Diffusion Tensor Imaging Correlates with Proton Magnetic Resonance Spectroscopy in Posterior Cingulate Region of Patients with Alzheimer’s Disease

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Abstract

Background/Aims: To compare proton magnetic resonance spectroscopy (<sup>1</sup>H-MRS) and diffusion tensor imaging (DTI) findings in the posterior cingulate regions in patients with Alzheimer’s disease (AD). Methods: 17 patients with mild AD, 20 with moderate to severe AD and 20 cognitively normal aging subjects (CN) underwent single-voxel MRS and DTI examinations. A region of interest was positioned in the posterior cingulate regions. Ratios of N-acetylaspartate (NAA), myo-inositol (mI), and choline to creatine (Cr) were measured. Mean spectroscopy data and DTI values (fractional anisotropy, FA, and mean diffusivity, MD) were analyzed with nonparametric testing. Results: The group with mild AD showed a significantly lower FA value in the left posterior cingulum compared to CN. The group with moderate to severe AD revealed significantly decreased FA values and increased MD values in both the left and right cingulum compared to the group with mild AD. Partial correlation analysis revealed a positive correlation between mI/Cr and left-side FA values in the group with mild AD and a negative correlation between NAA/Cr and right-side MD values in the group with moderate to severe AD. Conclusion: There are different regional and temporal patterns in AD, resulting from gliosis or axonal loss. Combining MRS with DTI could provide valuable information to better understand the AD process.

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A white matter disorder in dementia of the Alzheimer type: a pathoanatomical study.

E Englund, A Brun (1986)

In cases of Alzheimer's presenile and senile dementia, Alzheimer's disease (AD) and senile dementia of the Alzheimer type (SDAT), respectively, we have observed, in addition to the gray matter degeneration, a lesion that has the character of an incomplete infarction confined to the white matter. It is encountered in 60% of both groups, with mild changes in two thirds and moderate or severe changes in one third. It involves the deep white matter symmetrically, tapering off toward the cortex. It is characterized by partial loss of myelin, axons, and oligodendroglial cells; mild reactive astrocytic gliosis; and sparsely distributed macrophages as well as stenosis resulting from hyaline fibrosis of arterioles and smaller vessels. No complete or cavitating infarctions and no hypertensive vascular changes were observed. The white matter changes are thought to be due to hypoperfusion of the concerned white matter territories since, in addition to the white matter hyaline vascular stenosis, these cases show signs of cardiovascular disease, usually with hypotension. The white matter disorder also occurs independent of the gray matter process of AD and SDAT and may be seen as the sole brain lesion in non-AD subjects. Its occurrence is thus neither regularly related to the severity nor to the regional appearance and accentuation of the cortical Alzheimer process and is thus not likely to be just the result of a wallerian degeneration. Histologically it is similar in several respects to Binswanger's disease, although with some distinct differences. It is thus related to the cerebrovascular group of disorders in addition to AD and SDAT. In view of its frequency and severity, this white matter lesion is important to define, to diagnose, and ultimately to prevent or cure.

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Diffusion tensor imaging of cingulum fibers in mild cognitive impairment and Alzheimer disease.

Y. Zhang, N. Schuff, G-H Jahng … (2007)

Neuroimaging in mild cognitive impairment (MCI) and Alzheimer disease (AD) generally shows medial temporal lobe atrophy and diminished glucose metabolism and cerebral blood flow in the posterior cingulate gyrus. However, it is unclear whether these abnormalities also impact the cingulum fibers, which connect the medial temporal lobe and the posterior cingulate regions. To use diffusion tensor imaging (DTI), by measuring fractional anisotropy (FA), to test 1) if MCI and AD are associated with DTI abnormalities in the parahippocampal and posterior cingulate regions of the cingulum fibers; 2) if white matter abnormalities extend to the neocortical fiber connections in the corpus callosum (CC); 3) if DTI improves accuracy to separate AD and MCI from healthy aging vs structural MRI. DTI and structural MRI were preformed on 17 patients with AD, 17 with MCI, and 18 cognitively normal (CN) subjects. FA of the cingulum fibers was significantly reduced in MCI, and even more in AD. FA was also significantly reduced in the splenium of the CC in AD, but not in MCI. Adding DTI to hippocampal volume significantly improved the accuracy to separate MCI and AD from CN. Assessment of the cingulum fibers using diffusion tensor imaging may aid early diagnosis of Alzheimer disease.

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Regional metabolic patterns in mild cognitive impairment and Alzheimer's disease: A 1H MRS study.

E Tangalos, N Campeau, R Ivnik … (2000)

Mild cognitive impairment (MCI) is a recently described transitional clinical state between normal aging and AD. Assuming that amnestic MCI patients had pathologic changes corresponding to an early phase and probable AD patients to a later phase of the disease progression, the authors could approximate the temporal course of proton MR spectroscopic (1H MRS) alterations in AD with a cross-sectional sampling scheme. The authors compared 1H MRS findings in the superior temporal lobe, posterior cingulate gyri, and medial occipital lobe in 21 patients with MCI, 21 patients with probable AD, and 63 elderly controls. These areas are known to be involved at different neurofibrillary pathologic stages of AD. The N-acetylaspartate (NAA)/creatine (Cr) ratios were significantly lower in AD patients compared to both MCI and normal control subjects in the left superior temporal and the posterior cingulate volumes of interest (VOI) and there were no between-group differences in the medial occipital VOI. Myoinositol (MI)/Cr ratios measured from the posterior cingulate VOI were significantly higher in both MCI and AD patients than controls. The choline (Cho)/Cr ratios measured from the posterior cingulate VOI were higher in AD patients compared to both MCI and control subjects. These findings suggest that the initial 1H MRS change in the pathologic progression of AD is an increase in MI/Cr. A decrease in NAA/Cr and an increase in Cho/Cr develop later in the disease course.

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Author and article information

Journal

Journal ID (publisher-id): DEM

Journal ID (nlm-ta): Dement Geriatr Cogn Disord

Journal ID (doi): 10.1159/issn.1420-8008

Title: Dementia and Geriatric Cognitive Disorders

Publisher: S. Karger AG

ISSN (Print): 1420-8008

ISSN (Electronic): 1421-9824

Publication date Subscription-year: 2008

Publication date (Print): March 2008

Publication date (Electronic): 25 January 2008

Volume: 25

Issue: 3

Pages: 218-225

Affiliations

^aDepartment of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, and ^bDepartment of Geratology, Shanghai Mental Health Center, Shanghai, China

Article

Publisher ID: 113948 Other ID: Dement Geriatr Cogn Disord 2008;25:218–225

DOI: 10.1159/000113948

PubMed ID: 18219201

SO-VID: 16614c91-0b40-46b8-90a7-c6ce81d14cfb

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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Date accepted : 11 September 2007

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Figures: 4, Tables: 3, References: 37, Pages: 8

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Diffusion Tensor Imaging Correlates with Proton Magnetic Resonance Spectroscopy in Posterior Cingulate Region of Patients with Alzheimer’s Disease

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Karger: Neurology and Neuroscience

Most cited references 24

A white matter disorder in dementia of the Alzheimer type: a pathoanatomical study.

Diffusion tensor imaging of cingulum fibers in mild cognitive impairment and Alzheimer disease.

Regional metabolic patterns in mild cognitive impairment and Alzheimer's disease: A 1H MRS study.

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Cited by 8

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