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Lien WC, Yeh CH, Chang CY, Chang CH, Wang WM, Chen CH, Lin YC. Convolutional Neural Networks to Classify Alzheimer’s Disease Severity Based on SPECT Images: A Comparative Study. J Clin Med 2023; 12:jcm12062218. [PMID: 36983226 PMCID: PMC10052955 DOI: 10.3390/jcm12062218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Image recognition and neuroimaging are increasingly being used to understand the progression of Alzheimer’s disease (AD). However, image data from single-photon emission computed tomography (SPECT) are limited. Medical image analysis requires large, labeled training datasets. Therefore, studies have focused on overcoming this problem. In this study, the detection performance of five convolutional neural network (CNN) models (MobileNet V2 and NASNetMobile (lightweight models); VGG16, Inception V3, and ResNet (heavier weight models)) on medical images was compared to establish a classification model for epidemiological research. Brain scan image data were collected from 99 subjects, and 4711 images were used. Demographic data were compared using the chi-squared test and one-way analysis of variance with Bonferroni’s post hoc test. Accuracy and loss functions were used to evaluate the performance of CNN models. The cognitive abilities screening instrument and mini mental state exam scores of subjects with a clinical dementia rating (CDR) of 2 were considerably lower than those of subjects with a CDR of 1 or 0.5. This study analyzed the classification performance of various CNN models for medical images and proved the effectiveness of transfer learning in identifying the mild cognitive impairment, mild AD, and moderate AD scoring based on SPECT images.
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Affiliation(s)
- Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Correspondence: (W.-C.L.); (Y.-C.L.)
| | - Chung-Hsing Yeh
- Faculty of Information Technology, Monash University, Victoria 3800, Australia
| | - Chun-Yang Chang
- Department of Industrial Design, National Cheng Kung University, Tainan 701, Taiwan
| | - Chien-Hsiang Chang
- Department of Industrial Design, National Cheng Kung University, Tainan 701, Taiwan
| | - Wei-Ming Wang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan 701, Taiwan
| | - Chien-Hsu Chen
- Department of Industrial Design, National Cheng Kung University, Tainan 701, Taiwan
| | - Yang-Cheng Lin
- Department of Industrial Design, National Cheng Kung University, Tainan 701, Taiwan
- Correspondence: (W.-C.L.); (Y.-C.L.)
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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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3
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Amen DG, Easton M. A New Way Forward: How Brain SPECT Imaging Can Improve Outcomes and Transform Mental Health Care Into Brain Health Care. Front Psychiatry 2021; 12:715315. [PMID: 34955905 PMCID: PMC8702964 DOI: 10.3389/fpsyt.2021.715315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
In the past three decades, brain single-photon-emission-computed-tomography (SPECT) imaging has garnered a significant, evidence-based foundation for a wide array of indications relevant to the field of clinical psychiatry, including dementia, traumatic brain injuries, seizures, cerebrovascular disease, complex neuropsychiatric presentations, and treatment-resistant disorders. In clinical psychiatric practice, however, SPECT remains underutilized. Only a small percentage of psychiatric clinicians use brain imaging technology. In this article, the authors provide a rationale for shifting the paradigm to one that includes broader use of SPECT in the clinical psychiatric setting, primarily for patients with complex conditions. This paper will outline seven specific clinical applications. Adding neuroimaging tools like SPECT to day-to-day clinical practice can help move psychiatry forward by transforming mental health care, which can be stigmatizing and often shunned by the general public, to brain health care, which the authors argue will be more likely to be embraced by a larger group of people in need.
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Affiliation(s)
| | - Michael Easton
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
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Takahashi M, Tada T, Nakamura T, Koyama K, Momose T. Efficacy and Limitations of rCBF-SPECT in the Diagnosis of Alzheimer's Disease With Amyloid-PET. Am J Alzheimers Dis Other Demen 2019; 34:314-321. [PMID: 30966759 PMCID: PMC6610554 DOI: 10.1177/1533317519841192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study aimed to assess efficacy and limitations of regional cerebral blood flow
imaging using single-photon emission computed tomography (rCBF-SPECT) in the diagnosis of
Alzheimer’s disease (AD) with amyloid-positron emission tomography (amyloid-PET). Thirteen
patients, who underwent both rCBF-SPECT and amyloid-PET after clinical diagnosis of AD or
mild cognitive impairment, were retrospectively identified. The rCBF-SPECTs were
classified into 4 grades, from typical AD pattern to no AD pattern of hypoperfusion;
amyloid-beta (Aβ) positivity was assessed by amyloid-PET. Four patients were categorized
into a typical AD pattern on rCBF-SPECT, and all were Aβ+. The other 9 patients did not
exhibit a typical AD pattern; however, 4 were Aβ+. The Mini-Mental State Examination score
and Clinical Dementia Rating scale were not significantly different between Aβ+ and Aβ–
patients. A typical AD pattern on rCBF-SPECT can reflect Aβ+; however, if not, rCBF-SPECT
has a limitation to predict amyloid pathology.
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Affiliation(s)
- Miwako Takahashi
- 1 Division of Nuclear Medicine, Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | - Keitaro Koyama
- 1 Division of Nuclear Medicine, Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimitsu Momose
- 1 Division of Nuclear Medicine, Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Amen DG, Krishnamani P, Meysami S, Newberg A, Raji CA. Classification of Depression, Cognitive Disorders, and Co-Morbid Depression and Cognitive Disorders with Perfusion SPECT Neuroimaging. J Alzheimers Dis 2018; 57:253-266. [PMID: 28211813 DOI: 10.3233/jad-161232] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Depression and cognitive disorders (CDs) are two common co-morbid afflictions that commonly present with overlapping symptoms. OBJECTIVE To evaluate if perfusion neuroimaging with brain SPECT can distinguish persons with depression from those with CDs or both conditions. METHODS Inclusion criteria were DSM-IV defined depression or CDs (Alzheimer's disease, vascular dementia, dementia not otherwise specified, and amnestic disorders not otherwise specified) including persons with both (total n = 4,541; 847 CDs, 3,269 depression, 425 with both). Perfusion differences between the groups were calculated using two-sampled t-tests corrected for multiple comparisons. Diagnostic separation was determined with discriminant analysis. Feature selection revealed predictive regions in delineating depression from CDs and comorbid cases. RESULTS Persons with CDs had lower cerebral perfusion compared to depression. In co-morbid persons, cerebral hypoperfusion was additive, with regions showing lower regional cerebral blood flow compared to either diagnosis alone. Both baseline and concentration SPECT regions yielded correct classification of 86% and leave one out cross-validation of 83%. AUC analysis for SPECT regions showed 86% accuracy, 80% sensitivity and 75% specificity. Discriminant analysis separated depression and CDs from comorbid cases with correct classification of 90.8% and cross validated accuracy of 88.6%. Area under the curve was 83% with sensitivity of 80% and specificity of 70%. Feature selection identified the most predictive regions in left hippocampus, right insula, cerebellar, and frontal lobe regions. CONCLUSION Quantitative perfusion SPECT neuroimaging distinguishes depression from dementia and those with both co-morbidities. Perfusion brain SPECT can be utilized clinically to delineate between these two disorders.
