Regional cortical perfusion on arterial spin labeling MRI in dementia with Lewy bodies: Associations with clinical severity, glucose metabolism and tau PET

• Published in: NeuroImage clinical 2018-01, Vol.19, p.939-947
• Main Authors: Nedelska, Zuzana, Senjem, Matthew L., Przybelski, Scott A., Lesnick, Timothy G., Lowe, Val J., Boeve, Bradley F., Arani, Arvin, Vemuri, Prashanthi, Graff-Radford, Jonathan, Ferman, Tanis J., Jones, David T., Savica, Rodolfo, Knopman, David S., Petersen, Ronald C., Jack, Clifford R., Kantarci, Kejal
• Format: Article
• Language: English
• Subjects: Aged; Arterial spin labeling MRI; Cerebral Cortex - diagnostic imaging; Cerebral Cortex - metabolism; Cerebral Cortex - physiopathology; Cerebrovascular Circulation - physiology; Cingulate island sign ratio; Cortical perfusion; Dementia with Lewy bodies; FDG PET; Female; Glucose - metabolism; Humans; Lewy Body Disease - diagnostic imaging; Lewy Body Disease - metabolism; Lewy Body Disease - physiopathology; Magnetic Resonance Imaging; Male; Middle Aged; Or AV1–1451 tau PET; Positron-Emission Tomography; Regular; Severity of Illness Index; Spin Labels; tau Proteins - metabolism
• ISSN: 2213-1582; 2213-1582
• DOI: 10.1016/j.nicl.2018.06.020

Visually preserved metabolism in posterior cingulate cortex relative to hypometabolism in precuneus and cuneus, the cingulate island sign, is a feature of dementia with Lewy bodies (DLB) on FDG-PET. Lower cingulate island sign ratio (posterior cingulate cortex/cuneus+precuneus; FDG-CISr) values have been associated with a higher Braak neurofibrillary tangle stage in autopsied DLB. Using voxel-wise analysis, we assessed the patterns of regional cortical perfusion and metabolism, and using an atlas-based approach, we measured perfusion cingulate island sign ratio on arterial spin labeling MRI (ASL-CISr), and its associations with FDG-CISr, uptake on tau-PET and clinical severity in DLB. Our study sample (n = 114) included clinically probable DLB patients (n = 19), age-matched patients with probable Alzheimer's disease dementia (AD; n = 19) and matched controls (n = 76) who underwent MRI with 3-dimensional pseudo-continuous arterial spin labeling, 18F-FDG-PET and 18F-AV-1451 tau PET. Patterns of cortical perfusion and metabolism were derived from quantitative maps using Statistical Parametric Mapping. DLB patients showed hypoperfusion on ASL-MRI in precuneus, cuneus and posterior parieto-occipital cortices, compared to controls, and relatively spared posterior cingulate gyrus, similar to pattern of hypometabolism on FDG-PET. DLB patients had higher ASL-CISr and FDG-CISr than AD patients (p