Microbleeds in Alzheimer disease are more related to cerebral amyloid angiopathy than cerebrovascular disease.

Cerebral amyloid angiopathy (CAA) is one of the cardinal pathological features in the vascular components of Alzheimer's disease (AD). CAA itself results in disrupted microvasculature, mainly in the cerebral cortex, eventually leading to a brain cortical or subcortical hemorrhage in a population of elderly people, but clinically overt brain hemorrhages are not so frequent in AD patients. Here we assessed 50 AD patients and 26 controls to detect latent brain hemorrhages with gradient-echo T(2)*-weighted images, a sensitive magnetic resonance imaging technique to detect hemosiderin components in the brain. Microbleeds, demarcated as low-intensity spots in T(2)*-weighted images, were detected in 16.7% of AD patients without cerebrovascular disease (CVD) and in 12.5% of those with CVD, while no microbleeding was detected in the control subjects. No significant difference was observed between the microbleed-positive group and the microbleed-negative counterpart in their clinical background, such as hypertension, the use of antiplatelet drugs and smoking. In addition, white matter high intensities in the T(2)-weighted image were significantly more confluent in the microbleed-positive AD group than its negative counterpart. In conclusion, our evaluation of AD brains revealed that latent microbleeds in AD patients are more frequent than in normal controls. Microbleeds not being related to common hemorrhagic risk factors, but being significantly related to white matter pathologies suggested that microbleeds in AD may be associated with CAA, but not with hypertension or CVD.

[Multi-center study for the evaluation of clinical usefulness of attenuation and scatter correction on 201Tl myocardial SPECT].

The aim of this study was to evaluate the clinical usefulness of attenuation and scatter correction (AC, SC) on a 201Tl myocardial single-photon emission computed tomography (201Tl SPECT) as a multi-center trial. With a dual-detecter and a triple-detector SPECT systems with a 99mTc transmission source, simultaneous transmission/emission tomography (TCT/ECT) was performed on 38 patients with angiographically coronary heart disease (CHD) and 26 patients without evidence of CHD. Stress and delayed attenuation and scatter corrected images (SAC) and uncorrected images (NC) were reconstructed. On NC images of normal cases, influence of attenuation was greater in male than female. In comparison of 201Tl distribution between male and female, significant decrease in 201Tl activity was observed in the inferoposterior wall in male and that was observed in the anterobasal wall of the left myocardium in female. Such a difference in 201Tl distribution between male and female disappeared on SAC images. On the diagnostic performance for the identification of CHD, SAC images demonstrated improved specificity and accuracy values in the right coronary arterial territory (RCA) with visual analysis statistically. Sensitivity value in the RCA was also improved, but it was not statistically significant. Sensitivity value in the left circumflex arterial territory (LCX) increased without decrease in specificity value on SAC images. In the left anterior descending arterial territory (LAD), sensitivity value increased on SAC images. Although specificity value decreased on SAC images in LAD territory, it was not statistically significant. The difference in 201Tl distribution between male and female is improved in normal cases by attenuation and scatter correction on 201Tl myocardial SPECT. Diagnostic performance of CHD is also improved by attenuation and scatter correction, especially in territories of which specificity in assessing the absence of disease have been suboptimal. In conclusion, attenuation and scatter correction on 201Tl myocardial SPECT is considered to be clinically useful.