Relationship between Cerebral Perfusion on Arterial Spin Labeling (ASL) MRI with Brain Volumetry and Cognitive Performance in Mild Cognitive Impairment and Dementia due to Alzheimer's Disease

Abstract

Context: Cerebral blood flow (CBF) measurement using arterial spin labelling (ASL) MRI sequences has recently emerged as a prominent tool in dementia research. Aims: To establish association between quantified regional cerebral perfusion and gray matter (GM) volumes with cognitive measures in mild cognitive impairment (MCI) and early Alzheimer's Dementia (AD), using three dimensional fast spin echo pseudo-continuous ASL MRI sequences. Settings and Design: Hospital-based cross-sectional study. Methods and Material: Three age-matched groups, i.e., 21 cognitively normal healthy controls (HC), 20 MCI and 19 early AD patients diagnosed using neuropsychological tests and who consented for multimodality 3T MRI were recruited for the study. Statistical Analysis Used: Statistical parametric mapping and regions of interest (ROI) multivariate analysis of variance was used to ascertain differences between patients and controls on MRI-volumetry and ASL. Linear regression was used to assess relationship between CBF with GM atrophy and neuropsychological test measures. Results: Compared to HC, patients with MCI and AD had significantly lower quantified perfusion in posterior cingulate and lingual gyri, over hippocampus in MCI, with no differences noted between MCI and AD. Atrophy over the middle temporal gyrus and hippocampus differentiated AD from MCI. No significant positive correlations were noted between perfusion and GM volumes in ROI with the exception of temporal neocortex. Significantly positive coefficient b-value (p < 0.01) were apparent between global cognition with CBF in precuneus, temporal neocortex and precuneus volume, with negative b-values noted between medial temporal CBF for global cognition and recall scores. Conclusions: ROI-based CBF measurements differentiated MCI and AD from HC; volumetry of medial and neocortical temporal GM separates AD from MCI. Correlations between CBF and neuropsychology are variable and require further longitudinal studies to gauge its predictive utility on cognitive trajectory in MCI.

Alzheimer's disease: Potential pathogenesis and imaging findings

“…This study also showed that changes in cognitive function were not associated with changes in CBF 76 . However, some studies have found that the MMSE score of AD patients is correlated with CBF in the right posterior cingulate cortex (PCC), hippocampus and bilateral temporoparietal combined cortical 75,77 . Another study found that CBF in the precuneus and temporal cortex was positively correlated with cognitive function in AD patients, while it was negatively correlated in the hippocampus and middle frontal gyrus, which may also be related to compensation 75 .…”

“…Arterial spin labeling ASL is a noninvasive method to quantitatively detect cerebral blood flow (CBF) using arterial water molecules as endogenous tracer. 75 CBF is related to cerebrovascular and neuronal function, and CBF is decreased in AD patients. 76 A meta-analysis showed reduced CBF in precuneus in MCI patients and in broader areas, especially the posterior cingulate and temporal-parietal regions in AD patients.…”

“…75,77 Another study found that CBF in the precuneus and temporal cortex was positively correlated with cognitive function in AD patients, while it was negatively correlated in the hippocampus and middle frontal gyrus, which may also be related to compensation. 75 No association has been found between CBF reduction and brain atrophy in areas other than the temporal neocortex in AD dementia. 75,81 PCC and CBF from bilateral superior medial frontal regions could predict the progression of MCI into AD dementia and how long it will take.…”

“…75 No association has been found between CBF reduction and brain atrophy in areas other than the temporal neocortex in AD dementia. 75,81 PCC and CBF from bilateral superior medial frontal regions could predict the progression of MCI into AD dementia and how long it will take. 79 CBF in PCC, bilateral medial superior frontal gyrus, and left inferior frontal region can predict cognitive function changes (as assessed by modified MMSE-3MSE).…”

“…ASL is a noninvasive method to quantitatively detect cerebral blood flow (CBF) using arterial water molecules as endogenous tracer 75 . CBF is related to cerebrovascular and neuronal function, and CBF is decreased in AD patients 76 .…”