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Expert Panel on Neurological Imaging, Soderlund KA, Austin MJ, Ben-Haim S, Chu S, Ivanidze J, Joshi P, Kalnins A, Kennedy M, Kulshreshtha A, Kuo PH, Masdeu JC, Nikumbh T, Soares BP, Thaker AA, Wang LL, Yasar S, Shih RY. ACR Appropriateness Criteria® Dementia: 2024 Update. J Am Coll Radiol 2025; 22:S202-S233. [PMID: 40409878 DOI: 10.1016/j.jacr.2025.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 02/24/2025] [Indexed: 05/25/2025]
Abstract
Dementia is defined by significant chronic or acquired impairment in a single domain or loss of two or more cognitive functions by brain disease or injury. It is a common chronic syndrome in adults and constitutes the fifth leading cause of death in patients >65 years of age. Multiple etiologies of dementia exist, most notably Alzheimer disease, frontotemporal dementia, and dementia with Lewy bodies, as well as other neurologic diseases such as vascular dementia and normal pressure hydrocephalus. In addition to aiding clinicians in selecting the most appropriate imaging test for patients suspected of one of these dementia syndromes, this document highlights the most appropriate initial imaging tests for patients with suspected mild cognitive impairment and rapidly progressive dementia, as well as the most appropriate pre- and posttreatment imaging tests for patients undergoing therapy with antiamyloid monoclonal antibodies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Karl A Soderlund
- Panel Chair, Naval Medical Center Portsmouth, Portsmouth, Virginia.
| | | | - Sharona Ben-Haim
- University of California, San Diego, School of Medicine/UC San Diego Health, San Diego, California; American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Sammy Chu
- University of Washington, Seattle, Washington, and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Pallavi Joshi
- Banner Alzheimer's Institute, Phoenix, Arizona; American Psychiatric Association
| | | | - Maura Kennedy
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; American College of Emergency Physicians
| | - Ambar Kulshreshtha
- Emory University, Atlanta, Georgia; American Academy of Family Physicians
| | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | - Joseph C Masdeu
- Houston Methodist and Weill Cornell Medicine, Houston, Texas; American Academy of Neurology
| | - Tejas Nikumbh
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania; American College of Physicians
| | - Bruno P Soares
- Stanford University School of Medicine, Stanford, California
| | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Sevil Yasar
- Johns Hopkins University School of Medicine, Baltimore, Maryland; American Geriatrics Society
| | - Robert Y Shih
- Specialty Chair, Uniformed Services University, Bethesda, Maryland
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P L R, K S G. Revolutionizing dementia detection: Leveraging vision and Swin transformers for early diagnosis. Am J Med Genet B Neuropsychiatr Genet 2024; 195:e32979. [PMID: 38619385 DOI: 10.1002/ajmg.b.32979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 04/16/2024]
Abstract
Dementia, an increasingly prevalent neurological disorder with a projected threefold rise globally by 2050, necessitates early detection for effective management. The risk notably increases after age 65. Dementia leads to a progressive decline in cognitive functions, affecting memory, reasoning, and problem-solving abilities. This decline can impact the individual's ability to perform daily tasks and make decisions, underscoring the crucial importance of timely identification. With the advent of technologies like computer vision and deep learning, the prospect of early detection becomes even more promising. Employing sophisticated algorithms on imaging data, such as positron emission tomography scans, facilitates the recognition of subtle structural brain changes, enabling diagnosis at an earlier stage for potentially more effective interventions. In an experimental study, the Swin transformer algorithm demonstrated superior overall accuracy compared to the vision transformer and convolutional neural network, emphasizing its efficiency. Detecting dementia early is essential for proactive management, personalized care, and implementing preventive measures, ultimately enhancing outcomes for individuals and lessening the overall burden on healthcare systems.