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Affiliation(s)
| | | | | | - Andrew Newberg
- Thomas Jefferson University School of Medicine, Philadelphia, PA, USA
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Kaneta T, Katsuse O, Hirano T, Ogawa M, Yoshida K, Odawara T, Hirayasu Y, Inoue T. Head-to-Head Visual Comparison between Brain Perfusion SPECT and Arterial Spin-Labeling MRI with Different Postlabeling Delays in Alzheimer Disease. AJNR Am J Neuroradiol 2017; 38:1562-1568. [PMID: 28572147 DOI: 10.3174/ajnr.a5238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/24/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling MR imaging has been recently developed as a noninvasive technique with magnetically labeled arterial blood water as an endogenous contrast medium for the evaluation of CBF. Our aim was to compare arterial spin-labeling MR imaging and SPECT in the visual assessment of CBF in patients with Alzheimer disease. MATERIALS AND METHODS In 33 patients with Alzheimer disease or mild cognitive impairment due to Alzheimer disease, CBF images were obtained by using both arterial spin-labeling-MR imaging with a postlabeling delay of 1.5 seconds and 2.5 seconds (PLD1.5 and PLD2.5, respectively) and brain perfusion SPECT. Twenty-two brain regions were visually assessed, and the diagnostic confidence of Alzheimer disease was recorded. RESULTS Among all arterial spin-labeling images, 84.9% of PLD1.5 and 9% of PLD2.5 images showed the typical pattern of advanced Alzheimer disease (ie, decreased CBF in the bilateral parietal, temporal, and frontal lobes). PLD1.5, PLD2.5, and SPECT imaging resulted in obviously different visual assessments. PLD1.5 showed a broad decrease in CBF, which could have been due to an early perfusion. In contrast, PLD2.5 did not appear to be influenced by an early perfusion but showed fewer pathologic findings than SPECT. CONCLUSIONS The distinctions observed by us should be carefully considered in the visual assessments of Alzheimer disease. Further studies are required to define the patterns of change in arterial spin-labeling-MR imaging associated with Alzheimer disease.
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Affiliation(s)
- T Kaneta
- From the Departments of Radiology (T.K., T.H., M.O., K.Y., T.I.)
| | - O Katsuse
- Psychiatry (O.K., T.O., Y.H.), Yokohama City University, Yokohama, Japan
| | - T Hirano
- From the Departments of Radiology (T.K., T.H., M.O., K.Y., T.I.)
| | - M Ogawa
- From the Departments of Radiology (T.K., T.H., M.O., K.Y., T.I.)
| | - K Yoshida
- From the Departments of Radiology (T.K., T.H., M.O., K.Y., T.I.)
| | - T Odawara
- Psychiatry (O.K., T.O., Y.H.), Yokohama City University, Yokohama, Japan
| | - Y Hirayasu
- Psychiatry (O.K., T.O., Y.H.), Yokohama City University, Yokohama, Japan
| | - T Inoue
- From the Departments of Radiology (T.K., T.H., M.O., K.Y., T.I.)
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Kaneta T, Katsuse O, Hirano T, Ogawa M, Shihikura-Hino A, Yoshida K, Odawara T, Hirayasu Y, Inoue T. Voxel-wise correlations between cognition and cerebral blood flow using arterial spin-labeled perfusion MRI in patients with Alzheimer's disease: a cross-sectional study. BMC Neurol 2017; 17:91. [PMID: 28506213 PMCID: PMC5433075 DOI: 10.1186/s12883-017-0870-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/04/2017] [Indexed: 11/18/2022] Open
Abstract
Background To analyze voxel-wise correlation between cerebral blood flow (CBF) measured using ASL-MRI and cognition in patients with Alzheimer’s disease (AD). Methods Forty-one patients diagnosed with AD or mild cognitive impairment due to AD were recruited for this study. CBF images were obtained using ASL-MRI (n = 41) with a post-labeling delay (PLD) of 1.5 and 2.5 s (PLD1.5 and PLD2.5, respectively) using a 3 T scanner, in addition to brain perfusion SPECT with N-isopropyl-4-[I-123]iodoamphetamine (n = 28). Voxel-based analyses were performed for ASL-MRI and SPECT using Mini-Mental State Examination (MMSE) scores as covariates. Differences in CBF between PLD1.5 and PLD2.5 were assessed using a paired t-test with SPM12. Results Significant positive correlations were observed between MMSE scores and CBF at PLD1.5 in the right posterior cingulate cortex (PCC), and both temporo-parietal association cortexes. At PLD2.5, significant positive correlations were determined for MMSE scores and CBF in the superior parietal lobule and the right temporo-parietal association cortex. SPECT showed significant positive correlations in the PCC and both temporo-parietal association cortexes (right-side dominant). PLD1.5 showed significantly higher CBF than PLD2.5 in the proximal areas of vascular territories of the anterior, middle, and posterior cerebral arteries. Conclusions Significant positive correlations in CBF, measured with both ASL-MRI and SPECT, with cognition were found in the PCC and temporo-parietal association cortexes. PLD1.5 and PLD2.5 showed similar correlations with cognition, although the CBF images had significant differences.
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Affiliation(s)
- Tomohiro Kaneta
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Omi Katsuse
- Department of Psychiatry, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takamasa Hirano
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Matsuyoshi Ogawa
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ayako Shihikura-Hino
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Keisuke Yoshida
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Toshinari Odawara
- Department of Psychiatry, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomio Inoue
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Improved Diagnostic Accuracy of SPECT Through Statistical Analysis and the Detection of Hot Spots at the Primary Sensorimotor Area for the Diagnosis of Alzheimer Disease in a Community-Based Study: "The Osaki-Tajiri Project". Clin Nucl Med 2015; 41:e1-6. [PMID: 26359573 DOI: 10.1097/rlu.0000000000000976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE SPECT is an important diagnostic tool for dementia. Recently, statistical analysis of SPECT has been commonly used for dementia research. In this study, we evaluated the accuracy of visual SPECT evaluation and/or statistical analysis for the diagnosis (Dx) of Alzheimer disease (AD) and other forms of dementia in our community-based study "The Osaki-Tajiri Project." PATIENTS AND METHODS Eighty-nine consecutive outpatients with dementia were enrolled and underwent brain perfusion SPECT with 99mTc-ECD. Diagnostic accuracy of SPECT was tested using 3 methods: visual inspection (SPECT Dx), automated diagnostic tool using statistical analysis with easy Z-score imaging system (eZIS Dx), and visual inspection plus eZIS (integrated Dx). RESULTS Integrated Dx showed the highest sensitivity, specificity, and accuracy, whereas eZIS was the second most accurate method. We also observed that a higher than expected rate of SPECT images indicated false-negative cases of AD. Among these, 50% showed hypofrontality and were diagnosed as frontotemporal lobar degeneration. These cases typically showed regional "hot spots" in the primary sensorimotor cortex (ie, a sensorimotor hot spot sign), which we determined were associated with AD rather than frontotemporal lobar degeneration. CONCLUSION We concluded that the diagnostic abilities were improved by the integrated use of visual assessment and statistical analysis. In addition, the detection of a sensorimotor hot spot sign was useful to detect AD when hypofrontality is present and improved the ability to properly diagnose AD.
