Sun Mengfan, Wang Yan-Li, Li Runzhi, Jiang Jiwei, Zhang Yanling, Li Wenyi, Zhang Yuan, Jia Ziyan, Chappell Michael, Xu Jun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurosci. 2022 Jul 22;16:934471. doi: 10.3389/fnins.2022.934471. eCollection 2022.
Cerebral blood flow (CBF) alterations are involved in the onset and progression of Alzheimer's disease (AD) and can be a potential biomarker. However, CBF measured by single-delay arterial spin labeling (ASL) for discrimination of mild cognitive impairment (MCI, an early stage of AD) was lack of accuracy. Multi-delay ASL can not only provide CBF quantification but also provide arterial transit time (ATT). Unfortunately, the technique was scarcely applied to the diagnosis of AD. Here, we detected the utility of ASL with 1-delay and 7-delay in ten regions of interest (ROIs) to identify MCI and AD.
Pseudocontinuous ASL (pCASL) MRI was acquired on a 3T GE scanner in adults from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) Study of AD cohort, including 26 normal cognition (NC), 37 MCI, and 39 AD. Receiver operating characteristic (ROC) analyses with 1-delay and 7-delay ASL were performed for the identification of MCI and AD. The DeLong test was used to compare ROC curves.
For CBF of 1-delay or 7-delay the AUCs showed moderate-high performance for the AD/NC and AD/MCI comparisons (AUC = 0.83∼0.96) ( < 0.001). CBF of 1-delay performed poorly in MCI/NC comparison (AUC = 0.69) ( < 0.001), but CBF of 7-delay fared well with an AUC of 0.79 ( < 0.001). The combination of CBF and ATT of 7-delay showed higher performance for AD/NC, AD/MCI, and MCI/NC comparisons with AUCs of 0.96, 0.89, and 0.89, respectively ( < 0.001). Furthermore, combination of CBF, ATT, sex, age, ε4, and education improved further the accuracy ( < 0.001). In subgroups analyses, there were no significant differences in CBF of 7-delay ASL for identification of AD or MCI between age subgroups ( > 0.05).
The combination of CBF and ATT with 7-delay ASL showed higher performance for identification of MCI than CBF of 1-delay, when adding to sex, age, ε4 carrier status, and education years, the diagnostic performance was further increased, presenting a potential imaging biomarker in early AD.
脑血流量（CBF）改变与阿尔茨海默病（AD）的发病和进展有关，并且可能是一种潜在的生物标志物。然而，采用单延迟动脉自旋标记（ASL）测量CBF来鉴别轻度认知障碍（MCI，AD的早期阶段）缺乏准确性。多延迟ASL不仅可以提供CBF定量，还可以提供动脉传输时间（ATT）。遗憾的是，该技术很少应用于AD的诊断。在此，我们检测了1延迟和7延迟ASL在十个感兴趣区域（ROI）中识别MCI和AD的效用。
在3T通用电气扫描仪上对来自中国AD队列影像、生物标志物和生活方式（CIBL）研究的成年人进行伪连续ASL（pCASL）MRI检查，包括26名认知正常（NC）者、37名MCI患者和39名AD患者。采用1延迟和7延迟ASL进行受试者操作特征（ROC）分析以识别MCI和AD。使用德龙检验比较ROC曲线。
对于1延迟或7延迟的CBF，在AD/NC和AD/MCI比较中，曲线下面积（AUC）显示出中到高的性能（AUC = 0.83∼0.96）（P < 0.001）。1延迟的CBF在MCI/NC比较中表现不佳（AUC = 0.69）（P < 0.001），但7延迟的CBF表现良好，AUC为0.79（P < 0.001）。7延迟的CBF和ATT的组合在AD/NC、AD/MCI和MCI/NC比较中表现出更高的性能，AUC分别为0.96、0.89和0.89（P < 0.001）。此外，CBF、ATT、性别、年龄、ε4和教育程度的组合进一步提高了准确性（P < 0.001）。在亚组分析中，年龄亚组之间7延迟ASL的CBF在识别AD或MCI方面无显著差异（P > 0.05）。
7延迟ASL的CBF和ATT组合在识别MCI方面比1延迟的CBF表现出更高的性能，当加入性别、年龄、ε4携带者状态和受教育年限时，诊断性能进一步提高，呈现出一种早期AD潜在的影像生物标志物。
