Visually preserved metabolism in posterior cingulate cortex relative to hypometabolism in precuneus and cuneus, the cingulate island sign, is a feature of dementia with Lewy bodies (DLB) on FDG-PET. Lower cingulate island sign ratio (posterior cingulate cortex/cuneus+precuneus; FDG-CISr) values have been associated with a higher Braak neurofibrillary tangle stage in autopsied DLB. Using voxel-wise analysis, we assessed the patterns of regional cortical perfusion and metabolism, and using an atlas-based approach, we measured perfusion cingulate island sign ratio on arterial spin labeling MRI (ASL-CISr), and its associations with FDG-CISr, uptake on tau-PET and clinical severity in DLB. Our study sample (n = 114) included clinically probable DLB patients (n = 19), age-matched patients with probable Alzheimer's disease dementia (AD; n = 19) and matched controls (n = 76) who underwent MRI with 3-dimensional pseudo-continuous arterial spin labeling, 18F-FDG-PET and 18F-AV-1451 tau PET. Patterns of cortical perfusion and metabolism were derived from quantitative maps using Statistical Parametric Mapping. DLB patients showed hypoperfusion on ASL-MRI in precuneus, cuneus and posterior parieto-occipital cortices, compared to controls, and relatively spared posterior cingulate gyrus, similar to pattern of hypometabolism on FDG-PET. DLB patients had higher ASL-CISr and FDG-CISr than AD patients (p <0.001). ASL-CISr correlated with FDG-CISr in DLB patients (r = 0.67; p =0.002). Accuracy of distinguishing DLB from AD patients was 0.80 for ASL-CISr and 0.91 for FDG-CISr. Lower ASL-CISr was moderately associated with a higher composite medial temporal AV-1451 uptake (r = -0.50; p =0.03) in DLB. Lower perfusion in precuneus and cuneus was associated with worse global clinical scores. In summary, the pattern of cortical hypoperfusion on ASL-MRI is similar to hypometabolism on FDG-PET, and respective cingulate island sign ratios correlate with each other in DLB. Non-invasive and radiotracer-free ASL-MRI may be further developed as a tool for the screening and diagnostic evaluation of DLB patients in a variety of clinical settings where FDG-PET is not accessible.

译文

相对于前突和楔形的低代谢,后扣带回皮层的视觉上保留的代谢是扣带回岛的标志,是fdg-pet上带有路易体 (DLB) 的痴呆症的特征。较低的扣带回岛征比 (后扣带回皮层/楔形前突; Fdg-cisr) 值与尸检DLB中较高的Braak神经原纤维缠结阶段有关。使用体素分析,我们评估了区域皮质灌注和代谢的模式,并使用基于图谱的方法,我们在动脉自旋标记MRI (asl-cisr) 上测量了灌注扣带回岛征比及其与fdg-cisr,DLB对tau-PET的摄取和临床严重程度。我们的研究样本 (n   =   114) 包括临床可能的DLB患者 (n   =   19),年龄匹配的可能的阿尔茨海默氏病痴呆 (AD) 患者; N   =   19) 和匹配的对照组 (n   =   76),他们接受了三维假连续动脉自旋标记,18F-FDG-PET和18F-AV-1451 tau PET的MRI。皮质灌注和代谢的模式是使用统计参数映射从定量图中得出的。与对照组相比,DLB患者的asl-mri显示出前,楔形和顶枕后皮质的asl-mri灌注不足,并且相对较少的后扣带回,类似于fdg-pet的低代谢模式。DLB患者的ASL-CISr和FDG-CISr高于AD患者 (p  <0.001)。DLB患者asl-cisr与fdg-cisr相关 (r   =   0.67; P   = 0.002)。Asl-cisr和fdg-cisr区分DLB与AD患者的准确性0.80,fdg-cisr 0.91。在DLB中,较低的ASL-CISr与较高的复合内侧颞AV-1451摄取 (r   =  -0.50; P   = 0.03) 中度相关。前肌和楔形骨灌注降低与整体临床评分差有关。总而言之,asl-mri上的皮质低灌注模式与fdg-pet上的低代谢相似,并且DLB中各自的扣带回岛符号比率彼此相关。可以进一步开发非侵入性和无放射性示踪剂的asl-mri,作为在无法访问fdg-pet的各种临床环境中对DLB患者进行筛查和诊断评估的工具。

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