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Affiliation(s)
- Rini P L
- Department of Information Technology, Sri Sivasubramaniya Nadar College of Engineering, Kalavakkam, India
| | - Gayathri K S
- Department of Information Technology, Sri Sivasubramaniya Nadar College of Engineering, Kalavakkam, India
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Kunieda Y, Arakawa C, Yamada T, Suzuki M, Koyama S, Kimura Y, Ichikawa T, Shino S, Yamada M, Hirokawa R, Matsuda T, Takakura T, Adachi T, Hoshino H. Characteristics of Regional Cerebral Blood Flow in Alzheimer Disease and Amnestic Mild Cognitive Impairment by Single-Photon Emission Computerized Tomography: A Cross-Sectional Study. Dement Geriatr Cogn Dis Extra 2021; 11:91-98. [PMID: 34178012 PMCID: PMC8215965 DOI: 10.1159/000515864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The regional cerebral blood flow (rCBF) distribution can affect brain functioning, leading to amnestic mild cognitive impairment (aMCI) and mild Alzheimer disease (AD). This study aimed to clarify the detailed characteristics of rCBF distribution in patients with mild AD and aMCI. Methods This cross-sectional study from April 2015 to March 2018 included 103 older adults (mean age 78.9 years; 60% females), out of a total of 302 adults, and categorized them into 3 groups according to cognitive symptoms. The normal control (NC), aMCI, and mild AD groups included 20, 50, and 33 participants, respectively. The primary outcome was rCBF, which was compared among the 3 groups using a 2-sample t test without correction for multiple comparisons. Results In the aMCI group, the rCBF decreased in the bilateral parietal and left frontal association cortex and the bilateral premotor cortex (p < 0.01) but increased in the bilateral cerebellum (p < 0.01). In the mild AD group, the rCBF decreased in the bilateral parietal and occipital association cortex, the bilateral premotor cortex, the left temporal and frontal association cortex, and the left limbic lobe (p < 0.01). Conversely, the rCBF increased in some parts of the cerebellum, the bilateral frontal and temporal association cortex, the left occipital association cortex, and the right premotor cortex (p < 0.01). Conclusion Based on the analysis of the values obtained, it was inferred that the rCBF undergoes reduction and elevation in aMCI and AD patients.
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Affiliation(s)
- Yota Kunieda
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.,Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Chiaki Arakawa
- Department of Internal Medicine, Musubiha Clinic Shibuya, Tokyo, Japan
| | - Takumi Yamada
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Mizue Suzuki
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shingo Koyama
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Takeo Ichikawa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shuhei Shino
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Ryuto Hirokawa
- Department of Radiology and Nuclear Medicine, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, Tokyo, Japan
| | - Tomokazu Takakura
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Tomohide Adachi
- Dementia-Related Disease Medical Center, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Haruhiko Hoshino
- Dementia-Related Disease Medical Center, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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Sarikaya I, Kamel WA, Ateyah KK, Essa NB, AlTailji S, Sarikaya A. Visual versus semiquantitative analysis of 18F- fluorodeoxyglucose-positron emission tomography brain images in patients with dementia. World J Nucl Med 2021; 20:82-89. [PMID: 33850493 PMCID: PMC8034786 DOI: 10.4103/wjnm.wjnm_53_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/31/2018] [Accepted: 07/19/2018] [Indexed: 11/04/2022] Open
Abstract
Various studies have reported to the superiority of semiquantitative (SQ) analysis over visual analysis in detecting metabolic changes in the brain. In this study, we aimed to determine the limitations of SQ analysis programs and the current status of 18F- fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan in dementia. 18F- FDG-PET/computed tomography (CT) brain images of 39 patients with a history of dementia were analyzed both visually and semiquantitatively. Using the visually markedly abnormal 18F- FDG-PET images as standard, we wanted to test the accuracy of two commercially available SQ analysis programs. SQ analysis results were classified as matching, partially matching and nonmatching with visually markedly abnormal studies. On visual analysis, 18F- FDG-PET showed marked regional hypometabolism in 19 patients, mild abnormalities in 8 and was normal in 12 patients. SQ analysis-1 results matched with visual analysis in 8 patients (42.1%) and partially matched in 11. SQ analysis-2 findings matched with visual analysis in 11 patients (57.8%) and partially matched in 7 and did not match in 1. Marked regional hypometabolism was either on the left side of the brain or was more significant on the left than the right in 63% of patients. Preservation of metabolism in sensorimotor cortex was seen in various dementia subtypes. Reviewing images in color scale and maximum intensity projection (MIP) image was helpful in demonstrating and displaying regional abnormalities, respectively. SQ analysis provides less accurate results as compared to visual analysis by experts. Due to suboptimal image registration and selection of brain areas, SQ analysis provides inaccurate results, particularly in small areas and areas in close proximity. Image registration and selection of areas with SQ programs should be checked carefully before reporting the results.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait University, Kuwait
