Correlação entre os volumes hipocampais e a espectroscopia por ressonância magnética do giro do cíngulo posterior e dos hipocampos na doença de Alzheimer

Park, Eun Joo; Lyra, Katarina P.; Lee, Hae Won; Caramelli, Paulo; Otaduy, Maria C. G.; Leite, Claudia Costa

doi:10.1590/S1980-57642010DN40200006

Abstract

Prior studies have reported hippocampal volume loss, decrease in N-Acetylaspartate (NAA) concentration and increased myo-inositol (mI) concentration in patients with Alzheimer's disease (AD). The purpose of this study was to evaluate hippocampal volumes of AD patients and their correlation with metabolic changes detected by proton spectroscopy (1H MRS) of hippocampal formations and the posterior cingulate region.

Materials and Methods:

22 patients with probable AD (18 mild, 4 moderate) and 14 elderly controls without cognitive symptoms, were enrolled in the study. Hippocampal volumetric measurements, single-voxel 1H MRS of the posterior cingulate region and of hippocampal formations were obtained. The following metabolite ratios were evaluated: NAA/Cr, mI/Cr, mI/NAA. Statistical analysis was performed to detect differences and correlations between these parameters in patients and controls.

Results:

The hippocampal volume of patients and controls did not differ significantly. The results of 1H MRS differed significantly between patients and controls in the hippocampal formations (mI/Cr, mI/NAA) and posterior cingulate region (NAA/Cr, mI/Cr, mI/NAA). The best predictor of AD diagnosis was NAA/Cr in the posterior cingulate region, having a sensitivity of 0.899 and specificity of 0.800. There was no correlation between hippocampal volumes and the results of 1H MRS in patients with AD.

Conclusions:

The results of 1H MRS differed significantly between patients and controls in hippocampal formations and the posterior cingulate region, with NAA/Cr proving to be the best predictor for AD. No correlation between hippocampal volumes and the results of 1H MRS in patients with AD was observed.

Key words:
hippocampal volumetry; proton magnetic resonance spectroscopy; Alzheimer's disease

Resumo

Estudos anteriores demostraram redução do volume hipocampal, redução da concentração de N- Acetilaspartato (NAA) e aumento da concentração de mio-inositol (mI) em pacientes com doença de Alzheimer (DA). O objetivo deste trabalho foi de avaliar os volumes hipocampais de pacientes com DA e correlacioná-los com as alterações metabólicas detectadas pela espectroscopia de próton das formações hipocampais e da região do cíngulo posterior.

Material e Métodos:

22 pacientes com provável DA (18 leve, 4 moderada) e 14 controles sem sintomas cognitivos foram incluídos neste estudo . Medidas volumétricas hipocampais, espectroscopia de próton de voxel único das formações hipocampais e da região do cíngulo foram obtidos. As seguintes razões de metabólitos foram avaliadas NAA/Cr, mI/Cr, mI/NAA. Análise estatística foi realizada para detectar as diferenças e correlações entre estes parâmetros nos pacientes e nos controles.

Resultados:

Os volumes das formações hipocampais dos pacientes e dos controles não foram significativamente diferentes. Os resultados da espectroscopia de próton foram significativamente diferentes nas das formações hipocampais dos pacientes e controles (mI/Cr, mI/NAA) e na região do cíngulo posterior (NAA/Cr, mI/Cr, mI/NAA). O melhor indicador para DA foi a razão NAA/Cr na região do cíngulo posterior com sensibilidade de 0,899 e especificidade de 0,800. Não houve correlação entre os volumes das formações hipocampais e os resultados da espectroscopia de próton nos pacientes com DA.

Conclusões:

Os resultados da espectroscopia de próton foram significativamente diferentes entre pacientes e controles das formações hipocampais e na região do cíngulo posterior, sendo NAA/Cr o melhor indicador para DA. Não houve correlação entre os volumes das formações hipocampais e os resultados da espectroscopia de próton nos pacientes com DA.

Palavras-chave:
volumetria hipocampal; espectroscopia por ressonância magnética; doença de Alzheimer.

