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Early-stage differentiation between presenile Alzheimer's disease and frontotemporal dementia using arterial spin labeling MRI.

Steketee RM, Bron EE, Meijboom R, Houston GC, Klein S, Mutsaerts HJ, Mendez Orellana CP, de Jong FJ, van Swieten JC, van der Lugt A, Smits M - Eur Radiol (2015)

Bottom Line: Gray matter (GM) volume and cerebral blood flow (CBF), corrected for partial volume effects, were quantified in the entire supratentorial cortex and in 10 GM regions.ASL-MRI contributes to early diagnosis of and differentiation between presenile AD and FTD.ASL-MRI facilitates differentiation of early Alzheimer's disease and frontotemporal dementia.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Erasmus MC - University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.

ABSTRACT

Objective: To investigate arterial spin labeling (ASL)-MRI for the early diagnosis of and differentiation between the two most common types of presenile dementia: Alzheimer's disease (AD) and frontotemporal dementia (FTD), and for distinguishing age-related from pathological perfusion changes.

Methods: Thirteen AD and 19 FTD patients, and 25 age-matched older and 22 younger controls underwent 3D pseudo-continuous ASL-MRI at 3 T. Gray matter (GM) volume and cerebral blood flow (CBF), corrected for partial volume effects, were quantified in the entire supratentorial cortex and in 10 GM regions. Sensitivity, specificity and diagnostic performance were evaluated in regions showing significant CBF differences between patient groups or between patients and older controls.

Results: AD compared with FTD patients had hypoperfusion in the posterior cingulate cortex, differentiating these with a diagnostic performance of 74 %. Compared to older controls, FTD patients showed hypoperfusion in the anterior cingulate cortex, whereas AD patients showed a more widespread regional hypoperfusion as well as atrophy. Regional atrophy was not different between AD and FTD. Diagnostic performance of ASL to differentiate AD or FTD from controls was good (78-85 %). Older controls showed global hypoperfusion compared to young controls.

Conclusion: ASL-MRI contributes to early diagnosis of and differentiation between presenile AD and FTD.

Key points: ASL-MRI facilitates differentiation of early Alzheimer's disease and frontotemporal dementia. Posterior cingulate perfusion is lower in Alzheimer's disease than frontotemporal dementia. Compared to controls, Alzheimer's disease patients show hypoperfusion in multiple regions. Compared to controls, frontotemporal dementia patients show focal anterior cingulate hypoperfusion. Global decreased perfusion in older adults differs from hypoperfusion in dementia.

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Related in: MedlinePlus

Cerebral blood flow (CBF in ml/100 g GM/min) maps for a representative AD (left column) and FTD patient (right column). The top row shows their skull-stripped CBF map, the bottom row shows their colour-coded CBF maps overlaid on the structural T1w images. Hypoperfusion is prominent in the PCC (thick arrows) in AD compared to FTD. Also note the global and more extensive hypoperfusion in AD compared to the focal hypoperfusion in the ACC in FTD (thin arrows). CBF: cerebral blood flow; AD: Alzheimer’s disease; FTD: frontotemporal dementia; T1w: T1 weighted; PCC: posterior cingulate cortex; ACC: anterior cingulate cortex
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Fig1: Cerebral blood flow (CBF in ml/100 g GM/min) maps for a representative AD (left column) and FTD patient (right column). The top row shows their skull-stripped CBF map, the bottom row shows their colour-coded CBF maps overlaid on the structural T1w images. Hypoperfusion is prominent in the PCC (thick arrows) in AD compared to FTD. Also note the global and more extensive hypoperfusion in AD compared to the focal hypoperfusion in the ACC in FTD (thin arrows). CBF: cerebral blood flow; AD: Alzheimer’s disease; FTD: frontotemporal dementia; T1w: T1 weighted; PCC: posterior cingulate cortex; ACC: anterior cingulate cortex

Mentions: The ASL imaging dataset consisted of two images, a perfusion-weighted image (PWI) and a proton density image (PD), that were required for CBF calculation [16]. CBF maps from representative patients are shown in Figure 1. The GM map derived from the T1w image was rigidly registered with the PD image for each participant (Elastix registration software [19]). Then GM maps were transformed to ASL image space to enable partial volume (PV) correction. PV effects were corrected in PWI and PD images using local linear regression within a 3D kernel based on tissue maps [20]. The PV-corrected ASL images were quantified as CBF maps using the single-compartment model [16] as implemented by the scanner manufacturer. Finally CBF maps were transformed to T1w image space for further analysis.Fig. 1


Early-stage differentiation between presenile Alzheimer's disease and frontotemporal dementia using arterial spin labeling MRI.

