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Role of Neuroimaging in Alzheimer's Disease, with Emphasis on Brain Perfusion SPECT^*

Department of Nuclear Medicine, Saitama Medical University Hospital, Saitama, Japan

View larger version (25K): [in this window] [in a new window]   FIGURE 1.  Procedures for statistical image analysis of brain perfusion SPECT and MRI data. Anatomically standardized and then smoothed SPECT or gray matter image of subject is compared with each normal database by z score analysis. Obtained z score maps are displayed by overlay on anatomically standardized MRI template.

View larger version (108K): [in this window] [in a new window]   FIGURE 2.  Statistical image analysis for 78-y-old woman with amnestic MCI. (A) Brain perfusion SPECT data were analyzed with z score mapping system. Specific VOI for very early AD (bilateral posterior cingulate gyri and precunei and parietal association cortex) is demarcated by red lines on MRI template. Significantly decreased rCBF above z score of 2 was observed within this specific VOI (arrows). (B) Gray matter images extracted from MR images were analyzed with z score mapping system. Specific VOI for very early AD (bilateral medial temporal areas, including parahippocampal gyri and amygdaloid bodies) is demarcated by pink sections on MRI template. Significantly decreased gray matter concentration above z score of 2 was observed within this specific VOI (arrows).

View larger version (74K): [in this window] [in a new window]   FIGURE 3.  Comparison of z score mapping results for brain perfusion SPECT for converters (from amnestic MCI to AD) and nonconverters over 3 y. (A) For 56-y-old woman who converted from MCI to AD, high values characterizing decreases in rCBF (severity and extent) were seen even at baseline. These values were markedly elevated 3 y later. (B) For 68-y-old man who did not convert from MCI to AD, low values for severity and extent were seen at baseline. These values were not elevated 3 y later. X MMSE = mean score on Mini-Mental State Examination (MMSE) at the initial study; X+3 MMSE = score on MMSE at 3 y.

View larger version (72K): [in this window] [in a new window]   FIGURE 4.  Comparison of brain perfusion SPECT images for moderate AD and moderate DLB. DLB showed lower perfusion in occipital cortex than AD (arrows). In contrast, AD showed lower perfusion in medial temporal areas (arrowheads).

View larger version (119K): [in this window] [in a new window]   FIGURE 5.  Evaluation with z score mapping system of therapeutic effects of donepezil on brain perfusion SPECT for 68-y-old woman. (A) Baseline study 1 mo before donepezil showed significant decrease in rCBF within specific VOI for early AD. Mini-Mental State Examination (MMSE) score was 5 (out of 30). (B) At 3 mo after start of donepezil administration, all rCBF indices decreased from values at initial study, indicating amelioration of rCBF within specific VOI. MMSE score increased to 14 (out of 30).