| | - Walaa A Kamel
- Department of Neurology, Faculty of Medicine, Beni-Suef University, Egypt.,Department of Nuclear Medicine, Ibn Sina Hospital, Kuwait
| | | | - Nooraessa Bin Essa
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | | | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Modified Visual Magnetic Resonance Scale and Neuropsychometric Corelations in Alzheimer's disease. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.737253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Moonis G, Subramaniam RM, Trofimova A, Burns J, Bykowski J, Chakraborty S, Holloway K, Ledbetter LN, Lee RK, Pannell JS, Pollock JM, Powers WJ, Roca RP, Rosenow JM, Shih RY, Utukuri PS, Corey AS. ACR Appropriateness Criteria® Dementia. J Am Coll Radiol 2020; 17:S100-S112. [PMID: 32370954 DOI: 10.1016/j.jacr.2020.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/24/2022]
Abstract
Degenerative disease of the central nervous system is a growing public health concern. The primary role of neuroimaging in the workup of patients with probable or possible Alzheimer disease has typically been to exclude other significant intracranial abnormalities. In general, the imaging findings in structural studies, such as MRI, are nonspecific and have limited potential in differentiating different types of dementia. Advanced imaging methods are not routinely used in community or general practices for the diagnosis or differentiation of forms of dementia. Nonetheless, in patients who have been evaluated by a dementia expert, FDG-PET helps to distinguish Alzheimer disease from frontotemporal dementia. In patients with suspected dementia with Lewy bodies, functional imaging of the dopamine transporter (ioflupane) using SPECT may be helpful. In patients with suspected normal-pressure hydrocephalus, DTPA cisternography and HMPAO SPECT/CT brain may provide assessment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Gul Moonis
- Columbia University Medical Center, New York, New York.
| | | | | | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada; Canadian Association of Radiologists
| | - Kathryn Holloway
- MCVH-Virginia Commonwealth University, Richmond, Virginia; Neurosurgery Expert
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Robert P Roca
- Sheppard Pratt Health System, Towson, Maryland; American Psychiatric Association
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Neurosurgery Expert
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Chapko D, McCormack R, Black C, Staff R, Murray A. Life-course determinants of cognitive reserve (CR) in cognitive aging and dementia - a systematic literature review. Aging Ment Health 2018; 22:915-926. [PMID: 28703027 DOI: 10.1080/13607863.2017.1348471] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The concept of cognitive reserve (CR) is defined as a moderator, which allows an individual to preserve cognition despite underlying brain pathology. There is no consensus of what potentially modifiable CR determinants are of greatest importance. The aim of this review was to identify life-course factors which protect older individuals from expressing cognitive decline despite the presence of brain pathology. METHOD A systematic review search was performed in MEDLINE (1946-06/09/13), EMBASE (1947-06/09/13), and PsycheInfo (1967-06/09/13). We included studies examining CR in the context of the four commonest subtypes of dementia, mild cognitive impairment or healthy aging. Studies which combined measurement of underlying dementia-related neuropathology, cognitive function, and factors providing CR in a single model were accepted. We performed a qualitative synthesis of the results. RESULTS Thirty-four studies out of 9229 screened records met our inclusion criteria and were therefore quality assessed and data extracted. Variation in CR definition made comparison across studies difficult. One hundred and forty-four out of 156 models examined education and occupation: overall, 58% of eligible models classified education and 60% occupation as a CR determinant, with 12% and 44% of those, respectively, being of high quality. Within healthy population suitable to inform preventative interventions, there was consistent evidence for education having a protective effect on general cognition in the face of multiple brain burden measures, while occupation presented inconclusive results within cognitive groups. CONCLUSIONS Further research on modifiable determinants of CR beyond education/occupation including early-life factors and consensus on CR definition are warranted.