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Swan A, Waddell B, Holloway G, Bak T, Colville S, Khan Z, Pal S. The diagnostic utility of 99mTc-HMPAO SPECT imaging: a retrospective case series from a tertiary referral early-onset cognitive disorders clinic. Dement Geriatr Cogn Disord 2015; 39:186-93. [PMID: 25572595 DOI: 10.1159/000369551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Patients with early-onset dementia (EOD) often present atypically, making an accurate diagnosis difficult. Single-photon emission-computed tomography (SPECT) provides an indirect measure of cerebral metabolic activity and can help to differentiate between dementia subtypes. This study aims to investigate the clinical utility of SPECT imaging in the diagnosis of early-onset Alzheimer's disease. METHODS All patients attending a tertiary referral clinic specialising in EOD between April 2012 and October 2013 were included in the study. Statistical analysis of SPECT patterns with clinical diagnoses, Addenbrooke's Cognitive Examination version 3 scores, and magnetic resonance imaging (MRI) atrophy was undertaken. RESULTS The results demonstrated a highly significant association between SPECT hypoperfusion patterns and clinical diagnoses. SPECT changes were demonstrated more frequently than MRI atrophy. CONCLUSIONS The results suggest that SPECT imaging may be a useful adjunct to clinical evaluation and a more sensitive biomarker than standard structural imaging.
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Affiliation(s)
- Amanda Swan
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Davison CM, O'Brien JT. A comparison of FDG-PET and blood flow SPECT in the diagnosis of neurodegenerative dementias: a systematic review. Int J Geriatr Psychiatry 2014; 29:551-61. [PMID: 24123413 DOI: 10.1002/gps.4036] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Perfusion single photon emission computed tomography (SPECT) and 18F fluorodeoxyglucose positron emission tomography (FDG-PET) both have clinical utility for the differential diagnosis of dementia. Although PET is often viewed by some as more accurate and therefore preferential, the extent to which published evidence supports this is not clear. The aim of this review was to address the question by reviewing studies of SPECT and PET imaging in dementia diagnosis, with a particular focus on all published head-to-head studies. DESIGN A MEDLINE search was carried out using the following keywords: "PET" and "SPECT" and "dementia" or "Mild Cognitive Impairment," together with "alzheimers" or "DLB" or "lewy body" or "frontotemporal" or "FTD" or "Picks." Articles were included up to February 2013, limited to human studies and in English language. RESULTS Published studies of SPECT accuracy show that it is a useful tool for differential diagnosis, with sensitivities of 65-85% for diagnosing Alzheimer's disease (AD) and specificities (for other neurodegenerative dementias) of 72-87%. PET studies generally report higher accuracy, with sensitivities of 75-99% for AD and specificities of 71-93%. However, there have been few direct head-to-head comparisons, with some indicating SPECT and PET to be equally useful in dementia diagnosis and others favouring PET. Many of these studies are limited with respect to numbers and methodically with poorly matched control groups. CONCLUSIONS Overall, although studies suggest superiority of PET over SPECT, the evidence base for this is actually quite limited. We suggest that further direct comparative studies, including health economic and patient preference evaluations, are needed to help direct future service provision.
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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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12
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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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Brain imaging in the study of Alzheimer's disease. Neuroimage 2011; 61:505-16. [PMID: 22173295 DOI: 10.1016/j.neuroimage.2011.11.075] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 11/17/2011] [Accepted: 11/25/2011] [Indexed: 12/14/2022] Open
Abstract
Over the last 20 years, there has been extraordinary progress in brain imaging research and its application to the study of Alzheimer's disease (AD). Brain imaging researchers have contributed to the scientific understanding, early detection and tracking of AD. They have set the stage for imaging techniques to play growing roles in the clinical setting, the evaluation of disease-modifying treatments, and the identification of demonstrably effective prevention therapies. They have developed ground-breaking methods, including positron emission tomography (PET) ligands to measure fibrillar amyloid-β (Aβ) deposition, new magnetic resonance imaging (MRI) pulse sequences, and powerful image analysis techniques, to help in these endeavors. Additional work is needed to develop even more powerful imaging methods, to further clarify the relationship and time course of Aβ and other disease processes in the predisposition to AD, to establish the role of brain imaging methods in the clinical setting, and to provide the scientific means and regulatory approval pathway needed to evaluate the range of promising disease-modifying and prevention therapies as quickly as possible. Twenty years from now, AD may not yet be a distant memory, but the best is yet to come.
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Amen DG, Trujillo M, Newberg A, Willeumier K, Tarzwell R, Wu JC, Chaitin B. Brain SPECT Imaging in Complex Psychiatric Cases: An Evidence-Based, Underutilized Tool. Open Neuroimag J 2011; 5:40-8. [PMID: 21863144 PMCID: PMC3149839 DOI: 10.2174/1874440001105010040] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/28/2011] [Accepted: 04/01/2011] [Indexed: 11/22/2022] Open
Abstract
Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice. Unfortunately, SPECT in clinical practice is utilized by only a handful of clinicians. This article presents a rationale for a more widespread use of SPECT in clinical practice for complex cases, and includes seven clinical applications where it may help optimize patient care.
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Mossello E, Ballini E, Mello AM, Tarantini F, Simoni D, Baldasseroni S, Marchionni N. Biomarkers of Alzheimer's disease: from central nervous system to periphery? Int J Alzheimers Dis 2010; 2011:342980. [PMID: 21197431 PMCID: PMC3010633 DOI: 10.4061/2011/342980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 11/15/2010] [Indexed: 11/20/2022] Open
Abstract
Alzheimer's Disease (AD) is the most frequent form of dementia and represents one of the main causes of disability among older subjects. Up to now, the diagnosis of AD has been made according to clinical criteria. However, the use of such criteria does not allow an early diagnosis, as pathological alterations may be apparent many years before the clear-cut clinical picture. An early diagnosis is even more valuable to develop new treatments, potentially interfering with the pathogenetic process. During the last decade, several neuroimaging and cerebrospinal fluid (CSF) parameters have been introduced to allow an early and accurate detection of AD patients, and, recently, they have been included among research criteria for AD diagnosis. However, their use in clinical practice suffers from limitations both in accuracy and availability. The increasing amount of knowledge about peripheral biomarkers will possibly allow the future identification of reliable and easily available diagnostic tests.
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Affiliation(s)
- Enrico Mossello
- Unit of Gerontology and Geriatric Medicine, Department of Critical Care Medcine and Surgery, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Weih M, Degirmenci U, Kreil S, Lewczuk P, Schmidt D, Kornhuber J, Kuwert T. Perfusion Imaging with SPECT in the Era of Pathophysiology-Based Biomarkers for Alzheimer's Disease. Int J Alzheimers Dis 2010; 2010:109618. [PMID: 21197480 PMCID: PMC3010620 DOI: 10.4061/2010/109618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 11/15/2010] [Indexed: 11/20/2022] Open
Abstract
SPECT allows registration of regional cerebral blood flow (rCBF) which is altered in a characteristic temporoparietal pattern in Alzheimer's Dementia. Numerous studies have shown the diagnostic value of reduced cerebral blood flow and metabolic changes using perfusion SPECT and FDG-PEPT in AD diagnosis as well as in differential diagnosis against frontotemporal dementia, dementia with Lewy bodies and vascular disease. Recently more pathophysiology-based biomarkers in CSF and Amyloid-PET tracers have been developed that probably have a higher diagnostic accuracy than the more indirect rCBF changes seen in perfusion SPECT. In the paper review, we describe recent advances in AD biomarkers as well as improvements in the SPECT technique.
