus on the magnetic resonance imaging (MRI) markers of each subtype and highlight the role of advanced MR imaging sequences in the evaluation of these patients. Small vessel dementia appears as white matter hyperintensity, lacunae, microinfarcts, and microbleeds. Large vessel dementia includes strategic infarction and multi-infarction dementias. Hypoperfusion dementia can be seen as watershed infarcts and cortical laminar necrosis. Hemorrhagic dementia results from cerebral amyloid angiopathy and cortical superficial siderosis. Hereditary forms of VCI, caused by gene mutations such as CADASIL, should be suspected when dementia presents in young patients. Mixed dementia is seen in patients with Alzheimer's disease and the coexistence of cerebrovascular disease.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
| | - Nermeen A Elsebaie
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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Raja R, Caprihan A, Rosenberg GA, Rachakonda S, Calhoun VD. Discriminating VCID subgroups: A diffusion MRI multi-model fusion approach. J Neurosci Methods 2020; 335:108598. [PMID: 32004594 PMCID: PMC7443575 DOI: 10.1016/j.jneumeth.2020.108598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/06/2019] [Accepted: 01/17/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vascular cognitive impairment and dementia (VCID) and Alzheimer's disease are predominant diseases among the aging population resulting in decline of various cognitive domains. Diffusion weighted MRI (DW-MRI) has been shown to be a promising aid in the diagnosis of such diseases. However, there are various models of DW-MRI and the interpretation of diffusion metrics depends on the model used in fitting data. Most previous studies are entirely based on parameters calculated from a single diffusion model. NEW METHOD We employ a data fusion framework wherein diffusion metrics from different models such as diffusion tensor imaging, diffusion kurtosis imaging and constrained spherical deconvolution model are fused using well known blind source separation approach to investigate white matter microstructural changes in population comprising of controls and VCID subgroups. Multiple comparisons between subject groups and prediction analysis using features from individual models and proposed fusion model are carried out to evaluate performance of proposed method. RESULTS Diffusion features from individual models successfully distinguished between controls and disease groups, but failed to differentiate between disease groups, whereas fusion approach showed group differences between disease groups too. WM tracts showing significant differences are superior longitudinal fasciculus, anterior thalamic radiation, arcuate fasciculus, optic radiation and corticospinal tract. COMPARISON WITH EXISTING METHOD ROC analysis showed increased AUC for fusion (AUC = 0.913, averaged across groups and tracts) compared to that of uni-model features (AUC = 0.77) demonstrating increased sensitivity of proposed method. CONCLUSION Overall our results highlight the benefits of multi-model fusion approach, providing improved sensitivity in discriminating VCID subgroups.
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Affiliation(s)
- Rajikha Raja
- The Mind Research Network, Albuquerque, NM 87106, USA; Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA 30303, USA.
| | | | - Gary A Rosenberg
- UNM Health Sciences Center, University of New Mexico, Albuquerque, NM 87106, USA
| | - Srinivas Rachakonda
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA 30303, USA
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM 87106, USA; Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA 30303, USA
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Raposo Rodríguez L, Tovar Salazar DJ, Fernández García N, Pastor Hernández L, Fernández Guinea Ó. Magnetic resonance imaging in dementia. RADIOLOGIA 2018; 60:476-484. [PMID: 29903629 DOI: 10.1016/j.rx.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/11/2018] [Accepted: 04/25/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe and illustrate the key findings on structural magnetic resonance imaging (MRI) in the most common dementias of neurodegenerative origin: Alzheimer's disease, vascular dementia, dementia with Lewy bodies, variants of frontotemporal dementia, progressive supranuclear palsy, variants of multiple system atrophy, Parkinson dementia, and corticobasal degeneration. CONCLUSION Today the role of MRI is no longer limited to ruling out underlying causes of cognitive deterioration. MRI can show patterns of atrophy with a predictive value for certain dementias which, although not specific or unique to each disease, can help to confirm diagnostic suspicion or to identify certain processes. For this reason, it is important for radiologists to know the characteristic findings of the most common dementias.
