J Korean Neuropsychiatr Assoc.  2018 Feb;57(1):12-22. 10.4306/jknpa.2018.57.1.12.

Current Knowledge and Clinical Application of Brain Imaging in Alzheimer's Disease

• Kang DW
• Lim HK

• KMID: 2405528
• DOI: http://doi.org/10.4306/jknpa.2018.57.1.12

Abstract

Alzheimer's disease (AD) is a debilitating syndrome with cognitive decline and impairment in daily activities. Although clinical assessment forms the basis for diagnosing AD, structural and functional brain imaging tools have been known to enhance accuracy of differential diagnosis and prognosis prediction by presenting structural and functional signatures for AD. Associated with the important role of brain imaging in diagnosing and treating AD, brain imaging has been recommended in the current diagnostic guidelines of AD. Visual rating scales, a cost-effective diagnostic tool, have been known to assess atrophy and functional changes in patients with cognitive impairment as accurate as quantitative assessment. In this regard, visual rating scales for brain imaging interpretation could be useful in clinical settings. In this review, we interpret structural and functional brain imaging results with standardized visual rating scales, and review recent findings concerning brain imaging tools for differential diagnosing and predicting prognosis of AD.

Keyword

Alzheimer's disease; Brain imaging; Visual rating scale; Magnetic resonance imaging; Positron emission tomography

MeSH Terms

Alzheimer Disease*
Atrophy
Brain*
Cognition Disorders
Diagnosis, Differential
Functional Neuroimaging
Humans
Magnetic Resonance Imaging
Neuroimaging*
Positron-Emission Tomography
Prognosis
Weights and Measures

Figure

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  Fig. 1. Scheltens scale for medial temporal atrophy. A : Coronal images of the hippocampus. B : Coronal brain images of Scheltens scale for medial temporal lobe atrophy. Image courtesy of Frederick Barkhof and Alzheimer Centre and Image Analysis Centre, Vrije Universiteit Medical Center, Amsterdam, Netherlands. Score 0 : No atrophy, Score 1 : Only widening of choroid fissure, Score 2 : Also widening of temporal horn of lateral ventricle, Score 3 : Moderate loss of hippocampal volume (decrease in height), Score 4 : Severe volume loss of hippocampus.

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  Fig. 2. Transaxial brain images of Pasquier scale for global cortical atrophy. Image courtesy of Jonathan M Schott and Dementia Research Centre, University College London Institute of Neurology. London, UK. Adapted from Harper L et al. J Neurol Neurosurg Psychiatry 2015;86:1125-1233.6) Score 0 : No cortical atrophy, Score 1 : Mild atrophy : opening of sulci, Score 2 : Moderate atrophy : volume loss of gyri, Score 3 : Severe (end-stage) atrophy : ‘knife blade’ atrophy.

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  Fig. 3. Brain images of Koedam scale for posterior cortical atrophy. Koedam scale is rated by evaluating atrophy of posterior cingulate sulcus, precuneus, parieto-occipital sulcus, and cortex of parietal lobe. ∗ : Extreme widening of the posterior cingulate, † : Widening of parieto-occipital sulci. Image courtesy of Frederick Barkhof and Alzheimer Centre and Image Analysis Centre, Vrije Universiteit Medical Center, Amsterdam, Netherlands.

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  Fig. 4. Transaxial brain images of Fazeka scale for rating of white matter hyperintensities. Image courtesy of Hyun Kook Lim, Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. Fazeka 0 : No white matter hyperintensity, Fazeka 1 : Punctate lesions in the deep white matter with a maximum diameter of 9 mm for a single lesion and of 20 mm for grouped lesions, Fazeka 2 : Early confluent lesions of 10–20 mm single lesions and > 20 mm grouped lesions, in any diameter, and no more than connecting bridges between the individual lesions, Fazeka 3 : Single lesions or confluent areas of hyperintensity of ≥20 mm in any diameter.

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  Fig. 5. Normal 18F-fludeoxyglucose positron emission tomography scans. Yellow labeled regions display some asymmetry due to normal variations. A : 3 orthogonal scans with crosshairs displaying mutual references of cut location. B : Transaxial and coronal scans representing grey matter structures which guide anatomical orientation. Image courtesy of Herholz, K, Wolfson Molecular Imaging Centre and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. IF : Inter hemispheric fissure, CC : Corpus callosum, CG : Cingulate gyrus, OP : Occipital pole, LPFC : Lateral prefrontal cortex, PCN : Precuneus, PCC : Posterior cingulate cortex, TH : Thalamus, PT : Putamen, CD : Caudate nucleus, HG : Heschl's gyrus, TL : Temporal lobe, CBL : Cerebellum, EM : Eye muscle, HP : Hippocampus.

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  Fig. 6. 18F-fludeoxyglucose positron emission tomography scans in the trajectory of Alzheimer's disease. A : Orthogonal scans showing normal high activity of posterior cingulate cortex. B : Orthogonal scans displaying reduced metabolism in right posterior cingulate cortex in mild cognitive impairment patient. C : Transaxial scans representing reduced metabolic activity in parietal and temporal lobes in Alzheimer's disease patient. Image courtesy of Herholz, K, Wolfson Molecular Imaging Centre and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. CG : Cingulate gyrus, CC : Corpus callosum, ACC : Anterior cingulate cortex, PCC : Posterior cingulate cortex, POS : Parieto-occipital sulci, PCN : Precuneus, LPFC : Lateral prefrontal cortex.

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  Fig. 7. Normal and positive 18F-flutemetamol scans in regions of interest. A : Frontal lobe. B : Posterior cingulate cortex and precuneus. C : Lateral temporal lobe. D : Parietal lobe. E : Striatum. Image courtesy of Hyun Kook Lim, Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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  Fig. 8. Normal and positive 18F-florbetaben scans in regions of interest. Cerebellum : Contrast between white matter (arrows) and grey matter is displayed in both normal and positive scans. Extracerebral tracer uptake in scalp and in posterior sagittal sinus (arrowheads) can be seen. Lateral temporal lobes : Positive scan shows smooth appearance of outer border (dashed line) in grey matter. Spiculated appearance of white matter (arrows) represents normal scan. Frontal lobes : Positive scan shows that tracer uptake has plumped appearance due to grey matter signal (dashed line). Spiculated appearance of white matter in frontal lobes (arrows) is seen in negative scan. Posterior cingulate/precuneus : Adjacent to splenium (arrows), region appears as hypointense hole (circle) in normal scan, whereas this hole is absent (circle) in positive scan. Parietal lobes : In positive scan, midline between parietal lobes is thinner. Cortical areas are filled up and show smoother appearance as uptake extends to outer rim. In normal scan, midline between parietal lobes can be easily detected (long arrows); white matter has spiculated appearance (short arrows) with less uptake to outer rim (dashed line). Image courtesy of the Piramal Physicians Training Site for Reading PET Amyloid Imaging. This research was originally published in JNM. John Seibyl et al. Impact of training method on the robustness of the visual assessment of 18F-florbetaben PET scans: results from a Phase-3 Study. J Nucl Med 2016;57:900-906. © by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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