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Affiliation(s)
- Dorota Chapko
- a Aberdeen Biomedical Imaging Centre , University of Aberdeen , Aberdeen , UK
| | - Roisin McCormack
- a Aberdeen Biomedical Imaging Centre , University of Aberdeen , Aberdeen , UK
| | - Corri Black
- b Farr Institute @ Scotland, Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , UK
| | - Roger Staff
- c Aberdeen Royal Infirmary , NHS Grampian , Aberdeen , UK
| | - Alison Murray
- a Aberdeen Biomedical Imaging Centre , University of Aberdeen , Aberdeen , UK
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Miller-Thomas MM, Sipe AL, Benzinger TLS, McConathy J, Connolly S, Schwetye KE. Multimodality Review of Amyloid-related Diseases of the Central Nervous System. Radiographics 2017; 36:1147-63. [PMID: 27399239 DOI: 10.1148/rg.2016150172] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Amyloid-β (Aβ) is ubiquitous in the central nervous system (CNS), but pathologic accumulation of Aβ results in four distinct neurologic disorders that affect middle-aged and elderly adults, with diverse clinical presentations ranging from chronic debilitating dementia to acute life-threatening intracranial hemorrhage. The characteristic imaging patterns of Aβ-related CNS diseases reflect the pathophysiology of Aβ deposition in the CNS. Aβ is recognized as a key component in the neuronal damage that characterizes the pathophysiology of Alzheimer disease, the most common form of dementia. Targeted molecular imaging shows pathologic accumulation of Aβ and tau protein, and fluorine 18 fluorodeoxyglucose positron emission tomography and anatomic imaging allow differentiation of typical patterns of neuronal dysfunction and loss in patients with Alzheimer disease from those seen in patients with other types of dementia. Cerebral amyloid angiopathy (CAA) is an important cause of cognitive impairment and spontaneous intracerebral hemorrhage in the elderly. Hemorrhage and white matter injury seen at imaging reflect vascular damage caused by the accumulation of Aβ in vessel walls. The rare forms of inflammatory angiopathy attributed to Aβ, Aβ-related angiitis and CAA-related inflammation, cause debilitating neurologic symptoms that improve with corticosteroid therapy. Imaging shows marked subcortical and cortical inflammation due to perivascular inflammation, which is incited by vascular Aβ accumulation. In the rarest of the four disorders, cerebral amyloidoma, the macroscopic accumulation of Aβ mimics the imaging appearance of tumors. Knowledge of the imaging patterns and pathophysiology is essential for accurate diagnosis of Aβ-related diseases of the CNS. (©)RSNA, 2016.
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Affiliation(s)
- Michelle M Miller-Thomas
- From the Mallinckrodt Institute of Radiology (M.M.M.T., A.L.S., T.L.S.B., J.M., S.C.) and Department of Pathology and Immunology (K.E.S.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Adam L Sipe
- From the Mallinckrodt Institute of Radiology (M.M.M.T., A.L.S., T.L.S.B., J.M., S.C.) and Department of Pathology and Immunology (K.E.S.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Tammie L S Benzinger
- From the Mallinckrodt Institute of Radiology (M.M.M.T., A.L.S., T.L.S.B., J.M., S.C.) and Department of Pathology and Immunology (K.E.S.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jonathan McConathy
- From the Mallinckrodt Institute of Radiology (M.M.M.T., A.L.S., T.L.S.B., J.M., S.C.) and Department of Pathology and Immunology (K.E.S.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Sarah Connolly
- From the Mallinckrodt Institute of Radiology (M.M.M.T., A.L.S., T.L.S.B., J.M., S.C.) and Department of Pathology and Immunology (K.E.S.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Katherine E Schwetye
- From the Mallinckrodt Institute of Radiology (M.M.M.T., A.L.S., T.L.S.B., J.M., S.C.) and Department of Pathology and Immunology (K.E.S.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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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: 0.9] [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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ACR Appropriateness Criteria Dementia and Movement Disorders. J Am Coll Radiol 2015; 12:19-28. [DOI: 10.1016/j.jacr.2014.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 11/22/2022]
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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: 3.8] [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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Degnan AJ, Levy LM. Neuroimaging of rapidly progressive dementias, part 2: prion, inflammatory, neoplastic, and other etiologies. AJNR Am J Neuroradiol 2013; 35:424-31. [PMID: 23413251 DOI: 10.3174/ajnr.a3455] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most dementias begin insidiously, developing slowly and generally occurring in the elderly age group. The so-called rapidly progressive dementias constitute a different, diverse collection of conditions, many of which are reversible or treatable. For this reason, accurate identification and assessment of acute and subacute forms of dementia are critical to effective treatment; neuroimaging aids greatly in narrowing the diagnosis of these conditions. This second installment of a 2-part review of rapidly progressive dementias examines the use of imaging in an assortment of other etiologies in the differential diagnosis, from prion disease and neoplastic-related conditions to rare metabolic and other conditions such as Wernicke encephalopathy. In these clinical conditions, MR imaging has the potential to narrow this broad differential diagnosis and, at times, can definitively aid in the diagnosis of certain conditions on the basis of typical imaging patterns.
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Affiliation(s)
- A J Degnan
- From the University of Pittsburgh Medical Center (A.J.D.), Pittsburgh, Pennsylvania
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