Article Figures & Data
Figures
- FIGURE 1.
ROI analyses of glucose metabolism in CADASIL patients given as percentage of mean of healthy volunteers in cortical and subcortical structures (mean value of corresponding ROIs of right and left hemispheres). Reductions of rCMRglc are most pronounced in subcortical gray matter but are similarly observed in all cortical lobes. front. = frontal; G. = Gyrus; inf. = inferior; lat. = lateral; med. = medial; occipitotemp. = occipitotemporal; par. = parietal; sup. = superior.
- FIGURE 2.
Asymmetry indices (%) of glucose metabolism in CADASIL patients and healthy volunteers. Considerably higher asymmetry in patients emphasizes inhomogeneous, focal accentuated character of lesion as also illustrated in case examples in Figures 4 and 5. *High asymmetry index in healthy volunteers in this particularly small ROI was due to structural asymmetry in this ROI in 2 individuals. front. = frontal; G. = Gyrus; inf. = inferior; lat. = lateral; med. = medial; occipitotemp. = occipitotemporal; par. = parietal; sup. = superior.
- FIGURE 3.
Comparison of CADASIL patient group and healthy volunteers. Transverse slices show z scores representing, on pixel-by-pixel basis, deviation of patient group from control template. Color scale represents SD and covers range from 0 to 4 SDs. Pixels with reduction of rCMRglc beyond 2 SDs were present in thalamus; striatum; insula; and parts of frontal, temporal, and parietal cortices.
- FIGURE 4.
Representative examples of characteristic 18F-FDG PET findings in CADASIL patients. (A) Template of control group for comparison. (B) A 64-y-old female CADASIL patient without physical disability (Rankin scale score, 0) or cognitive deficits (MMSE score, 30). In this patient, only moderate reductions of rCMRglc, predominantly in anterior cingulate, temporal lobe, insula, caudate (without marked asymmetry), and left thalamus, were seen. (C) A 50-y-old male CADASIL patient clinically presenting with marked disability (Rankin scale score, 3) and dementia (MMSE score, 14). Pronounced reduction of rCMRglc is seen in frontal, temporal, and parietal cortices (left > right) and in left striatum and thalamus. Metabolism is reduced in right cerebellar hemisphere, suggesting crossed cerebellar diaschisis.
- FIGURE 5.
Coregistered MR images and 18F-FDG PET scans of 62-y-old male CADASIL patient (Rankin scale score, 2; MMSE score, 15) illustrate structural and functional relationships. (A) Series of 4 consecutive slices at level of basal ganglia. Severe reduction of rCMRglc in left caudate, corresponding to subcortical infarction at this location, also extends into internal capsule. Moderate cortical atrophy but asymmetric glucose metabolism with marked decrease of rCMRglc is seen within left frontal and temporal cortices in absence of cortical infarcts. Left thalamus shows hypometabolism in absence of MRI-visible lesion. (B) Series of 4 consecutive slices at cerebellar level. Vascular lesion is seen in left cerebellar hemisphere, with corresponding defect in PET scan. Overall lower rCMRglc is seen in right cerebellar hemisphere, which shows no visible MRI lesion. In conjunction with observed hypometabolism in left cortex, this finding indicates crossed cerebellar diaschisis.
Tables
Group Parameter rCMRglc Frontal Parietal Temporal Occipital Thalamic Striatal Cerebellar CADASIL Mean 28.5 29.0 24.8 31.9 20.1 27.3 27.1 SD 8.1 8.1 6.3 7.2 7.0 6.9 8.0 Control Mean 42.5 42.7 36.8 41.7 39.0 45.3 37.2 SD 8.5 8.7 8.1 9.3 9.8 10.4 8.6 P <0.001 <0.001 <0.001 <0.01 <0.001 <0.001 <0.01 Data (μmol/100 g/min) are summarized for respective lobes and subcortical structures.
- TABLE 2
Asymmetry Indices of Glucose Metabolism for Cerebellar and Cerebral Hemispheres of Healthy Volunteers and CADASIL Patients
Group Cerebellar hemisphere Cerebral hemisphere Control 4.5 −0.9 CADASIL No apparent asymmetry of cerebellar rCMRglc (n = 5) 4.3 1.5 Visually apparent asymmetry of cerebellar rCMRglc (n = 6) 17.0 −9.1 Data (%) are given as mean reduction in cerebral hemisphere opposite respective cerebellar hemisphere.
