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Differential diagnosis of MCI with Lewy bodies and MCI due to Alzheimer’s disease by visual assessment of occipital hypoperfusion on SPECT images

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Abstract

Purpose

Predicting progression of mild cognitive impairment (MCI) to Alzheimer’s disease (AD) or dementia with Lewy bodies (DLB) is important. We evaluated morphological and functional differences between MCI with Lewy bodies (MCI-LB) and MCI due to AD (MCI-AD), and a method for differentiating between these conditions using brain MRI and brain perfusion SPECT.

Methods

A continuous series of 101 subjects, who had visited our memory clinic and met the definition of MCI, were enrolled retrospectively. They were consisted of 60 MCI-LB and 41 MCI-AD subjects. Relative cerebral blood flow (rCBF) on SPECT images and relative brain atrophy on MRI images were evaluated. We performed voxel-based analysis and visually inspected brain perfusion SPECT images for regional brain atrophy, occipital hypoperfusion and the cingulate island sign (CIS), for differential diagnosis of MCI-LB and MCI-AD.

Results

MRI showed no significant differences in regional atrophy between the MCI-LB and MCI-AD groups. In MCI-LB subjects, occipital rCBF was significantly decreased compared with MCI-AD subjects (p < 0.01, family wise error [FWE]-corrected). Visual inspection of occipital hypoperfusion had sensitivity, specificity, and accuracy values of 100%, 73.2% and 89.1%, respectively, for differentiating MCI-LB and MCI-AD. Occipital hypoperfusion was offered higher diagnostic utility than the CIS.

Conclusions

The occipital lobe was the region with significantly decreased rCBF in MCI-LB compared with MCI-AD subjects. Occipital hypoperfusion on brain perfusion SPECT may be a more useful imaging biomarker than the CIS for visually differentiating MCI-LB and MCI-AD.

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Authors and Affiliations

  1. Neurocognitive Disorders Medical Center, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiyacho, Himeji, Hyogo, 670-8560, Japan

    Takashi Nakata, Kenichi Shimada, Haruhiko Oda & Akira Terashima

  2. Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, Japan

    Takashi Nakata, Takahiro Yamada & Kazunari Ishii

  3. Department of Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center, 520 Saisho-Ko, Himji, Hyogo, Japan

    Takashi Nakata, Kenichi Shimada, Akiko Iba, Haruhiko Oda & Akira Terashima

  4. Department of Psychiatry, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiyacho, Himeji, Hyogo, Japan

    Akiko Iba

  5. Hyogo Mental Health Center, 3 Noborio, Kamitanigami, Yamadacho, Kita-Ku, Kobe, Hyogo, Japan

    Akiko Iba & Haruhiko Oda

  6. Department of Diagnostic and Interventional Radiology, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiyacho, Himeji, Hyogo, Japan

    Yutaka Koide, Ryota Kawasaki & Kazunari Ishii

  7. Department of Radiology and Nuclear Medicine, Hyogo Brain and Heart Center, 520 Saisho-Ko, Himeji, Hyogo, Japan

    Yutaka Koide, Ryota Kawasaki & Kazunari Ishii

Authors
  1. Takashi Nakata
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  2. Kenichi Shimada
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  3. Akiko Iba
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  4. Haruhiko Oda
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  5. Akira Terashima
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  6. Yutaka Koide
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  7. Ryota Kawasaki
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  8. Takahiro Yamada
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  9. Kazunari Ishii
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Correspondence to Takashi Nakata.

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All investigations were carried out according to the Declaration of Helsinki. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. All co-authors have read and approved the submission. This study was approved by the ethics committee of Hyogo Brain and Heart Center (now called Hyogo Prefectural Harima-Himeji General Medical Center) and the requirement to obtain written informed consent was waived because this was a retrospective study.

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Nakata, T., Shimada, K., Iba, A. et al. Differential diagnosis of MCI with Lewy bodies and MCI due to Alzheimer’s disease by visual assessment of occipital hypoperfusion on SPECT images. Jpn J Radiol 42, 308–318 (2024). https://doi.org/10.1007/s11604-023-01501-3

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