Title:Vascular Lesions and Brain Atrophy in Alzheimer’s, Vascular and Mixed
Dementia: An Optimized 3T MRI Protocol Reveals Distinctive Radiological
Profiles
Volume: 19
Issue: 6
关键词:
阿尔茨海默氏痴呆、血管性痴呆、混合性痴呆、白质病变、微出血、视觉评分
摘要:
Background: Vascular lesions may be a common finding also in Alzheimer's dementia,
but their role on cognitive status is uncertain.
Objective: The study aims to investigate their distribution in patients with Alzheimer's, vascular or
mixed dementia and detect any distinctive neuroradiological profiles.
Methods: Seventy-six subjects received a diagnosis of Alzheimer’s (AD=32), vascular (VD=26) and
mixed (MD=18) dementia. Three independent raters assessed the brain images acquired with an optimized
3T MRI protocol (including (3D FLAIR, T1, SWI, and 2D coronal T2 sequences) using semiquantitative
scales for vascular lesions (periventricular lesions (PVL), deep white matter lesions
(DWML), deep grey matter lesions (DGML), enlarged perivascular spaces (PVS), and microbleeds
(MB)) and brain atrophy (medial temporal atrophy (MTA), posterior atrophy (PA), global cortical atrophy-
frontal (GCA-F) and Evans’ index).
Results: Raters reached a good-to-excellent agreement for all scales (ICC ranging from 0.78-0.96). A
greater number of PVL (p<0.001), DWML (p<0.001), DGML (p=0.010), and PVS (p=0.001) was observed
in VD compared to AD, while MD showed a significant greater number of PVL (p=0.001),
DWML (p=0.002), DGML (p=0.018), and deep and juxtacortical MB (p=0.006 and p<0.001, respectively).
Comparing VD and MD, VD showed a higher number of PVS in basal ganglia and centrum
semiovale (p=0.040), while MD showed more deep and juxtacortical MB (p=0.042 and p=0.022, respectively).
No significant difference was observed in scores of cortical atrophy scales and Evans’ index
among the three groups.
Conclusion: The proposed MRI protocol represents a useful advancement in the diagnostic assessment
of patients with cognitive impairment by more accurately detecting vascular lesions, mainly microbleeds,
without a significant increase in time and resource expenditure. Our findings confirm that
white and grey matter lesions predominate in vascular and mixed dementia, whereas deep and juxtacortical
microbleeds predominate in mixed dementia, suggesting that cerebral amyloid angiopathy
could be the main underlying pathology.
