Top

Published in:

Open Access 01-12-2016 | Original research

The cingulate island sign within early Alzheimer’s disease-specific hypoperfusion volumes of interest is useful for differentiating Alzheimer’s disease from dementia with Lewy bodies

Authors: Etsuko Imabayashi, Kota Yokoyama, Tadashi Tsukamoto, Daichi Sone, Kaoru Sumida, Yukio Kimura, Noriko Sato, Miho Murata, Hiroshi Matsuda

Published in: EJNMMI Research | Issue 1/2016

Abstract

Background

In addition to occipital hypoperfusion, preserved metabolism of the posterior cingulate gyri (PCG) relative to the precunei is known as the cingulate island sign (CIS) in the patients with dementia with Lewy bodies (DLB). CIS has been detected using [¹⁸F]fluorodeoxyglucose positron emission tomography but not using brain perfusion single-photon emission computed tomography (SPECT). The purpose of this study was to optimize brain perfusion SPECT to enable differentiation of DLB from Alzheimer’s disease (AD) using CIS and occipital hypoperfusion.

Eighteen patients with probable DLB and 17 age-matched Pittsburgh compound B-positive patients with AD underwent technetium-99m ethyl cysteinate dimer SPECT. SPECT Z-score maps were generated using the easy Z-score imaging system (eZIS) analysis software (Matsuda H, Mizumura S, Nagao T, Ota T, Iizuka T, Nemoto K, Takemura N, Arai H, Homma A, AJNR Am J Neuroradiol 28(4):731–6, 2007), which included volumes of interest (VOIs) in which a group comparison between patients with AD and cognitively normal subjects revealed significant relative hypoperfusion. We used the Montreal Neurological Institute (MNI) space anatomical border to divide the bilateral PCG to precunei VOIs into two parts, the PCG and precunei. Z-scores in the PCG, precunei, and occipital areas and ratios were analysed and compared with receiver operating characteristic (ROC) curve analyses.

Results

The largest area under the curve (AUC) value for use in differentiating DLB from AD with the ratio of PCG to medial occipital was 0.87; the accuracy, sensitivity, and specificity were 85.7, 88.9, and 82.4 %, respectively. The AUC with the ratio of PCG to the precuneus was smaller, and it was 0.85, though no significant difference was observed between these two AUCs.

Conclusions

The Z-score ratio of the PCG within the early-AD-specific VOI to medial-occipital area is clinically useful in discriminating demented patients with DLB from those with AD.

Available only for authorised users

Walker Z, Costa DC, Walker RW, Shaw K, Gacinovic S, Stevens T, et al. Differentiation of dementia with Lewy bodies from Alzheimer’s disease using a dopaminergic presynaptic ligand. J Neurol Neurosurg Psychiatry. 2002;73:134–40.CrossRefPubMedPubMedCentral

Yoshita M, Arai H, Arai H, Arai T, Asada T, Fujishiro H, et al. Diagnostic accuracy of 123I-meta-iodobenzylguanidine myocardial scintigraphy in dementia with Lewy bodies: a multicenter study. PLoS One. 2015;10:e0120540. doi:10.1371/journal.pone.0120540.CrossRefPubMedPubMedCentral

Shimizu S, Hirao K, Kanetaka H, Namioka N, Hatanaka H, Hirose D, et al. Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer’s disease. Eur J Nucl Med Mol Imaging. 2015;43:184–92. doi:10.1007/s00259-015-3146-y.CrossRefPubMedPubMedCentral

Caroli A, Testa C, Geroldi C, Nobili F, Barnden LR, Guerra UP, et al. Cerebral perfusion correlates of conversion to Alzheimer’s disease in amnestic mild cognitive impairment. J Neurol. 2007;254:1698–707. doi:10.1007/s00415-007-0631-7.CrossRefPubMed

Waragai M, Mizumura S, Yamada T, Matsuda H. Differentiation of early-stage Alzheimer’s disease from other types of dementia using brain perfusion single photon emission computed tomography with easy Z-score imaging system analysis. Dement Geriatr Cogn Disord. 2008;26:547–55. doi:10.1159/000180280.CrossRefPubMed