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Affiliation(s)
- Markus Weih
- Department for Psychiatry and Psychiatry, University of Erlangen-Nuermberg, Schwabachanlage 6, 91054 Erlangen, Germany
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TC-99m HMPAO Brain Blood Flow Imaging in the Dementias with Histopathologic Correlation in 73 Patients. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2010; 2011:409101. [PMID: 21490729 PMCID: PMC3065903 DOI: 10.1155/2011/409101] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 10/12/2010] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to determine the value of Tc-99m HMPAO SPECT in the diagnosis of the dementias. Tc-99m HMPAO was used with a 3-camera scanner to produce 5 sets of sectional images of the brain. Images were further processed using Statistical Parametric Mapping. Diagnosis was made by a physician blinded to the clinical diagnosis. Results in 73 subjects were compared with a neuropathologic study of the brain at autopsy. Data were analyzed for sensitivity, specificity, positive and negative predictive values and accuracy. These results are compared with several other studies performed with Tc-99m HMPAO SPECT with histopathologic correlation. This procedure is widely available and relatively inexpensive and may be of value in patients with dementias and problematic diagnoses. Further, a degree of differential diagnosis between Alzheimer's and Frontotemporal diseases may be effected. The study was approved by our Institutional Review Board.
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Rusina R, Kukal J, Belícek T, Buncová M, Matej R. Use of fuzzy edge single-photon emission computed tomography analysis in definite Alzheimer's disease--a retrospective study. BMC Med Imaging 2010; 10:20. [PMID: 20809946 PMCID: PMC2939533 DOI: 10.1186/1471-2342-10-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 09/01/2010] [Indexed: 12/13/2022] Open
Abstract
Background Definite Alzheimer's disease (AD) requires neuropathological confirmation. Single-photon emission computed tomography (SPECT) may enhance diagnostic accuracy, but due to restricted sensitivity and specificity, the role of SPECT is largely limited with regard to this purpose. Methods We propose a new method of SPECT data analysis. The method is based on a combination of parietal lobe selection (as regions-of-interest (ROI)), 3D fuzzy edge detection, and 3D watershed transformation. We applied the algorithm to three-dimensional SPECT images of human brains and compared the number of watershed regions inside the ROI between AD patients and controls. The Student's two-sample t-test was used for testing domain number equity in both groups. Results AD patients had a significantly reduced number of watershed regions compared to controls (p < 0.01). A sensitivity of 94.1% and specificity of 80% was obtained with a threshold value of 57.11 for the watershed domain number. The narrowing of the SPECT analysis to parietal regions leads to a substantial increase in both sensitivity and specificity. Conclusions Our non-invasive, relatively low-cost, and easy method can contribute to a more precise diagnosis of AD.
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Affiliation(s)
- Robert Rusina
- Department of Neurology, Thomayer Teaching Hospital and Institute for Postgraduate Education in Medicine, Prague, Czech Republic.
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Raji CA, Lee C, Lopez OL, Tsay J, Boardman JF, Schwartz ED, Bartynski WS, Hefzy HM, Gach HM, Dai W, Becker JT. Initial experience in using continuous arterial spin-labeled MR imaging for early detection of Alzheimer disease. AJNR Am J Neuroradiol 2010; 31:847-55. [PMID: 20075093 DOI: 10.3174/ajnr.a1955] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging of the brain has significant potential in the early detection of neurodegenerative disorders such as AD. The purpose of this work was to determine if perfusion MR imaging can be used to separate AD from normal cognition in individual subjects. We investigated the diagnostic utility of perfusion MR imaging for early detection of AD compared with structural imaging. MATERIALS AND METHODS Data were analyzed from 32 participants in the institutional review board-approved CHS-CS: 19 cognitively healthy individuals and 13 with clinically adjudicated AD. All subjects underwent structural T1-weighted SGPR and CASL MR imaging. Four readers with varying experience separately rated each CASL and SPGR scan finding as normal or abnormal on the basis of standardized qualitative diagnostic criteria for observed perfusion abnormalities on CASL or volume loss on SPGR and rated the confidence in their evaluation. RESULTS Inter-rater reliability was superior in CASL (kappa = 0.7 in experienced readers) compared with SPGR (kappa = 0.17). CASL MR imaging had the highest sensitivity (85%) and accuracy (70%). Frontal lobe CASL findings increased sensitivity to 88% and accuracy to 79%. Fifty-seven percent of false-positive readings with CASL were in controls with cognitive decline or instability within 5 years. Three of the 4 readers revealed a statistically significant relationship between confidence and correct classification when using CASL. CONCLUSIONS Readers were able to separate individuals with mild AD from those with normal cognition with high sensitivity by using CASL but not volumetric MR imaging. This initial experience suggests that CASL MR imaging may be a useful technique for detecting AD.
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Affiliation(s)
- C A Raji
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213-2582, USA.
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Mueller SG, Weiner MW, Thal LJ, Petersen RC, Jack CR, Jagust W, Trojanowski JQ, Toga AW, Beckett L. Ways toward an early diagnosis in Alzheimer's disease: the Alzheimer's Disease Neuroimaging Initiative (ADNI). Alzheimers Dement 2009; 1:55-66. [PMID: 17476317 PMCID: PMC1864941 DOI: 10.1016/j.jalz.2005.06.003] [Citation(s) in RCA: 678] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
With the increasing life expectancy in developed countries, the incidence of Alzheimer's disease (AD) and thus its socioeconomic impact are growing. Increasing knowledge over the last years about the pathomechanisms involved in AD allow for the development of specific treatment strategies aimed at slowing down or even preventing neuronal death in AD. However, this requires also that (1) AD can be diagnosed with high accuracy, because non-AD dementias would not benefit from an AD-specific treatment; (2) AD can be diagnosed in very early stages when any intervention would be most effective; and (3) treatment efficacy can be reliably and meaningfully monitored. Although there currently is no ideal biomarker that would fulfill all these requirements, there is increasing evidence that a combination of currently existing neuroimaging and cerebrospinal fluid (CSF) and blood biomarkers can provide important complementary information and thus contribute to a more accurate and earlier diagnosis of AD. The Alzheimer's Disease Neuroimaging Initiative (ADNI) is exploring which combinations of these biomarkers are the most powerful for diagnosis of AD and monitoring of treatment effects.
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Affiliation(s)
- Susanne G. Mueller
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, USA
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, USA
- Department of Neurology, Psychiatry and Medicine, University of California, San Francisco, USA
- * Corresponding author. Tel.: 415-221-4810 ext 3642; Fax: 415-668-2864. E-mail address: (M. Weiner)
| | - Leon J. Thal
- Department of Neuroscience, University of California, San Diego, USA
| | - Ronald C. Petersen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Clifford R. Jack
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - William Jagust
- School of Public Health and Helen Wills Neuroscience Institute, University of California, Berkeley, USA
| | | | - Arthur W. Toga
- Department of Neurology, University of California, Los Angeles, USA
| | - Laurel Beckett
- Department of Public Health Science, University of California, Davis, USA
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Cuellar H, Gómez-Ramos P, Riascos R, De Alba L. Neuroimaging Studies in Alzheimer's Disease. Neuroradiol J 2009; 22:525-33. [DOI: 10.1177/197140090902200503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 10/07/2009] [Indexed: 11/16/2022] Open
Abstract
Alzheimer's Disease (AD) is a progressive neurodegenerative disease associated with memory loss and gradual behavioral, functional and cognitive impairment. Conventional imaging studies, such as magnetic resonance or computed tomography have played a secondary role in AD diagnosis: While other causes of memory loss and cognitive deficit can be evaluated by these imaging methods, AD structural changes are not detected until very late in the course of the disease. Recent and more precise techniques have been developed to detect subtle changes not visualized with those imaging methods. This article presents a review of the neuroimaging techniques used as a diagnostic aid for AD.
