Comparative Diagnostic Utility of Different MR Modalities in Mild Cognitive Impairment and Alzheimer’s DiseaseKantarci K. · Xu Y. · Shiung M.M. · O’Brien P.C. · Cha R.H. · Smith G.E. · Ivnik R.J. · Boeve B.F. · Edland S.D. · Kokmen E. · Tangalos E.G. · Petersen R.C. · Jack Jr. C.R.
Departments of aDiagnostic Radiology, bHealth Sciences Research, cPsychiatry and Psychology, dNeurology, eClinical Epidemiology and fInternal Medicine, Mayo Clinic, Rochester, Minn., USA
This study compares the diagnostic accuracy of magnetic resonance (MR)-based hippocampal volumetry, single voxel 1H MR spectroscopy (1H MRS) and MR diffusion-weighted imaging (DWI) measurements in discriminating patients with amnestic mild cognitive impairment (MCI), Alzheimer’s disease (AD) and normally aging elderly. Sixty-one normally aging elderly, 24 MCI and 22 AD patients underwent MR-based hippocampal volumetry, 1H MRS and DWI. 1H MRS voxels were placed over both of the posterior cingulate gyri, and N-acetyl aspartate (NAA)/creatine (Cr), myoinositol (MI)/Cr and NAA/MI ratios were obtained. Apparent diffusion coefficient (ADC) maps were derived from DWI, and hippocampal borders were traced to measure hippocampal ADC. At 80% specificity, the most sensitive single measurement to discriminate MCI (79%) and AD (86%) from controls was hippocampal volumes. The most sensitive single measurement to discriminate AD from MCI was posterior cingulate gyrus NAA/Cr (67%). At high specificity (>85–90%), combinations of MR measures had superior diagnostic sensitivity compared with any single MR measurement for the AD vs. control and control vs. MCI comparisons. The MR measures that best discriminate more from less affected individuals along the cognitive continuum from normal to AD vary with disease severity. Selection of imaging measures used for clinical assessment or monitoring efficiency of therapeutic intervention should be tailored to the clinical stage of the disease.
Clifford R. Jack, Jr., MD
Mayo Clinic, 200 First Street SW
Rochester, MN 55905 (USA)
Tel. +1 507 284 8548, Fax +1 507 284 2405
Accepted: June 21, 2002
Number of Figures : 3, Number of Tables : 4, Number of References : 46
Dementia and Geriatric Cognitive Disorders
Vol. 14, No. 4, Year 2002 (Cover Date: Released November 2002)
Journal Editor: V. Chan-Palay, New York, N.Y.
ISSN: 1420–8008 (print), 1421–9824 (Online)
For additional information: http://www.karger.com/journals/dem