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Raposo Rodríguez L, Tovar Salazar D, Fernández García N, Pastor Hernández L, Fernández Guinea Ó. Magnetic resonance imaging in dementia. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Castaneda Vega S, Weinl C, Calaminus C, Wang L, Harant M, Ehrlichmann W, Thiele D, Kohlhofer U, Reischl G, Hempel JM, Ernemann U, Quintanilla Martinez L, Nordheim A, Pichler BJ. Characterization of a novel murine model for spontaneous hemorrhagic stroke using in vivo PET and MR multiparametric imaging. Neuroimage 2017; 155:245-256. [DOI: 10.1016/j.neuroimage.2017.04.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/29/2017] [Accepted: 04/29/2017] [Indexed: 01/07/2023] Open
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Usman S, Oskouian RJ, Loukas M, Tubbs RS. Clinical anatomy of the most common dementias. Clin Anat 2016; 30:53-57. [PMID: 27588364 DOI: 10.1002/ca.22784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Sameera Usman
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
| | - Marios Loukas
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington
- Department of Anatomical Sciences, St. George's University, Seattle, Washington
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Aguilar C, Edholm K, Simmons A, Cavallin L, Muller S, Skoog I, Larsson EM, Axelsson R, Wahlund LO, Westman E. Automated CT-based segmentation and quantification of total intracranial volume. Eur Radiol 2015; 25:3151-60. [DOI: 10.1007/s00330-015-3747-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/09/2015] [Accepted: 03/26/2015] [Indexed: 11/28/2022]
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Abstract
Dementia, whether secondary to Alzheimer disease or another process, is a significant cause of morbidity and mortality worldwide. Although dementia remains a clinical diagnosis, for many years imaging has served as a key component in the assessment of patients with cognitive impairment. There have been tremendous advancements in the neuroimaging of dementia over the past decade, moving the field past the rule-out dogma toward ruling in specific pathophysiologic processes. This article is written for the practicing clinician, to provide a review of neuroimaging findings associated with selected degenerative and nondegenerative forms of dementia.
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Paniagua Bravo Á, Sánchez Hernández JJ, Ibáñez Sanz L, Alba de Cáceres I, Crespo San José JL, García-Castaño Gandariaga B. A comparative MRI study for white matter hyperintensities detection: 2D-FLAIR, FSE PD 2D, 3D-FLAIR and FLAIR MIP. Br J Radiol 2014; 87:20130360. [PMID: 24588665 DOI: 10.1259/bjr.20130360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The main objective of this study was to not only determine the most appropriate sequence for the analysis of white matter hyperintensities (WMH) on MRI but also to confirm the advantage of three-dimensional (3D) acquisition, as it has been suggested in previous studies, and to test the convenience of using maximum intensity projection (MIP) algorithms on 3D-fluid-attenuated inversion-recovery (FLAIR) images for a quicker evaluation of brain MR studies. METHODS The number of WMH was compared in 40 patients and a control group of 10 volunteers using 4 different imaging modalities: two dimensional (2D)-FLAIR, 2D fast spin echo proton density (FSE PD), 3D-FLAIR and FLAIR MIP. Four experienced radiologists took part in the imaging analysis. All studies were performed on a 1.5-T whole-body MR unit. RESULTS A statistically significant difference between the number of lesions detected on 3D acquisitions (FLAIR CUBE® or FLAIR MIP sequences) compared with those on 2D-FLAIR or 2D FSE PD was demonstrated. There is no significant difference between 3D-FLAIR and FLAIR MIP, therefore both of them can be used with similar results. CONCLUSION 3D-FLAIR sequences should replace conventional 2D-FLAIR and/or FSE PD sequences in the MR acquisition protocol when WMH are suspected. MIP reformat algorithms are less time consuming, therefore these can also be used to simplify the detection. ADVANCES IN KNOWLEDGE 3D sequences are superior for WMH depiction. Moreover, MIP algorithms allow easier analyses with similar results.