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Affiliation(s)
- H. Cuellar
- Department of Radiology, “José E. González” University Hospital, Universidad Autónoma de Nuevo León; Monterrey, México
| | - P. Gómez-Ramos
- Department of Anatomy, Histology and Neurosciences, Faculty of Medicine, Universidad Autónoma de Madrid; Madrid, Spain
| | - R. Riascos
- Department of Radiology, The University of Texas Medical Branch; Galveston, TX, USA
| | - L. De Alba
- Department of Radiology, “José E. González” University Hospital, Universidad Autónoma de Nuevo León; Monterrey, México
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Pagani M, Salmaso D, Rodriguez G, Nardo D, Nobili F. Principal component analysis in mild and moderate Alzheimer's disease--a novel approach to clinical diagnosis. Psychiatry Res 2009; 173:8-14. [PMID: 19443186 DOI: 10.1016/j.pscychresns.2008.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 07/11/2008] [Accepted: 07/11/2008] [Indexed: 11/30/2022]
Abstract
Principal component analysis (PCA) provides a method to explore functional brain connectivity. The aim of this study was to identify regional cerebral blood flow (rCBF) distribution differences between Alzheimer's disease (AD) patients and controls (CTR) by means of volume of interest (VOI) analysis and PCA. Thirty-seven CTR, 30 mild AD (mildAD) and 27 moderate AD (modAD) subjects were investigated using single photon emission computed tomography with (99m)Tc-hexamethylpropylene amine oxime. Analysis of covariance (ANCOVA), PCA, and discriminant analysis (DA) were performed on 54 VOIs. VOI analysis identified in both mildAD and modAD subjects a decreased rCBF in six regions. PCA in mildAD subjects identified four principal components (PCs) in which the correlated VOIs showed a decreased level of rCBF, including regions that are typically affected early in the disease. In five PCs, including parietal-temporal-limbic cortex, and hippocampus, a significantly lower rCBF in correlated VOIs was found in modAD subjects. DA significantly discriminated the groups. The percentage of subjects correctly classified was 95, 70, and 81 for CTR, mildAD and modAD groups, respectively. PCA highlighted, in mildAD and modAD, relationships not evident when brain regions are considered as independent of each other, and it was effective in discriminating groups. These findings may allow neurophysiological inferences to be drawn regarding brain functional connectivity in AD that might not be possible with univariate analysis.
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Affiliation(s)
- Marco Pagani
- Institute of Cognitive Sciences and Technologies, CNR, Rome & Padua, Italy.
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Borrie M. Functional neuroimaging in the diagnosis of dementia. Alzheimers Dement 2007; 3:336-40. [PMID: 19595955 DOI: 10.1016/j.jalz.2007.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 07/12/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Michael Borrie
- Division of Geriatric Medicine, St. Joseph's Health Care London-Parkwood Site, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
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25
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McNeill R, Sare GM, Manoharan M, Testa HJ, Mann DMA, Neary D, Snowden JS, Varma AR. Accuracy of single-photon emission computed tomography in differentiating frontotemporal dementia from Alzheimer's disease. J Neurol Neurosurg Psychiatry 2007; 78:350-5. [PMID: 17158559 PMCID: PMC2077783 DOI: 10.1136/jnnp.2006.106054] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 11/06/2006] [Accepted: 11/22/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the commonest causes of presenile dementia. In the absence of a biological marker, diagnosis is reliant on clinical evaluation. Confirmation is often sought from neuroimaging, including single-photon emission computed tomography (SPECT). Most previous SPECT studies lack pathological validation. AIM To examine the accuracy of SPECT in differentiating FTD from AD in patients with subsequent pathological confirmation. METHODS Technetium-99-labelled hexamethyl propylene amine oxime SPECT images obtained at initial evaluation in 25 pathologically confirmed cases of FTD were examined. These images were visually rated by an experienced blinded nuclear medicine consultant and compared with those of 31 patients with AD, also with pathological validation. RESULTS A reduction in frontal cerebral blood flow (CBF) was more common in FTD and was of diagnostic value (sensitivity 0.8, specificity 0.65 and likelihood ratio (LR) 2.25; 95% CI 1.35 to 3.77). A pattern of bilateral frontal CBF reduction without the presence of associated bilateral parietal CBF change is diagnostically more accurate (sensitivity 0.80, specificity 0.81 and +LR 4.13, 95% CI 1.96 to 8.71). Diagnostic categorisation (FTD or AD) on the basis of SPECT alone was less accurate than clinical diagnosis (based on neurology and detailed neuropsychological evaluation). One patient with FTD was initially clinically misdiagnosed as AD, owing to the lack of availability of full neuropsychological assessment. However, SPECT correctly diagnosed this patient, providing a diagnostic gain of 4%. CONCLUSION Technetium-99-labelled hexamethyl propylene amine oxime SPECT CBF patterns provide valuable information in the diagnosis of FTD and AD. These data can be better used as an adjunct to clinical diagnosis if pathology is to be correctly predicted in life.
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Affiliation(s)
- R McNeill
- Department of Neurology, Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford, Manchester, UK
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26
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Weaver JD, Espinoza R, Weintraub NT. The Utility of PET Brain Imaging in the Initial Evaluation of Dementia. J Am Med Dir Assoc 2007; 8:150-7. [PMID: 17349943 DOI: 10.1016/j.jamda.2006.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 10/25/2006] [Accepted: 10/28/2006] [Indexed: 02/06/2023]
Abstract
Given the challenges and benefits of timely and accurate diagnosis of neurodegenerative disorders and the importance of appropriate subsequent treatments, physicians and patients alike desire tools that aid in diagnosing dementia as early and as precisely as possible. One of these tools may be functional brain imaging, specifically positron emission tomography (PET). Recent technological advancements, ongoing research studies, and approval for reimbursement by various insurance companies and Medicare, under certain circumstances, have led to an increased interest in the use of this tool in the evaluation of dementia. This article will review PET brain imaging in the initial assessment and diagnosis of dementia, including its place in current guidelines and role in diagnostic algorithms, its applicability in differentiating among various dementia syndromes and major psychiatric disorders, and some of the controversies surrounding its utility in general clinical practice.
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Affiliation(s)
- Jonathan D Weaver
- Multicampus Fellowship Program in Geriatric Medicine, Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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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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Bonte FJ, Harris TS, Hynan LS, Bigio EH, White CL. Tc-99m HMPAO SPECT in the differential diagnosis of the dementias with histopathologic confirmation. Clin Nucl Med 2007; 31:376-8. [PMID: 16785801 DOI: 10.1097/01.rlu.0000222736.81365.63] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study is to determine the value of Tc-99m HMPAO SPECT in the diagnosis of the dementias, with particular reference to Alzheimer disease. MATERIALS AND METHODS Tc-99m HMPAO was used with a 3-camera scanner to produce 5 sets of sectional images of the brain. Diagnosis was made by a physician blinded to the clinical diagnosis. Results in 49 subjects were ultimately compared with neuropathologic study of the brain at autopsy. RESULTS Sensitivity = 86.7% (68.4-95.6%, 95% confidence interval [CI]), specificity = 89.5% (65.5-98.2% CI), positive predictive value = 92.9% (75.0-98.8% CI), negative predictive value = 81% (57.4-93.7% CI), accuracy = 87.8% (74.5-94.9% CI), likelihood ratio = 8.23% (7.09-9.57% CI). CONCLUSIONS Comparison is made with several other SPECT and PET series with histopathologic correlation. Brain blood flow SPECT is useful in the diagnosis and differential diagnosis of the dementias.
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Affiliation(s)
- Frederick J Bonte
- Nuclear Medicine Center, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9061, USA.
