Okada Yukinori, Ohno Norikazu, Kitahara Yoshisuke, Niioka Hirofumi, Tanaka Koji, Ueda Hiromitsu, Tsujii Katsunori, Sato Masayuki
Department of Radiology, Iga City General Hospital/Expert Imaging and Interventonal Support, Iga, Japan.
Department of Radiology, Tokyo Medical University, Tokyo, Japan.
Curr Med Imaging. 2025 Jul 10. doi: 10.2174/0115734056337828250526070304.
Introduction: Magnetic resonance imaging can differentiate Alzheimer-type dementia from dementia with Lewy bodies using voxel-based specific regional analysis systems for Alzheimer's disease and arterial spin labeling, which reveal reduced blood flow from the posterior cingulate gyrus to the precuneus in Alzheimer-type dementia. However, the relationship between voxel-based specific regional analysis system scores and arterial spin labeling remains unclear. To investigate the relationship between brain atrophy scores and arterial spin labeling values in the posterior cingulate precuneus.
Methods: Participants with suspected dementia who underwent brain magnetic resonance imaging using a voxel-based regional analysis system were included. They were classified as follows: Group 1 (suspected Alzheimer-type dementia) had atrophy ≥2 in the volume of interest; Group 2 (suspected dementia with Lewy body) had atrophy <2 in the volume of interest and ≥0.2 in the gray and white matter of the dorsal brainstem; and Group 3 included those not meeting these criteria. Correlation values among atrophy within the volume of interest, percentage of atrophic areas, atrophy ratio, percentage of total brain atrophy, age, and maximum arterial spin labeling value at the posterior cingulate precuneus were evaluated.
Results: Groups 1, 2, and 3 comprised 179, 143, and 197 patients, respectively. Arterial spin labeling values at the posterior cingulate precuneus were 77.0±24.4-77.3±25.2, 78.3±81.3-80.2±23.6, and 80.2±22.3-80.4±22.8 mL/min/100 g, respectively. Group 1 had a correlation coefficient between total brain atrophy and arterial spin labeling of -0.189 to-0.214 (P<0.01). Group 2 had a correlation coefficient between total brain atrophy and arterial spin labeling of -0.215 to -0.223 (P<0.01). Group 3 showed no significant correlations. No statistically significant difference was observed in ASL 1 and 2 values between the Alzheimer-type dementia and other groups (ASL 1: 74.5 mL/min/100 g vs. 78.8 mL/min/100 g, P=0.08; ASL 2: 74.8 mL/min/100 g vs. 79.2 mL/min/100 g, P=0.101). No statistically significant difference was observed in ASL 1 and 2 values between the Alzheimer-type dementia and DLB groups (ASL 1: 74.5 mL/min/100 g vs. 69.3. mL/min/100 g, P=0.093; ASL 2: 74.8 mL/min/100 g vs. 78.9 mL/min/100 g, P=0.258).
Discussion: Reduced blood flow in the posterior cingulate gyrus and precuneus shows only a weak correlation with brain atrophy in both Alzheimer-type dementia and dementia with Lewy bodies. Therefore, it is not a reliable marker for differentiating Alzheimer-type dementia from dementia with Lewy bodies and other groups.
Conclusion: It is necessary to avoid using cerebral blood flow assessment alone when diagnosing dementia.
.磁共振成像可通过基于体素的阿尔茨海默病特异性区域分析系统和动脉自旋标记，将阿尔茨海默型痴呆与路易体痴呆区分开来，该系统显示在阿尔茨海默型痴呆中，从后扣带回至楔前叶的血流减少。然而，基于体素的特异性区域分析系统评分与动脉自旋标记之间的关系仍不清楚。为了研究后扣带回楔前叶的脑萎缩评分与动脉自旋标记值之间的关系。
纳入使用基于体素的区域分析系统进行脑磁共振成像的疑似痴呆患者。他们被分类如下：第1组（疑似阿尔茨海默型痴呆）在感兴趣体积中有≥2的萎缩；第2组（疑似路易体痴呆）在感兴趣体积中有<2的萎缩且在脑桥背侧的灰质和白质中有≥0.2的萎缩；第3组包括不符合这些标准的患者。评估感兴趣体积内的萎缩、萎缩区域百分比、萎缩率、全脑萎缩百分比、年龄以及后扣带回楔前叶的最大动脉自旋标记值之间的相关值。
第1、2和3组分别包括179、143和197名患者。后扣带回楔前叶的动脉自旋标记值分别为77.0±24.4 - 77.3±25.2、78.3±81.3 - 80.2±23.6和80.2±22.3 - 80.4±22.8 mL/min/100g。第1组全脑萎缩与动脉自旋标记之间的相关系数为-0.189至-0.214（P<0.01）。第2组全脑萎缩与动脉自旋标记之间的相关系数为-0.215至-0.223（P<0.01）。第3组未显示出显著相关性。在阿尔茨海默型痴呆与其他组之间，ASL 1和2值未观察到统计学显著差异（ASL 1：74.5 mL/min/100g对78.8 mL/min/100g，P = 0.08；ASL 2：74.8 mL/min/100g对79.2 mL/min/100g，P = 0.101）。在阿尔茨海默型痴呆与DLB组之间，ASL 1和2值未观察到统计学显著差异（ASL 1：74.5 mL/min/100g对69.3 mL/min/100g，P = 0.093；ASL 2：74.8 mL/min/100g对78.9 mL/min/100g，P = 0.258）。
后扣带回和楔前叶血流减少在阿尔茨海默型痴呆和路易体痴呆中与脑萎缩仅显示出弱相关性。因此，它不是区分阿尔茨海默型痴呆与路易体痴呆及其他组的可靠标志物。
在诊断痴呆时，有必要避免单独使用脑血流评估。
