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Neuroimage Clin. 2014 Dec 5;7:187-94. doi: 10.1016/j.nicl.2014.12.004. eCollection 2015.

Brain metabolic maps in Mild Cognitive Impairment predict heterogeneity of progression to dementia.

Author information

1
Università Vita-Salute San Raffaele, Milan, Italy ; Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy ; Clinical Neuroscience Department, Neurorehabilitation Unit, San Raffaele Hospital, Milan, Italy.
2
Istituto di Bioimmagini e Fisiologia Molecolare C.N.R., Segrate, Italy.
3
Department of Neurology, San Raffaele Hospital, Milan, Italy.
4
Clinical Neuroscience Department, Neurorehabilitation Unit, San Raffaele Hospital, Milan, Italy.
5
Istituto Universitario degli Studi Superiori, Pavia, Italy.
6
Università Vita-Salute San Raffaele, Milan, Italy ; Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy ; Istituto di Bioimmagini e Fisiologia Molecolare C.N.R., Segrate, Italy ; Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy.

Abstract

[(18)F]FDG-PET imaging has been recognized as a crucial diagnostic marker in Mild Cognitive Impairment (MCI), supporting the presence or the exclusion of Alzheimer's Disease (AD) pathology. A clinical heterogeneity, however, underlies MCI definition. In this study, we aimed to evaluate the predictive role of single-subject voxel-based maps of [(18)F]FDG distribution generated through statistical parametric mapping (SPM) in the progression to different dementia subtypes in a sample of 45 MCI. Their scans were compared to a large normal reference dataset developed and validated for comparison at single-subject level. Additionally, Aβ42 and Tau CSF values were available in 34 MCI subjects. Clinical follow-up (mean 28.5 ± 7.8 months) assessed subsequent progression to AD or non-AD dementias. The SPM analysis showed: 1) normal brain metabolism in 14 MCI cases, none of them progressing to dementia; 2) the typical temporo-parietal pattern suggestive for prodromal AD in 15 cases, 11 of them progressing to AD; 3) brain hypometabolism suggestive of frontotemporal lobar degeneration (FTLD) subtypes in 7 and dementia with Lewy bodies (DLB) in 2 subjects (all fulfilled FTLD or DLB clinical criteria at follow-up); and 4) 7 MCI cases showed a selective unilateral or bilateral temporo-medial hypometabolism without the typical AD pattern, and they all remained stable. In our sample, objective voxel-based analysis of [(18)F]FDG-PET scans showed high predictive prognostic value, by identifying either normal brain metabolism or hypometabolic patterns suggestive of different underlying pathologies, as confirmed by progression at follow-up. These data support the potential usefulness of this SPM [(18)F]FDG PET analysis in the early dementia diagnosis and for improving subject selection in clinical trials based on MCI definition.

KEYWORDS:

Alzheimer's disease; Dementia diagnosis; Mild Cognitive Impairment; PET imaging; [18F]FDG

PMID:
25610780
PMCID:
PMC4300010
DOI:
10.1016/j.nicl.2014.12.004
[Indexed for MEDLINE]
Free PMC Article

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