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CT perfusion as a useful tool in the evaluation of leuko-araiosis

Ramli N, Ho K, Nawawi O, Chong H, Tan C - Biomed Imaging Interv J (2006)

Bottom Line: Mean white matter CBF was considerably reduced in patients with LA in the frontal region by 42% (p = 0.000), basal ganglia by 37% (p = 0.000) and occipital region by 18% (p = 0.019).The mean white matter CBV was reduced in patients with LA in the frontal region by 36% (p = 0.000) and basal ganglia by 28% (p = 0.017).The CTP showed reduced white matter CBF and CBV in patients with LA.

Affiliation: Departments of Biomedical Imaging and Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.

ABSTRACT

Background: Leuko-araiosis (LA) and dementia are common geriatric conditions but their pathogenesis and clinical significance are not completely understood. An evaluation of CT perfusion (CTP) in both these conditions can further enhance the understanding of these diseases.

Methods: Twenty-one patients with LA and 21 age-matched controls were studied with CTP and assessed for their cognitive function. The subjects were classified into four groups: Group 1, with LA (n = 21); Group 2, without LA (n = 21); Group 3, with dementia (n = 7); Group 4, without dementia (n = 11). The mean cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) values were compared between groups 1 and 2, while mean CBF values were compared between groups 3 and 4.

Results: Mean white matter CBF was considerably reduced in patients with LA in the frontal region by 42% (p = 0.000), basal ganglia by 37% (p = 0.000) and occipital region by 18% (p = 0.019). The mean white matter CBV was reduced in patients with LA in the frontal region by 36% (p = 0.000) and basal ganglia by 28% (p = 0.017). The mean white matter CBF was dramatically reduced in patients with dementia in the frontal region by 44% (p = 0.000), basal ganglia by 32% (p = 0.038) and occipital regions by 24% (p = 0.001).

Conclusion: The CTP showed reduced white matter CBF and CBV in patients with LA. This is consistent with chronic ischemia as the pathogenesis of LA. The CTP is also a potentially important technique in the diagnosis and management of dementia, because of its ability to reveal cerebral hypoperfusion.

Plain CT brain at the basal ganglia (A) and corona radiata (B) levels showing periventricular white matter lucency in a patient with leuko-araiosis.
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Figure 1: Plain CT brain at the basal ganglia (A) and corona radiata (B) levels showing periventricular white matter lucency in a patient with leuko-araiosis.

Mentions: The subjects were selected from a group of patients who were referred to our department for CT examination of the brain. The reasons for referral were stroke (n = 18), dementia or cognitive impairment (n = 14), headache (n = 6), giddiness (n = 5), psychiatric disorder (n = 4), syncope (n = 1) and metastatic malignancy of the brain (n = 1). The subjects were selected based on the identification of LA in non-contrasted CT brain using standard window (Figure 1). A total of 23 patients with LA were identified and they underwent CTP on the same day as the scam. A total of 26 patients without LA were also selected for CTP as an age-matched control sample. All subjects were assessed with Mini Mental State Examination (MMSE) either before or after the procedure. Patients with an MMSE score of less than 24 and with clinical features of dementia or cognitive impairment were used for the sample with dementia. The following information was collected from the patients: age, sex and risk factors (diabetes mellitus, hypertension and cardiovascular disease). Based on the non-contrasted CT findings and MMSE scores, the subjects were classified into four groups: Group 1, patients with LA (n = 21, 10 Male, 11 Female); Group 2, patients without LA (n = 21, 9 Male, 12 Female); Group 3, patients with dementia (n = 7, 3 Male, 4 Female; 3 with LA, 4 without LA); Group 4, patients without dementia (n = 11, 6 Male, 5 Female; all with no LA).

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CT perfusion as a useful tool in the evaluation of leuko-araiosis

Ramli N, Ho K, Nawawi O, Chong H, Tan C - Biomed Imaging Interv J (2006)

Plain CT brain at the basal ganglia (A) and corona radiata (B) levels showing periventricular white matter lucency in a patient with leuko-araiosis.
© Copyright Policy
Figure 1: Plain CT brain at the basal ganglia (A) and corona radiata (B) levels showing periventricular white matter lucency in a patient with leuko-araiosis.
Mentions: The subjects were selected from a group of patients who were referred to our department for CT examination of the brain. The reasons for referral were stroke (n = 18), dementia or cognitive impairment (n = 14), headache (n = 6), giddiness (n = 5), psychiatric disorder (n = 4), syncope (n = 1) and metastatic malignancy of the brain (n = 1). The subjects were selected based on the identification of LA in non-contrasted CT brain using standard window (Figure 1). A total of 23 patients with LA were identified and they underwent CTP on the same day as the scam. A total of 26 patients without LA were also selected for CTP as an age-matched control sample. All subjects were assessed with Mini Mental State Examination (MMSE) either before or after the procedure. Patients with an MMSE score of less than 24 and with clinical features of dementia or cognitive impairment were used for the sample with dementia. The following information was collected from the patients: age, sex and risk factors (diabetes mellitus, hypertension and cardiovascular disease). Based on the non-contrasted CT findings and MMSE scores, the subjects were classified into four groups: Group 1, patients with LA (n = 21, 10 Male, 11 Female); Group 2, patients without LA (n = 21, 9 Male, 12 Female); Group 3, patients with dementia (n = 7, 3 Male, 4 Female; 3 with LA, 4 without LA); Group 4, patients without dementia (n = 11, 6 Male, 5 Female; all with no LA).

Bottom Line: Mean white matter CBF was considerably reduced in patients with LA in the frontal region by 42% (p = 0.000), basal ganglia by 37% (p = 0.000) and occipital region by 18% (p = 0.019).The mean white matter CBV was reduced in patients with LA in the frontal region by 36% (p = 0.000) and basal ganglia by 28% (p = 0.017).The CTP showed reduced white matter CBF and CBV in patients with LA.

Affiliation: Departments of Biomedical Imaging and Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.

ABSTRACT

Background:

Background: Leuko-araiosis (LA) and dementia are common geriatric conditions but their pathogenesis and clinical significance are not completely understood. An evaluation of CT perfusion (CTP) in both these conditions can further enhance the understanding of these diseases.

Methods: Twenty-one patients with LA and 21 age-matched controls were studied with CTP and assessed for their cognitive function. The subjects were classified into four groups: Group 1, with LA (n = 21); Group 2, without LA (n = 21); Group 3, with dementia (n = 7); Group 4, without dementia (n = 11). The mean cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) values were compared between groups 1 and 2, while mean CBF values were compared between groups 3 and 4.

Results: Mean white matter CBF was considerably reduced in patients with LA in the frontal region by 42% (p = 0.000), basal ganglia by 37% (p = 0.000) and occipital region by 18% (p = 0.019). The mean white matter CBV was reduced in patients with LA in the frontal region by 36% (p = 0.000) and basal ganglia by 28% (p = 0.017). The mean white matter CBF was dramatically reduced in patients with dementia in the frontal region by 44% (p = 0.000), basal ganglia by 32% (p = 0.038) and occipital regions by 24% (p = 0.001).

Conclusion: The CTP showed reduced white matter CBF and CBV in patients with LA. This is consistent with chronic ischemia as the pathogenesis of LA. The CTP is also a potentially important technique in the diagnosis and management of dementia, because of its ability to reveal cerebral hypoperfusion.

View Similar Images In: Results  - Collection
View Article: Medline Plus - Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3097620&rFormat=json&query=null&req=5