Kantarci K, Lowe VJ, Boeve BF, Weigand SD, Senjem ML, Przybelski SA, et al. Multimodality imaging characteristics of dementia with Lewy bodies. Neurobiol Aging. 2012;33:2091–105. doi:10.1016/j.neurobiolaging.2011.09.024.CrossRefPubMed

Yeo JM, Lim X, Khan Z, Pal S. Systematic review of the diagnostic utility of SPECT imaging in dementia. Eur Arch Psychiatry Clin Neurosci. 2013;263:539–52. doi:10.1007/s00406-013-0426-z.CrossRefPubMed

Kemp PM, Hoffmann SA, Tossici-Bolt L, Fleming JS, Holmes C. Limitations of the HMPAO SPECT appearances of occipital lobe perfusion in the differential diagnosis of dementia with Lewy bodies. Nucl Med Commun. 2007;28:451–6. doi:10.1097/MNM.0b013e328155d143.CrossRefPubMed

Imamura T, Ishii K, Sasaki M, Kitagaki H, Yamaji S, Hirono N, et al. Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer’s disease: a comparative study using positron emission tomography. Neurosci Lett. 1997;235:49–52.CrossRefPubMed

10.

Lim SM, Katsifis A, Villemagne VL, Best R, Jones G, Saling M, et al. The 18F-FDG PET cingulate island sign and comparison to 123I-beta-CIT SPECT for diagnosis of dementia with Lewy bodies. J Nucl Med. 2009;50:1638–45. doi:10.2967/jnumed.109.065870.CrossRefPubMed

11.

Graff-Radford J, Murray ME, Lowe VJ, Boeve BF, Ferman TJ, Przybelski SA, et al. Dementia with Lewy bodies: basis of cingulate island sign. Neurology. 2014;83:801–9. doi:10.1212/wnl.0000000000000734.CrossRefPubMedPubMedCentral

12.

O’Brien JT, Firbank MJ, Davison C, Barnett N, Bamford C, Donaldson C, et al. 18F-FDG PET and perfusion SPECT in the diagnosis of Alzheimer and Lewy body dementias. J Nucl Med. 2014;55:1959–65. doi:10.2967/jnumed.114.143347.CrossRefPubMed

13.

Matsuda H, Mizumura S, Nagao T, Ota T, Iizuka T, Nemoto K, Takemura N, Arai H, Homma A. Automated discrimination between very early Alzheimer disease and controls using an easy Z-score imaging system for multicenter brain perfusion single-photon emission tomography. AJNR Am J Neuroradiol. 2007;28(4):731-6. PubMed PMID: 17416830.

14.

Omachi Y, Ito K, Arima K, Matsuda H, Nakata Y, Sakata M, et al. Clinical impact of (11)C-Pittsburgh compound-B positron emission tomography carried out in addition to magnetic resonance imaging and single-photon emission computed tomography on the diagnosis of Alzheimer’s disease in patients with dementia and mild cognitive impairment. Psychiatry Clin Neurosci. 2015;69:741–51. doi:10.1111/pcn.12326.CrossRefPubMed

15.

McKeith IG, Dickson DW, Lowe J, Emre M, O’Brien JT, Feldman H, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65:1863–72. doi:10.1212/01.wnl.0000187889.17253.b1.CrossRefPubMed

16.

Matsuda H, Yagishita A, Tsuji S, Hisada K. A quantitative approach to technetium-99m ethyl cysteinate dimer: a comparison with technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med. 1995;22:633–7.CrossRefPubMed

17.

Takeuchi R, Matsuda H, Yonekura Y, Sakahara H, Konishi J. Noninvasive quantitative measurements of regional cerebral blood flow using technetium-99m-L, L-ECD SPECT activated with acetazolamide: quantification analysis by equal-volume-split 99mTc-ECD consecutive SPECT method. J Cereb Blood Flow Metab. 1997;17:1020–32. doi:10.1097/00004647-199710000-00003.CrossRefPubMed

18.

Imon Y, Matsuda H, Ogawa M, Kogure D, Sunohara N. SPECT image analysis using statistical parametric mapping in patients with Parkinson’s disease. J Nucl Med. 1999;40:1583–9.PubMed

19.

