van Gils Aniek M, Tolonen Antti J, Rhodius-Meester Hanneke F M, Mecocci Patrizia, Vanninen Ritva, Frederiksen Kristian Steen, Barkhof Frederik, Jasperse Bas, Lötjönen Jyrki, van der Flier Wiesje M, Lemstra Afina W
Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
Eur Radiol. 2024 Dec 30. doi: 10.1007/s00330-024-11257-7.
Distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) dementia, particularly in patients with DLB and concomitant AD pathology (DLB/AD+), can be challenging and there is no specific MRI signature for DLB. The aim of this study is to examine the additional value of MRI-based brain volumetry in separating patients with DLB (AD+/-) from patients with AD and controls.
We included 1518 participants from four cohorts (ADC, ADNI, PDBP and PredictND); 147 were patients with DLB (n = 76, DLB/AD+; n = 71, DLB/AD-), 668 patients with AD dementia, and 703 controls. We used an automatic segmentation tool to compute volumes of 70 brain regions, for which age, sex, and head size-dependent z-scores were calculated. We compared individual regions between the diagnostic groups and evaluated whether combining multiple regions improves differentiation. To assess the diagnostic performance, we used the area under the receiver operating characteristic curve (AUC) and sensitivity.
The classifier using the combination of 70 volumetric brain regions correctly classified 60% of patients with DLB and 70% of patients with AD dementia. For DLB vs. AD, the classifier produced an AUC of 0.80 (0.77-0.83), which outperformed the best individual region, hippocampus (AUC: 0.73 [0.69-0.76], p < 0.01). For the comparison of DLB/AD+ vs. AD, the classifier increased the AUC to 0.74 (0.68-0.80), which was 0.70 (0.64-0.76) for the hippocampus, p = 0.25.
Using a combination of volumetric brain regions improved the classification accuracy, and thus the discrimination, of patients with DLB with and without concomitant AD pathology and AD.
Question No specific MRI signature for dementia with Lewy bodies (DLB) exists, making the differential diagnosis challenging, especially with dementia due to Alzheimer's disease (AD). Findings Volumes of individual brain regions defined by automatic MRI segmentation differed between DLB and AD patients and controls. Clinical relevance Automatic MRI segmentation can contribute to improving the discrimination of patients with DLB and AD, especially in non-specialized memory clinics.
区分路易体痴呆（DLB）与阿尔茨海默病（AD）痴呆，尤其是在伴有AD病理改变的DLB患者（DLB/AD+）中，可能具有挑战性，且DLB没有特定的MRI特征。本研究的目的是检验基于MRI的脑容量测定在区分DLB患者（AD+/-）与AD患者及对照组中的附加价值。
我们纳入了来自四个队列（ADC、ADNI、PDBP和PredictND）的1518名参与者；147名是DLB患者（n = 76，DLB/AD+；n = 71，DLB/AD-），668名是AD痴呆患者，703名是对照组。我们使用自动分割工具计算70个脑区的体积，并计算其年龄、性别和头大小相关的z分数。我们比较了诊断组之间的各个脑区，并评估多个脑区组合是否能提高区分度。为评估诊断性能，我们使用了受试者操作特征曲线下面积（AUC）和敏感性。
使用70个脑区体积组合的分类器正确分类了60%的DLB患者和70%的AD痴呆患者。对于DLB与AD的比较，该分类器产生的AUC为0.80（0.77 - 0.83），优于最佳的单个脑区海马体（AUC：0.73 [0.69 - 0.76]，p < 0.01）。对于DLB/AD+与AD的比较，该分类器将AUC提高到0.74（0.68 - 0.80），而海马体的AUC为0.70（0.64 - 0.76），p = 0.25。
使用脑区体积组合提高了DLB伴或不伴AD病理改变患者及AD患者的分类准确性，从而提高了鉴别能力。
问题 路易体痴呆（DLB）不存在特定的MRI特征，这使得鉴别诊断具有挑战性，尤其是与阿尔茨海默病（AD）所致痴呆的鉴别。发现 通过自动MRI分割定义的各个脑区体积在DLB患者、AD患者和对照组之间存在差异。临床意义 自动MRI分割有助于提高DLB和AD患者的鉴别能力，尤其是在非专科记忆门诊。