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Shidahara M, Inoue K, Maruyama M, Watabe H, Taki Y, Goto R, Okada K, Kinomura S, Osawa S, Onishi Y, Ito H, Arai H, Fukuda H. Predicting human performance by channelized Hotelling observer in discriminating between Alzheimer’s dementia and controls using statistically processed brain perfusion SPECT. Ann Nucl Med 2006; 20:605-13. [PMID: 17294671 DOI: 10.1007/bf02984658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We compared the diagnostic accuracy achieved by a human observer (nuclear medicine physician) and a channelized Hotelling (CH) observer on the basis of receiver-operating characteristics (ROC) curve for the differential diagnosis of Alzheimer's disease (AD) from SPECT images. METHODS The I-123-IMP brain perfusion SPECT images of 42 subjects (21 AD patients and 21 healthy controls) were used for an interpretation study and those of 10 healthy subjects were for a normal database. SPECT images were processed into four types: original SPECT images, three-dimensional stereotactic surface projection (3DSSP) images derived from them, Z-scores of SPECT images, and Z-scores of 3DSSP images. Five nuclear medicine physicians evaluated the test dataset sequentially as to whether the presented images were those of AD patients, which were rated using five categories of certainty: definitely, possibly, equivocally, possibly not, and definitely not. The test statistics (lambda) of the dataset generated by the CH observer were rated for ROC analysis. The areas under the ROC curves (Az) for the four image types interpreted by the human and CH observers were estimated and compared. RESULTS Among the four image types, the best performance based on Az obtained by both the CH and human observers was observed for the Z-score of 3DSSP images, and the lowest was for the original SPECT images. CONCLUSIONS The performance of the CH observer was similar to that of the human observers, and both were dependent on the image type. This indicates that the CH observer may predict human performance in discriminating Alzheimer's dementia and can be useful for comparing and optimizing image processing methods of brain perfusion SPECT without human observers.
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Affiliation(s)
- Miho Shidahara
- Department of Radiology and Nuclear Medicine, Institute of Development, Aging and Cancer, Tohoku University, Seiryou-machi 4-1, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
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Albayrak R, Yaman M, Uslan I, Degirmenci B, Acar M, Haktanir A. Evaluation of total cerebral blood flow volume in cerebral atrophy. Neurosci Lett 2006; 399:124-8. [PMID: 16497438 DOI: 10.1016/j.neulet.2006.01.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 01/10/2006] [Accepted: 01/22/2006] [Indexed: 11/26/2022]
Abstract
The goal of our study is to determine total cerebral blood flow volume (tCBFV) via extracranial Doppler ultrasound and to investigate its value in the differential diagnosis of dementia. Twenty-eight outpatients with cerebral atrophy confirmed by cranial computed tomography were enrolled into the study. Nine patients with Alzheimer's disease (AD) and nine patients with vascular dementia (VaD) based on neuropsychologic test and imaging findings, as well as 10 neurologically normal elderly subjects underwent Doppler sonographic examination of extracranial internal carotid artery (ICA) and vertebral artery (VA). Angle corrected time averaged flow velocity and cross-sectional areas of vessels have been measured. Flow volumes and tCBFV have been calculated. The measures of tCBFV, anterior CBFV (aCBFV), right CBFV (rCBFV) and right ICA flow volume were significantly lower in patients with dementia. The amounts of tCBFV, aCBFV, rCBFV and right ICA flow volume have been found to be low in AD and VaD patients compared with normal elderly group. Of all parameters measured for AD and VaD, no significant difference was found except Mini-Mental State Examination (MMSE) scores. To the best of our knowledge, this is the first reporting the CBF measurements using Doppler ultrasound of extracranial ICA and VA in the differential diagnosis of dementia in cerebral atrophy. The tCBFV, aCBFV, rCBFV and right ICA flow volumes and MMSE scores are significant in the diagnosis of dementia, whereas only MMSE scores are significant in the differential diagnosis of AD and VaD.
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Masdeu JC, Zubieta JL, Arbizu J. Neuroimaging as a marker of the onset and progression of Alzheimer's disease. J Neurol Sci 2005; 236:55-64. [PMID: 15961110 DOI: 10.1016/j.jns.2005.05.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Revised: 05/02/2005] [Accepted: 05/03/2005] [Indexed: 11/25/2022]
Abstract
Several neuroimaging techniques are promising tools as early markers of brain pathology in Alzheimer's disease (AD). On structural MRI, atrophy of the entorhinal cortex is present already in mild cognitive impairment (MCI). In the autosomal dominant forms of AD, the rate of atrophy of medial temporal structures separates affected from control persons even 3 years before the clinical onset of cognitive impairment. The elevated annual rate of brain atrophy offers a surrogate tool for the evaluation of newer therapies using smaller samples, thereby saving time and resources. On functional MRI, activation paradigms activate a larger area of parieto-temporal association cortex in persons at higher risk for AD, whereas the entorhinal cortex activation is lesser in MCI. Similar findings have been detected with activation procedures and water (H(2)(15)O) PET. Regional metabolism in the entorhinal cortex, studied with FDG PET, seems to predict normal elderly who will deteriorate to MCI or AD. SPECT shows decreased regional perfusion in limbic areas, both in MCI and AD, but with a lower likelihood ratio than PET. Newer PET compounds allow for the determination in AD of microglial activation, regional deposition of amyloid and the evaluation of enzymatic activity in the brain of AD patients.
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Affiliation(s)
- Jose C Masdeu
- Department of Neurology and Neurosurgery, Pamplona, Spain.
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Ebmeier KP, Donaghey C, Dougall NJ. Neuroimaging in dementia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2005; 67:43-72. [PMID: 16291019 DOI: 10.1016/s0074-7742(05)67002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- K P Ebmeier
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Morningside Park Edinburgh EH10 5HF, United Kingdom
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Döbert N, Pantel J, Frölich L, Hamscho N, Menzel C, Grünwald F. Diagnostic value of FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment: metabolic index and perfusion index. Dement Geriatr Cogn Disord 2005; 20:63-70. [PMID: 15908747 DOI: 10.1159/000085857] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The diagnostic potential of F-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (PET) and technetium-99m hexamethylpropylene amine oxime single-photon emission tomography (SPET) in early detection and differential diagnosis of early dementia was evaluated including a comparison of metabolic and perfusion indices (PI). METHODS Twenty-four patients with initial clinical suspicion of beginning dementia were examined, 12 of them with mild cognitive impairment. All patients underwent SPET and PET within 2 weeks. Data were compared with the final clinical diagnosis at follow-up - 9 with Alzheimer's disease (AD), 1 with frontotemporal dementia, 1 with vascular dementia (VD), 7 with mixed type of dementia (MIX) and 6 without any type of dementia. Metabolic indices (MI) and PI were compared with each other. The regional cerebral blood flow difference (rCBFdiff) calculated as local uptake difference between the right and left hemisphere was measured for patients with VD and MIX. RESULTS PET showed higher sensitivity and specificity in identifying the different types of early dementia (44--91 and 78--89%, respectively) than SPET (11--64 and 79--89%, respectively), especially in detecting AD (sensitivity 44%, specificity 83%) and MIX (sensitivity 71%, specificity 78%). Especially in patients with mild cognitive impairment, PET was the superior imaging modality for predicting dementia. Using PET, dementia could be excluded in all patients who did not develop dementia during the follow-up. In all patients, a weak correlation between PI and MI was observed (rho=0.64, p<0.002). The rCBFdiff in patients with VD and MIX ranged from 7 to 37%. CONCLUSION In this study on patients with initial suspicion of beginning dementia who underwent both imaging modalities, PET and SPET, PET was the superior imaging method, especially in the detection of early AD or MIX.
