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Comparison of Regional Brain Volume and Glucose Metabolism Between Patients with Mild Dementia with Lewy Bodies and Those with Mild Alzheimer's Disease

¹ Department of Radiology and Nuclear Medicine, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan; ² Department of Medical Engineering, School of Allied Health Sciences, Faculty of Medicine, Osaka University, Suita, Osaka, Japan; ³ Clinical Application Technology Group, Daiichi Radioisotope Laboratories, Tokyo, Japan; ⁴ Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and ⁵ Division of Medical Technology and Science, Health Science Course, Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

View larger version (33K): [in this window] [in a new window]   FIGURE 1.  Algorithm for calculating regional structural volume and glucose metabolism An example of calculating hippocampal volume and metabolism is shown. Hippocampal VOI template is transformed to individual brain and, using this VOI template on individual segmented MR image, hippocampi are extracted and hippocampal volume is calculated. Then, using extracted hippocampi as a hippocampal VOI for individual coregistered PET image, hippocampal counts representing glucose metabolism are determined.

View larger version (54K): [in this window] [in a new window]   FIGURE 2.  Voxels with significantly lower GM density or glucose metabolism are shown in axial plane of standard brain. (A) Left caudate and putamen GM densities in DLB group were significantly lower than those of NC group (upper left row). Left hippocampal and parahippocampal GM densities in AD group were significantly lower than those of NC group (lower left row). Bilateral occipital, temporoparietal, and frontal glucose metabolisms in DLB group were significantly lower than those in NC group (upper right row), and parietal and posterior cingulated metabolisms were also decreased (not shown). Bilateral posterior cingulate glucose metabolism in AD group was significantly lower than that in NC group (lower right row) (P < 0.05, corrected). (B) Left caudate GM densities in DLB group were significantly lower than those of AD group (upper row). Bilateral occipital glucose metabolism was significantly decreased in DLB compared with that in AD (lower row), and glucose metabolism in bilateral frontal, parietotemporal association cortices and left posterior cingulate gyrus, was also significantly reduced in DLB (not shown) (P < 0.001, uncorrected).

View larger version (7K): [in this window] [in a new window]   FIGURE 3.  ROC curves for PET and MRI diagnostic performances in discriminating DLB from AD. Area under ROC curve of Occ/Hipp by PET (area under the curve [Az] = 0.941) was the largest among all values. (A) Relative regional volumes of hippocampi (Hipp/TIV) and striata (Str/TIV) by MRI. (B) Relative regional glucose metabolism in hippocampi (Hipp/pons) and occipital lobes (Occ/pons) by 18F-FDG PET. (C) Affected regional ratio obtained by PET (Occ/Hipp) and MRI (Str/Hipp). TPF = true-positive fraction = sensitivity; FPF = false-positive fraction = 1 – specificity.