RESUMO
Most MRI studies of Alzheimer's disease (AD) and frontotemporal dementia (FTD) have assessed structural, perfusion and diffusion abnormalities separately while ignoring the relationships across imaging modalities. This paper aimed to assess brain gray (GM) and white matter (WM) abnormalities jointly to elucidate differences in abnormal MRI patterns between the diseases. Twenty AD, 20 FTD patients, and 21 healthy control subjects were imaged using a 4 Tesla MRI. GM loss and GM hypoperfusion were measured using high-resolution T1 and arterial spin labeling MRI (ASL-MRI). WM degradation was measured with diffusion tensor imaging (DTI). Using a new analytical approach, the study found greater WM degenerations in FTD than AD at mild abnormality levels. Furthermore, the GM loss and WM degeneration exceeded the reduced perfusion in FTD whereas, in AD, structural and functional damages were similar. Joint assessments of multimodal MRI have potential value to provide new imaging markers for improved differential diagnoses between FTD and AD.
RESUMO
Structural magnetic resonance imaging (MRI) of brain tissue loss and physiological imaging of regional cerebral blood flow (rCBF) can provide complimentary information for the characterization of brain disorders, such as Alzheimer's disease (AD) but studies into gains in classification power for AD using these image modalities jointly have been limited. Our aim in this study was to determine the joint contribution of structural and perfusion-weighted imaging for the classification of AD in a cross-sectional study using an integrated multimodality MRI processing framework and a cortical surface-based analysis approach. We used logistic regression analysis to determine sequentially the value of cortical thickness, rCBF, and cortical thickness and rCBF jointly for classification for diagnosis of AD compared to controls. We further tested the extent to which cortical thinning and reduced rCBF explain individually or together variability in dementia severity. Separate analysis of structural MRI and perfusion-weighted MRI data yielded the well-established pattern of cortical thinning and rCBF reduction in AD, affecting predominantly temporo-parietal brain regions. Using structural MRI and perfusion-weighted MRI jointly indicated that cortical thinning dominated the classification of AD and controls without significant contributions from rCBF. However there was also a positive interaction between reduced rCBF and cortical thinning in the right superior temporal sulcus, implying that structural and physiological brain alterations in AD can be complementary. Compared to reduced rCBF, regional cortical thinning better explained the variability in dementia severity. In conclusion, structural brain alterations compared to physiological variations are the dominant features of MRI in AD.