Chang L-T. A method for attenuation correction in radionuclide computed tomography. IEEE Trans Nucl Sci. 1978;25:638–43.CrossRef

20.

Friberg L, Andersen AR, Lassen NA, Holm S, Dam M. Retention of 99mTc-bicisate in the human brain after intracarotid injection. J Cereb Blood Flow Metab. 1994;14 Suppl 1:S19–27.PubMed

21.

Minoshima S, Frey KA, Koeppe RA, Foster NL, Kuhl DE. A diagnostic approach in Alzheimer’s disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET. J Nucl Med. 1995;36:1238–48.PubMed

22.

Matsuda H, Mizumura S, Nagao T, Ota T, Iizuka T, Nemoto K, et al. Automated discrimination between very early Alzheimer disease and controls using an easy Z-score imaging system for multicenter brain perfusion single-photon emission tomography. AJNR Am J Neuroradiol. 2007;28:731–6.PubMed

23.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.CrossRefPubMed

24.

Colloby SJ, Fenwick JD, Williams ED, Paling SM, Lobotesis K, Ballard C, et al. A comparison of (99m)Tc-HMPAO SPET changes in dementia with Lewy bodies and Alzheimer’s disease using statistical parametric mapping. Eur J Nucl Med Mol Imaging. 2002;29:615–22. doi:10.1007/s00259-002-0778-5.CrossRefPubMed

25.

Binnewijzend MA, Kuijer JP, van der Flier WM, Benedictus MR, Moller CM, Pijnenburg YA, et al. Distinct perfusion patterns in Alzheimer’s disease, frontotemporal dementia and dementia with Lewy bodies. Eur Radiol. 2014;24:2326–33. doi:10.1007/s00330-014-3172-3.CrossRefPubMed

26.

Fong TG, Inouye SK, Dai W, Press DZ, Alsop DC. Association cortex hypoperfusion in mild dementia with Lewy bodies: a potential indicator of cholinergic dysfunction? Brain Imaging Behav. 2011;5:25–35. doi:10.1007/s11682-010-9108-x.CrossRefPubMedPubMedCentral

27.

Gur RC, Ragland JD, Reivich M, Greenberg JH, Alavi A, Gur RE. Regional differences in the coupling between resting cerebral blood flow and metabolism may indicate action preparedness as a default state. Cereb Cortex. 2009;19:375–82. doi:10.1093/cercor/bhn087.CrossRefPubMed

28.

Laforce Jr R, Rabinovici GD. Amyloid imaging in the differential diagnosis of dementia: review and potential clinical applications. Alzheimers Res Ther. 2011;3:31. doi:10.1186/alzrt93.CrossRefPubMedPubMedCentral

Title: The cingulate island sign within early Alzheimer’s disease-specific hypoperfusion volumes of interest is useful for differentiating Alzheimer’s disease from dementia with Lewy bodies
Authors: Etsuko Imabayashi
Kota Yokoyama
Tadashi Tsukamoto
Daichi Sone
Kaoru Sumida
Yukio Kimura
Noriko Sato
Miho Murata
Hiroshi Matsuda
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: EJNMMI Research / Issue 1/2016
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/s13550-016-0224-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The cingulate island sign within early Alzheimer’s disease-specific hypoperfusion volumes of interest is useful for differentiating Alzheimer’s disease from dementia with Lewy bodies

Abstract

Background

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Targeted scVEGF/177Lu radiopharmaceutical inhibits growth of metastases and can be effectively combined with chemotherapy

Impact of fasting on 18F-fluorocholine gastrointestinal uptake and detection of lymph node metastases in patients with prostate cancer

The effect of purification of Ga-68-labeled exendin on in vivo distribution

Quantitative accuracy of 177Lu SPECT reconstruction using different compensation methods: phantom and patient studies

Pre-clinical quantitative imaging and mouse-specific dosimetry for 111In-labelled radiotracers

Dynamic PET evaluation of elevated FLT level after sorafenib treatment in mice bearing human renal cell carcinoma xenograft