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Affiliation(s)
- Natascha Döbert
- Department of Nuclear Medicine, University of Frankfurt, Frankfurt, Germany. Doebert@em,uni-frankfurt.de
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Abstract
Considerable data exist to support the use of positron emission tomography (PET) and single photon emission computed tomography (SPECT) scanning as biomarkers for Alzheimer's disease (AD). The techniques are reasonably sensitive and specific in differentiating AD from normal aging, and recent studies with pathological confirmation show good sensitivity and specificity in differentiating AD from other dementias. These techniques also can detect abnormalities in groups of asymptomatic and presymptomatic individuals and may be able to predict decline to dementia. However, there are a number of existing questions related to the use of these techniques in samples that are fully representative of the spectrum of patients with dementia. For example, it is unclear how well PET and SPECT perform in comparison to a clinical diagnosis obtained in the same patient group, when autopsy is used as a gold standard. It will also be important to know what PET and SPECT add to the certainty of diagnosis in addition to the standard clinical diagnosis. Despite these unanswered questions, PET and SPECT may have application as biomarkers for AD in a number of clinical and research settings, especially in academic centers, where most of the existing studies have been done.
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Affiliation(s)
- William Jagust
- School of Public Health and Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, California 94720, USA.
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Honda N, Machida K, Matsumoto T, Matsuda H, Imabayashi E, Hashimoto J, Hosono M, Inoue Y, Koizum K, Kosuda S, Momose T, Mori Y, Oshima M. Three-dimensional stereotactic surface projection of brain perfusion SPECT improves diagnosis of Alzheimer’s disease. Ann Nucl Med 2003; 17:641-8. [PMID: 14971605 DOI: 10.1007/bf02984969] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Alzheimer's disease (AD) is diagnosed by either inspection of the brain perfusion SPECT, or three-dimensional stereotactic surface display (3D-SSP). The purpose was to compare diagnostic performances of these methods. METHODS Sixteen nuclear medicine physicians independently interpreted 99mTc-ECD SPECT in one session and SPECT with 3D-SSP in another session without clinical information for 50 studies of AD patients and 40 studies of healthy volunteers. Probabilities of AD were reported according to a subjective scale from 0% (normal) to 100% (definite AD). Receiver operating characteristics curves were generated to calculate areas under the ROC curves (Az's) for the inspection as well as for an automated diagnosis based on a mean Z value in the bilateral posterior cingulate gyri in a 3D-SSP template. RESULTS Mean Az for visual interpretation of SPECT alone (0.679 +/- 0.058) was significantly smaller than that for visual interpretation of both SPECT and 3D-SSP (0.778 +/- 0.060). Az for the automated diagnosis (0.883 +/- 0.037) was significantly greater than that for both modes of visual interpretation. CONCLUSIONS 3D-SSP enhanced performance of the nuclear medicine physicians inspecting SPECT. Performance of the automated diagnosis exceeded that of the physicians inspecting SPECT with and without 3D-SSP.
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Affiliation(s)
- Norinari Honda
- Department of Radiology, Saitama Medical Center, Saitama Medical School, Kawagoe, Japan.
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Abstract
Current clinical criteria (DSM-IIIR and NINCDS-ADRDA) for the diagnosis of dementia and AD are reliable; however, these criteria remain to be validated by clinicians of different levels of expertise at different clinical settings. Structural neuroimaging has an important role in initial evaluation of dementia for ruling out potentially treatable causes. Although CT is the appropriate choice when brain tumors, subdural hematoma, or normal pressure hydrocephalus is suspected, MR imaging is more sensitive to the white-matter changes in vascular dementia. The diagnostic accuracy of PET, SPECT, 1H MRS, and MR volumetry of the hippocampus for distinguishing patients with AD from healthy elderly individuals is comparable to the accuracy of a pathologically confirmed clinical diagnosis. Sensitivity of PET for distinguishing patients with dementia with Lewy bodies from AD, however, is higher than that of clinical evaluation; similarly, SPECT and 1H MRS may be adjuncts to clinical evaluation for distinguishing patients with frontotemporal dementia from those with AD. Neuroimaging is valuable in predicting future development of AD in patients with MCI and in carriers of the ApoE epsilon 4 allele who are at a higher risk of developing AD than are cognitively normal elderly individuals. Quantitative MR techniques (e.g., MR volumetry, DWI, magnetization transfer MR imaging, and 1H MRS) and PET are sensitive to the structural and functional changes in the brains of patients with MCI, and hippocampal volumes on MR imaging are associated with future development of AD in these individuals. PET is also sensitive to the regional metabolic decline in the brains of carriers of the ApoE epsilon 4 allele. The longitudinal decrease of whole brain and hippocampal volumes on MR imaging, NAA levels on 1H MRS, cerebral glucose metabolism on PET, and cerebral blood flow on SPECT are associated with rate of cognitive decline in patients with AD. These neuroimaging markers may be useful for monitoring symptomatic progression in groups of patients with AD for drug trials. Furthermore, antemortem MR-based hippocampal volumes correlate with the pathologic stage of AD, and the rate of hippocampal volume loss on MR imaging correlates with clinical disease progression in the cognitive continuum from normal aging to MCI and to AD. Hence, as an in vivo correlate of pathologic involvement, structural imaging measures are potential surrogate markers for disease progression in patients with established AD and in patients with prodromal AD, who will benefit most from disease-modifying therapies underway.
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Affiliation(s)
- Kejal Kantarci
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Varma AR, Adams W, Lloyd JJ, Carson KJ, Snowden JS, Testa HJ, Jackson A, Neary D. Diagnostic patterns of regional atrophy on MRI and regional cerebral blood flow change on SPECT in young onset patients with Alzheimer's disease, frontotemporal dementia and vascular dementia. Acta Neurol Scand 2002; 105:261-9. [PMID: 11939938 DOI: 10.1034/j.1600-0404.2002.1o148.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Alzheimer's disease (AD), frontotemporal dementia (FTD) and vascular dementia (VaD) are the three most common causes of young onset dementias. Most neuroimaging studies of these disorders have involved comparisons with normal controls. The aims of this study were to examine the clinical diagnostic value of magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) (in combination and in isolation) in the differentiation of one form of dementia from another from amongst a group of AD, FTD and VaD. METHODS T1 weighted MRI images and 99mTc-HMPAO SPECT images were obtained from consecutive patients with FTD (n=21), AD (n=23) and VaD (n=20) and rated visually by experienced neuroradiologists and nuclear medicine physicians. RESULTS Asymmetrical atrophy was seen only in FTD. Frontotemporal dementia patients were the most atrophic whereas severe atrophy was rarely observed in VaD. Severe frontal atrophy (unilaterally or bilaterally) and/or asymmetrical atrophy on MRI is highly diagnostic (sensitivity 0.71, specificity 0.93, LR 10.24) of FTD from within a group of FTD and non-FTD (AD, VaD) patients. Mild or severe parietal atrophy with severe reduction in parietal regional cerebral blood flow on SPECT is diagnostic (sensitivity 0.71, specificity 0.76, LR 3.02) of AD from within a group of AD and non-AD (VaD, FTD) patients. CONCLUSION Anatomical (MRI) and functional (SPECT) imaging provide different information and a combination of these modalities improves diagnostic specificity.