Steketee RM, Bron EE, Meijboom R, Houston GC, Klein S, Mutsaerts HJ, Mendez Orellana CP, de Jong FJ, van Swieten JC, van der Lugt A, Smits M - Eur Radiol (2015)

Cerebral blood flow (CBF in ml/100 g GM/min) maps for a representative AD (left column) and FTD patient (right column). The top row shows their skull-stripped CBF map, the bottom row shows their colour-coded CBF maps overlaid on the structural T1w images. Hypoperfusion is prominent in the PCC (thick arrows) in AD compared to FTD. Also note the global and more extensive hypoperfusion in AD compared to the focal hypoperfusion in the ACC in FTD (thin arrows). CBF: cerebral blood flow; AD: Alzheimer’s disease; FTD: frontotemporal dementia; T1w: T1 weighted; PCC: posterior cingulate cortex; ACC: anterior cingulate cortex
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4666273&req=5

Fig1: Cerebral blood flow (CBF in ml/100 g GM/min) maps for a representative AD (left column) and FTD patient (right column). The top row shows their skull-stripped CBF map, the bottom row shows their colour-coded CBF maps overlaid on the structural T1w images. Hypoperfusion is prominent in the PCC (thick arrows) in AD compared to FTD. Also note the global and more extensive hypoperfusion in AD compared to the focal hypoperfusion in the ACC in FTD (thin arrows). CBF: cerebral blood flow; AD: Alzheimer’s disease; FTD: frontotemporal dementia; T1w: T1 weighted; PCC: posterior cingulate cortex; ACC: anterior cingulate cortex
Mentions: The ASL imaging dataset consisted of two images, a perfusion-weighted image (PWI) and a proton density image (PD), that were required for CBF calculation [16]. CBF maps from representative patients are shown in Figure 1. The GM map derived from the T1w image was rigidly registered with the PD image for each participant (Elastix registration software [19]). Then GM maps were transformed to ASL image space to enable partial volume (PV) correction. PV effects were corrected in PWI and PD images using local linear regression within a 3D kernel based on tissue maps [20]. The PV-corrected ASL images were quantified as CBF maps using the single-compartment model [16] as implemented by the scanner manufacturer. Finally CBF maps were transformed to T1w image space for further analysis.Fig. 1

Bottom Line: Gray matter (GM) volume and cerebral blood flow (CBF), corrected for partial volume effects, were quantified in the entire supratentorial cortex and in 10 GM regions.ASL-MRI contributes to early diagnosis of and differentiation between presenile AD and FTD.ASL-MRI facilitates differentiation of early Alzheimer's disease and frontotemporal dementia.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Erasmus MC - University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.

ABSTRACT

Objective: To investigate arterial spin labeling (ASL)-MRI for the early diagnosis of and differentiation between the two most common types of presenile dementia: Alzheimer's disease (AD) and frontotemporal dementia (FTD), and for distinguishing age-related from pathological perfusion changes.

Methods: Thirteen AD and 19 FTD patients, and 25 age-matched older and 22 younger controls underwent 3D pseudo-continuous ASL-MRI at 3 T. Gray matter (GM) volume and cerebral blood flow (CBF), corrected for partial volume effects, were quantified in the entire supratentorial cortex and in 10 GM regions. Sensitivity, specificity and diagnostic performance were evaluated in regions showing significant CBF differences between patient groups or between patients and older controls.

Results: AD compared with FTD patients had hypoperfusion in the posterior cingulate cortex, differentiating these with a diagnostic performance of 74 %. Compared to older controls, FTD patients showed hypoperfusion in the anterior cingulate cortex, whereas AD patients showed a more widespread regional hypoperfusion as well as atrophy. Regional atrophy was not different between AD and FTD. Diagnostic performance of ASL to differentiate AD or FTD from controls was good (78-85 %). Older controls showed global hypoperfusion compared to young controls.

Conclusion: ASL-MRI contributes to early diagnosis of and differentiation between presenile AD and FTD.

Key points: ASL-MRI facilitates differentiation of early Alzheimer's disease and frontotemporal dementia. Posterior cingulate perfusion is lower in Alzheimer's disease than frontotemporal dementia. Compared to controls, Alzheimer's disease patients show hypoperfusion in multiple regions. Compared to controls, frontotemporal dementia patients show focal anterior cingulate hypoperfusion. Global decreased perfusion in older adults differs from hypoperfusion in dementia.

Show MeSH
Related in: MedlinePlus