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Affiliation(s)
- Á Paniagua Bravo
- Unidad Central de Radiodiagnóstico, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
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Román G, Pascual B. Contribution of Neuroimaging to the Diagnosis of Alzheimer’s Disease and Vascular Dementia. Arch Med Res 2012; 43:671-6. [DOI: 10.1016/j.arcmed.2012.10.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 01/05/2023]
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Nichtweiß M, Weidauer S, Treusch N, Hattingen E. White Matter Lesions and Vascular Cognitive Impairment. Clin Neuroradiol 2012; 22:193-210. [DOI: 10.1007/s00062-012-0134-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/17/2012] [Indexed: 12/13/2022]
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Abstract
Clinical neuroimaging is increasingly being used in the diagnosis of neurodegenerative diseases and has become one of the most important paraclinical tools in the diagnosis of dementia. According to current guidelines, neuroimaging, preferably magnetic resonance imaging (MRI), should be performed at least once during the diagnostic work-up of patients with suspected or definite dementia. MRI is helpful in identifying or excluding potentially treatable causes of dementia; however, these account only for a small proportion of dementias. In addition, MRI is able to support the clinical diagnosis in a memory clinic setting by identifying certain patterns of atrophy and vascular damage. Visual rating scales are well-established methods in the clinical routine for the assessment and quantification of regional/global cortical atrophy, hippocampal atrophy and vascular damage. In addition, MRI is able to detect certain aspects of pathology associated with dementia, such as cerebral microbleeds which are related to cerebral amyloid angiopathy and Alzheimer pathology. This review paper aims to give an overview of the application of structural MRI in the diagnostic procedure for memory clinic patients in terms of excluding and supporting the diagnosis of various diseases associated with dementia.
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Ihl R, Frölich L, Winblad B, Schneider L, Burns A, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of Alzheimer's disease and other dementias. World J Biol Psychiatry 2011; 12:2-32. [PMID: 21288069 DOI: 10.3109/15622975.2010.538083] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To define a practice guideline for biological treatment of dementia and to make transparent the development of the guideline connecting the original data with the resulting recommendations. METHODS This guideline includes pharmacologic treatment considerations for patients with Alzheimer's disease, vascular dementia, DLB, and fronto-temporal dementia. Studies were selected that represent double-blind placebo-controlled trials of at least 3 months duration in patients with a diagnosis of dementia according to accepted international diagnostic criteria (for example the NINCDS/ADRDA or NINDS/AIREN criteria). Moreover, to be included studies had to fulfill a restrictive set of methodological criteria. Original studies and not meta-analyses determined the evaluation and the development of recommendations. RESULTS Antidementia pharmaceuticals neither cure nor arrest the disease. A modest effect of improvement of symptoms compared with placebo can be observed. Antidementia pharmaceuticals show different efficacy and side effect profiles. The type of dementia, the individual symptom constellation and the tolerability should determine what medication should be used. There are hints that combination therapy of drugs with different therapeutic mechanisms might improve the efficacy. In treating neuropsychiatric symptoms (NPS), psychosocial intervention should be the treatment of first choice. Pharmaceuticals can only be recommended when psychosocial interventions is not adequate. However, even then the side effects of pharmaceuticals limit their use. CONCLUSIONS Depending on the diagnostic entity and the pathology treated different anti-dementia drugs can be recommended to improve symptoms. In the management of NPS, side effects limit the use of medications even when psychosocial interventions have failed. Thus, there is an urgent need to develop more efficacious medications for the treatment of dementia.
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Affiliation(s)
- Ralf Ihl
- Alexian Hospital Krefeld and Department of Psychiatry, University of Duesseldorf, Germany.