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Affiliation(s)
- A R Varma
- Cerebral Function Unit, Neurology Department, Manchester Royal Infirmary, Central Manchester Healthcare Trust, Manchester, UK.
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Van Heertum RL, Drocea C, Ichise M, Lobotesis K, Fawwaz RA. Single photon emission CT and positron emission tomography in the evaluation of neurologic disease. Radiol Clin North Am 2001; 39:1007-33. [PMID: 11587056 DOI: 10.1016/s0033-8389(05)70326-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Widely available SPECT allows imaging of certain critical components of neurotransmission, providing clinically and experimentally significant information. Future efforts may be directed toward developing innovative techniques to delineate dynamic neurochemical changes in vivo.
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Affiliation(s)
- R L Van Heertum
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, Small GW, Miller B, Stevens JC. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1143-53. [PMID: 11342678 DOI: 10.1212/wnl.56.9.1143] [Citation(s) in RCA: 1151] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To update the 1994 practice parameter for the diagnosis of dementia in the elderly. BACKGROUND The AAN previously published a practice parameter on dementia in 1994. New research and clinical developments warrant an update of some aspects of diagnosis. METHODS Studies published in English from 1985 through 1999 were identified that addressed four questions: 1) Are the current criteria for the diagnosis of dementia reliable? 2) Are the current diagnostic criteria able to establish a diagnosis for the prevalent dementias in the elderly? 3) Do laboratory tests improve the accuracy of the clinical diagnosis of dementing illness? 4) What comorbidities should be evaluated in elderly patients undergoing an initial assessment for dementia? RECOMMENDATIONS Based on evidence in the literature, the following recommendations are made. 1) The DSM-III-R definition of dementia is reliable and should be used (Guideline). 2) The National Institute of Neurologic, Communicative Disorders and Stroke--AD and Related Disorders Association (NINCDS-ADRDA) or the Diagnostic and Statistical Manual, 3rd edition, revised (DSM-IIIR) diagnostic criteria for AD and clinical criteria for Creutzfeldt--Jakob disease (CJD) have sufficient reliability and validity and should be used (Guideline). Diagnostic criteria for vascular dementia, dementia with Lewy bodies, and frontotemporal dementia may be of use in clinical practice (Option) but have imperfect reliability and validity. 3) Structural neuroimaging with either a noncontrast CT or MR scan in the initial evaluation of patients with dementia is appropriate. Because of insufficient data on validity, no other imaging procedure is recommended (Guideline). There are currently no genetic markers recommended for routine diagnostic purposes (Guideline). The CSF 14-3-3 protein is useful for confirming or rejecting the diagnosis of CJD (Guideline). 4) Screening for depression, B(12) deficiency, and hypothyroidism should be performed (Guideline). Screening for syphilis in patients with dementia is not justified unless clinical suspicion for neurosyphilis is present (Guideline). CONCLUSIONS Diagnostic criteria for dementia have improved since the 1994 practice parameter. Further research is needed to improve clinical definitions of dementia and its subtypes, as well as to determine the utility of various instruments of neuroimaging, biomarkers, and genetic testing in increasing diagnostic accuracy.
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Affiliation(s)
- D S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Jagust W, Thisted R, Devous MD, Van Heertum R, Mayberg H, Jobst K, Smith AD, Borys N. SPECT perfusion imaging in the diagnosis of Alzheimer's disease: a clinical-pathologic study. Neurology 2001; 56:950-6. [PMID: 11294935 DOI: 10.1212/wnl.56.7.950] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Numerous studies have suggested that temporoparietal hypoperfusion seen on brain imaging with SPECT may be useful in diagnosing AD during life. However, these studies have often been limited by lack of pathologic validation and unrepresentative samples. The authors performed this study to determine whether SPECT imaging provides diagnostically useful information in addition to that obtained from a clinical examination. METHODS Clinical data and SPECT images were collected prospectively, and patients were followed to autopsy. Clinical history, pathologic findings, and SPECT images were each evaluated by raters blind to other features, and clinical and SPECT diagnoses were compared with pathologic diagnoses. The study population consisted of 70 patients with dementia, followed to autopsy; 14 controls followed to autopsy; and 71 controls (no autopsy performed). The primary outcome was the likelihood of a pathologic diagnosis of AD given a positive clinical diagnosis, a positive SPECT diagnosis, and both. RESULTS When all participants (patients and controls) were included in the analysis, the clinical diagnosis of "probable" AD was associated with an 84% likelihood of pathologic AD. A positive SPECT scan raised the likelihood of AD to 92%, whereas a negative SPECT scan lowered the likelihood to 70%. SPECT was more useful when the clinical diagnosis was "possible" AD, with the likelihood of 67% without SPECT, 84% with a positive SPECT, and 52% with a negative SPECT. Similar results were found when only patients with dementia were included in the analysis. CONCLUSIONS In the evaluation of dementia, SPECT imaging can provide clinically useful information indicating the presence of AD in addition to the information that is obtained from clinical evaluation.
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Affiliation(s)
- W Jagust
- Department of Neurology, University of California, Davis Medical Center, Sacramento 95817, USA
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Abstract
Positron emission tomography, single photon emission computed tomography, and MR imaging are brain imaging techniques that have been applied widely to the study of patients with dementia. This article reviews current data on the clinical use of these techniques in the differential diagnosis of dementia and the prediction of dementia in those at risk.
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Affiliation(s)
- W J Jagust
- Department of Neurology, University of California Davis Alzheimer's Disease Center, University of California Davis, School of Medicine, Davis, California 95817, USA.
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Abstract
AbstractFunctional neuroimaging is playing an increasing role in psychiatry and has moved from academic isolation into clinical practice. This review examines the basis for the use of Single Photon Emission Computed Tomography, the most widely available functional modality, in the two important areas of dementia and parkinsonism. Its contribution to the diagnosis and management of patients is discussed and its likely impact in clinical trials indicated. As functional imaging moves closer to those most able to utilise its power its impact in these and other areas of psychiatry and neurology will increase further.
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Verwer RW, Jansen KA, Sluiter AA, Pool CW, Kamphorst W, Swaab DF. Decreased hippocampal metabolic activity in Alzheimer patients is not reflected in the immunoreactivity of cytochrome oxidase subunits. Exp Neurol 2000; 163:440-51. [PMID: 10833319 DOI: 10.1006/exnr.2000.7385] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the present study we have compared histochemically determined cytochrome oxidase activity with the levels of immunocytochemically stained cytochrome oxidase subunits (CO II and CO IV) and ATP synthase in the human hippocampus in relation with Alzheimer's disease. Cytochrome oxidase activity was significantly reduced in all hippocampal areas of Alzheimer patients. The protein levels of subunits II and IV were not different between control subjects and Alzheimer patients. Additionally, it was observed that the active cytochrome oxidase is evenly distributed over both cell bodies and neuropil, while a relatively large pool of inactive enzyme or precursors is limited to the neuronal somata. Further, in Alzheimer patients the CO IV immunoreactivity decreased with age, whereas in control subjects it increased with age. Our results suggest that the assembly of cytochrome oxidase or the processing of its subunits may be impaired.
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Affiliation(s)
- R W Verwer
- Graduate School for Neurosciences Amsterdam, Netherlands Institute for Brain Research, Amsterdam, The Netherlands
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Whalley LJ. Vascular Dementia. J R Coll Physicians Edinb 1998. [DOI: 10.1177/147827159802800418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- L. J. Whalley
- Department of Mental Health, The University of Aberdeen
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