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Distinct perfusion patterns in Alzheimer’s disease, frontotemporal dementia and dementia with Lewy bodies

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Abstract

Objectives

To compare pseudo-continuous arterial spin-labelled (PCASL) magnetic resonance imaging (MRI) measured quantitative cerebral blood flow (CBF) of patients with frontotemporal dementia (FTD), dementia with Lewy Bodies (DLB), Alzheimer’s disease (AD) and controls, in a region of interest (ROI) and voxel-wise fashion.

Methods

We analysed whole-brain 3D fast-spin-echo PCASL images of 20 FTD patients, 14 DLB patients, 48 AD patients and 50 controls from the Amsterdam Dementia Cohort. Regional CBF patterns were compared using analyses of variance for repeated measures. Permutation tests were used for voxel-wise comparisons. Analyses were performed using uncorrected and partial volume corrected (PVC) maps. All analyses were corrected for age and sex.

Results

There was an interaction between diagnosis and region (p < 0.001), implying differences in regional CBF changes between diagnostic groups. In AD patients, CBF was decreased in all supratentorial regions, most prominently so in the posterior regions. DLB patients showed lowest CBF values throughout the brain, but temporal CBF was preserved. Supratentorial PVC cortical CBF values were lowest in the frontal lobes in FTD patients, and in the temporal lobes in AD patients.

Conclusions

Patients with AD, FTD and DLB display distinct patterns of quantitative regional CBF changes. 3D-PCASL may provide additional value in the workup of dementia patients.

Key points

• Patterns of regional CBF changes differ between AD, FTD and DLB patients

• CBF is lower throughout the brain in DLB than AD and FTD

• 3D-PCASL MRI is a potential non-invasive and easily accessible alternative to FDG-PET

• 3D-PCASL MRI may be of additional value in the workup of dementia

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Abbreviations

Abeta:

Amyloid beta

NGMV:

Normalized grey matter volume

PCASL:

Pseudo-continuous arterial spin-labelling

PPC:

Precuneus and posterior cingulate

PVC:

Partial volume corrected

P-tau:

Phosphorylated-tau

T-tau:

Total-tau

WMH:

Vascular white matter hyperintensities

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Acknowledgments

The authors thank Ajit Shankaranarayanan of GE Healthcare for providing the 3D pseudo-continuous ASL sequence that was used to obtain data for this paper. The study was supported by the Alzheimer Center of the VU University Medical Center Amsterdam, the Netherlands.

The scientific guarantor of this publication is Prof. Dr. Frederik Barkhof. The authors of this manuscript declare relationships with the following companies:

M.A.A. Binnewijzend, J.P.A. Kuijer, W.M. van der Flier, M.R. Benedictus, C.M. Möller, Y.A.L. Pijnenburg and A.W. Lemstra report no disclosures.

N.D. Prins serves on the advisory board of Boehringer Ingelheim and Envivo. He has been a speaker at symposia organised by Janssen and Novartis. NDP has a senior fellowship at the Alzheimer Center VUmc partly supported by Vereniging AEGON and receives research support from the Brain Foundation of the Netherlands and Alzheimer Nederland. NDP receives no personal compensation for the activities mentioned above.

M.P. Wattjes serves as a consultant for Biogen-Idec. Dr. Wattjes receives research support from Biogen Idec, Bayer Healthcare, Roche and Janssen Cilag.

B.N.M. van Berckel receives research support from the Alzheimer Assistance Foundation, the Center for Translational Molecular Imaging, the Alzheimer Association, De Hersenstichting Nederland and the Internationale Stichting Alzheimer Onderzoek. Dr. van Berckel receives no personal compensation from these organizations.

P. Scheltens receives grant support (for the institution; the VUmc Alzheimer Center, see also below) from GE Healthcare, Danone Researcrh and MERCK. In the past 2 years he has received speaker’s fees (paid to the institution) from Lilly, GE Healthcare, Lundbeck, Danone and Jansen AI-Pfizer.

Research of the VUmc Alzheimer Center is part of the neurodegeneration research program of the Neuroscience Campus Amsterdam. The VUmc Alzheimer Center is supported by Alzheimer Nederland and Stichting VUmc fonds. The clinical database structure was developed with funding from Stichting Dioraphte.

F. Barkhof serves on the editorial boards of Brain, European Radiology, Radiology, Multiple Sclerosis and Neuroradiology and serves as a consultant for Bayer-Shering Pharma, Sanofi-Aventis, Biogen-Idec, EVA, Synthon BV, Merck-Serono, Jansen Alzheimer Immunotherapy, Novartis and Roche. Dr. Barkhof receives research support from the Dutch MS Society (EU-FP7). Dr. Barkhof has received consulting fees or honoraria for the consultancy mentioned above. Dr. Barkhof has received speaker’s fees from the Serono Symposia Foundation.

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (W.M. Van der Flier) has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because there were no animal subjects involved in this study. Some study subjects or cohorts have been previously reported elswhere by Binnewijzend et al. (Radiology 267:221–230, 2013). Methodology: retrospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, VU University Medical Center and Neuroscience Campus Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

    Maja A. A. Binnewijzend, Mike P. Wattjes, Bart N. M. van Berckel & Frederik Barkhof

  2. Department of Physics and Medical Technology, VU University Medical Center and Neuroscience Campus Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

    Joost P. A. Kuijer

  3. Alzheimercenter & Department of Neurology, VU University Medical Center and Neuroscience Campus Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

    Wiesje M. van der Flier, Marije R. Benedictus, Christiane M. Möller, Yolande A. L. Pijnenburg, Afina W. Lemstra, Niels D. Prins & Philip Scheltens

  4. Department of Epidemiology & Biostatistics, VU University Medical Center and Neuroscience Campus Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

    Wiesje M. van der Flier

Authors
  1. Maja A. A. Binnewijzend
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  2. Joost P. A. Kuijer
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  6. Yolande A. L. Pijnenburg
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Correspondence to Maja A. A. Binnewijzend.

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Binnewijzend, M.A.A., Kuijer, J.P.A., van der Flier, W.M. et al. Distinct perfusion patterns in Alzheimer’s disease, frontotemporal dementia and dementia with Lewy bodies. Eur Radiol 24, 2326–2333 (2014). https://doi.org/10.1007/s00330-014-3172-3

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  • DOI: https://doi.org/10.1007/s00330-014-3172-3

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