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Arana Fernández de Moya E. Dementia and imaging: the basics. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arana Fernández de Moya E. Demencias e imagen: lo básico. RADIOLOGIA 2010; 52:4-17. [DOI: 10.1016/j.rx.2009.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 07/18/2009] [Accepted: 09/03/2009] [Indexed: 01/08/2023]
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Wattjes MP, Henneman WJP, van der Flier WM, de Vries O, Träber F, Geurts JJG, Scheltens P, Vrenken H, Barkhof F. Diagnostic Imaging of Patients in a Memory Clinic: Comparison of MR Imaging and 64–Detector Row CT. Radiology 2009; 253:174-83. [DOI: 10.1148/radiol.2531082262] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Although dementia is a clinical diagnosis, neuroimaging often is crucial for proper assessment. Magnetic resonance imaging (MRI) and computed tomography (CT) may identify nondegenerative and potentially treatable causes of dementia. Recent neuroimaging advances, such as the Pittsburgh Compound-B (PIB) ligand for positron emission tomography imaging in Alzheimer's disease, will improve our ability to differentiate among the neurodegenerative dementias. High-resolution volumetric MRI has increased the capacity to identify the various forms of the frontotemporal lobar degeneration spectrum and some forms of parkinsonism or cerebellar neurodegenerative disorders, such as corticobasal degeneration, progressive supranuclear palsy, multiple system atrophy, and spinocerebellar ataxias. In many cases, the specific pattern of cortical and subcortical abnormalities on MRI has diagnostic utility. Finally, among the new MRI methods, diffusion-weighted MRI can help in the early diagnosis of Creutzfeldt-Jakob disease. Although only clinical assessment can lead to a diagnosis of dementia, neuroimaging is clearly an invaluable tool for the clinician in the differential diagnosis.
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Affiliation(s)
- Paolo Vitali
- Department of Neurology, UCSF Memory and Aging Center, University of California-San Francisco, CA 94143, USA
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Jellinger KA. Morphologic diagnosis of “vascular dementia” — A critical update. J Neurol Sci 2008; 270:1-12. [DOI: 10.1016/j.jns.2008.03.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 03/07/2008] [Accepted: 03/13/2008] [Indexed: 01/24/2023]
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Bradač GB, Daniele D, Bergui M, Cerrato P, Ferrio MF, Stura G, Coriasco M. Lacunes and other holes: diagnosis, pathogenesis, therapy. Neuroradiol J 2008; 21:35-52. [PMID: 24256748 DOI: 10.1177/197140090802100105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 10/28/2007] [Indexed: 11/16/2022] Open
Abstract
Lacunar ischemic lesions are related to a pathology involving perforators, due to direct changes in the arteries or to an indirect mechanism, such as cardiac or artery to artery embolism, or to hypoperfusion in cases of cardiac failure, or proximal occlusion of large arteries. Changes involving the large intracranial arteries have progressively been taken into consideration as a cause of the disease. This latter aspect is interesting since possible endovascular treatment can be proposed in selected cases. In patients with lacunar syndrome an extended clinical and neuroradiological approach is indicated to choose the most appropriate therapy. Not all lesions recognizable on CT/MR are the expressions of ischemic lesions, this is another important aspect that should be considered in the differential diagnosis.
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Affiliation(s)
- G B Bradač
- Neuroscience-Neuroradiology Department, University of Turin; Turin, Italy -
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Archer HA, McFarlane F, Frost C, Cutler D, Fox NC, Rossor MN. Symptoms of memory loss as predictors of cognitive impairment?: the use and reliability of memory ratings in a clinic population. Alzheimer Dis Assoc Disord 2007; 21:101-6. [PMID: 17545734 DOI: 10.1097/wad.0b013e318065bfc2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Symptoms of memory loss are very common with estimated prevalence between 22% and 50% in those older than 65 years of age. Those with symptoms of memory loss and impaired performance on memory tests are at high risk of progression to Alzheimer disease. The relative importance of different aspects of the clinical history in predicting cognitive impairment is uncertain. METHODS Fifty-six patients with symptoms of memory loss were recruited from the National Hospital for Neurology and Neurosurgery. A clinician recorded type and duration of memory symptoms as perceived by the patient and their informant, and use of memory aids. All patients subsequently underwent magnetic resonance imaging (MRI) and neuropsychologic testing. FINDINGS (i) Informant, but not patient, ratings of memory were associated with performance on tests of memory function and with hippocampal size on MRI. (ii) Decreased use of memory aids and shorter duration of memory symptoms were more common in those with memory impairment. INTERPRETATION In a clinical setting, information gathered from the history was associated with cognitive impairment on memory testing and brain appearances on MRI. The history from a close informant is particularly important being more strongly predictive of cognitive impairment (P=0.0002) than subjective symptoms, use of memory aids or duration of symptoms.
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Affiliation(s)
- Hilary A Archer
- Institute of Neurology, Dementia Research Centre, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
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