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References

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Carr DB, Goate A, Phil D, Morris JC. Current concepts in the pathogenesis of Alzheimer's disease. Am J Med. 1997;103:3S-10S.
²
Nitrini R, Bottino CM, Albala C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:622-630.
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Jack CR Jr, Shiung MM, Gunter JL, et al. Comparison of different MRI brain atrophy rate measures with clinical disease progression in AD. Neurology 2004;62:591-600.
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Jack CR Jr, Dickson DW, Parisi JE, et al. Antemortem MRI findings correlate with hippocampal neuropathology in typical aging and dementia. Neurology 2002;58:750-757.
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van de Pol LA, Hensel A, Barkhof F, Gertz HJ, Scheltens P, van der Flier WM. Hippocampal atrophy in Alzheimer disease: age matters. Neurology 2006;66:236-238.
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Salibi N, Brown MA, Editors. Clinical MR spectroscopy: first principles. New York: Wiley-Liss; 1998:200.
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Huang W, Alexander GE, Chang L, et al. Brain metabolite concentration and dementia severity in Alzheimer's disease: a (1)H MRS study. Neurology 2001;57:626-632.
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Rami L, Gómez-Ansón B, Bosch B, et al. Cortical brain metabolism as measured by proton spectroscopy is related to memory performance in patients with amnestic mild cognitive impairment and Alzheimer's disease. Dement Geriatr Cogn Disord 2007;24:274-279.
¹⁰
Engelhardt E, Moreira DM, Laks J, Cavalcanti JL. Alzheimer's disease and proton magnetic resonance spectroscopy of limbic regions: a suggestion of a clinical-spectroscopic staging. Arq Neuropsiquiatr 2005;63:195-200.
¹¹
Shonk TK, Moats RA, Gifford P, et al. Probable Alzheimer disease: diagnosis with proton MR spectroscopy. Radiology 1995;195:65-72.
¹²
Kantarci K, Knopman DS, Dickson DW, et al. Alzheimer disease: postmortem neuropathologic correlates of antemortem 1H MR spectroscopy metabolite measurements. Radiology 2008;248:210-220.
¹³
Watson C, Andermann F, Gloor P, et al. Anatomic basis of amydaloid and hippocampal volume measurement by magnetic resonance imaging. Neurology 1992;42:1743-1750.
¹⁴
Parnetti L, Tarducci R, Presciutti O, et al. Proton magnetic resonance spectroscopy can differentiate Alzheimer's disease from normal aging. Mech Ageing Dev 1997;97:9-14.
¹⁵
Rose SE, de Zubicaray GI, Wang D, et al. A 1H MRS study of probable Alzheimer's disease and normal aging: implications for longitudinal monitoring of dementia progression. Magn Reson Imaging 1999;17:291-299.
¹⁶
Squire LR, Zola-Morgan S. The medial temporal lobe memory system. Science 1991; 253(5026):1380-1386.
¹⁷
Kesslak JP, Nalcioglu O, Cotman CW. Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer's disease. Neurology 1991;41:51-54.
¹⁸
Jack CR Jr, Petersen RC, O'Brien PC, Tangalos EG. MR-based hippocampal volumetry in the diagnosis of Alzheimer's disease. Neurology 1992;42:183-188.
¹⁹
Lehéricy S, Baulac M, Chiras J, et al. Amygdalohippocampal MR volume measurements in the early stages of Alzheimer disease. AJNR Am J Neuroradiol 1994;15:929-937.
²⁰
Jack CR Jr, Theodore WH, Cook M, McCarthy G. MRI-based hippocampal volumetrics: data acquisition, normal ranges, and optimal protocol. Magc Reson Imaging 1995;13:1057-1064.
²¹
Giesel FL, Thomann PA, Hahn HK, et al. Comparison of manual direct and automated indirect measurement of hippocampus using magnetic resonance imaging. Eur J Radiol 2008;66:268-273.
²²
Bottino CM, Castro CC, Gomes RL, Buchpiguel CA, Marchetti RL, Neto MR. Volumetric MRI measurements can differentiate Alzheimer's disease, mild cognitive impairment, and normal aging. Int Psychogeriatr 2002;14:59-72.

Publication Dates

Publication in this collection
Apr-Jun 2010

History

Received
29 Jan 2009
Accepted
20 Apr 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Carr DB, Goate A, Phil D, Morris JC. Current concepts in the pathogenesis of Alzheimer's disease. Am J Med. 1997;103:3S-10S.

[2] ²
Nitrini R, Bottino CM, Albala C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:622-630.

[3] ³
Braak H, Braak E, Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol 1991;82:239-259.

[4] ⁴
Jack CR Jr, Shiung MM, Gunter JL, et al. Comparison of different MRI brain atrophy rate measures with clinical disease progression in AD. Neurology 2004;62:591-600.

[5] ⁵
Jack CR Jr, Dickson DW, Parisi JE, et al. Antemortem MRI findings correlate with hippocampal neuropathology in typical aging and dementia. Neurology 2002;58:750-757.

[6] ⁶
van de Pol LA, Hensel A, Barkhof F, Gertz HJ, Scheltens P, van der Flier WM. Hippocampal atrophy in Alzheimer disease: age matters. Neurology 2006;66:236-238.

[7] ⁷
Salibi N, Brown MA, Editors. Clinical MR spectroscopy: first principles. New York: Wiley-Liss; 1998:200.

[8] ⁸
Huang W, Alexander GE, Chang L, et al. Brain metabolite concentration and dementia severity in Alzheimer's disease: a (1)H MRS study. Neurology 2001;57:626-632.

[9] ⁹
Rami L, Gómez-Ansón B, Bosch B, et al. Cortical brain metabolism as measured by proton spectroscopy is related to memory performance in patients with amnestic mild cognitive impairment and Alzheimer's disease. Dement Geriatr Cogn Disord 2007;24:274-279.

[10] ¹⁰
Engelhardt E, Moreira DM, Laks J, Cavalcanti JL. Alzheimer's disease and proton magnetic resonance spectroscopy of limbic regions: a suggestion of a clinical-spectroscopic staging. Arq Neuropsiquiatr 2005;63:195-200.

[11] ¹¹
Shonk TK, Moats RA, Gifford P, et al. Probable Alzheimer disease: diagnosis with proton MR spectroscopy. Radiology 1995;195:65-72.

[12] ¹²
Kantarci K, Knopman DS, Dickson DW, et al. Alzheimer disease: postmortem neuropathologic correlates of antemortem 1H MR spectroscopy metabolite measurements. Radiology 2008;248:210-220.

[13] ¹³
Watson C, Andermann F, Gloor P, et al. Anatomic basis of amydaloid and hippocampal volume measurement by magnetic resonance imaging. Neurology 1992;42:1743-1750.

[14] ¹⁴
Parnetti L, Tarducci R, Presciutti O, et al. Proton magnetic resonance spectroscopy can differentiate Alzheimer's disease from normal aging. Mech Ageing Dev 1997;97:9-14.

[15] ¹⁵
Rose SE, de Zubicaray GI, Wang D, et al. A 1H MRS study of probable Alzheimer's disease and normal aging: implications for longitudinal monitoring of dementia progression. Magn Reson Imaging 1999;17:291-299.

[16] ¹⁶
Squire LR, Zola-Morgan S. The medial temporal lobe memory system. Science 1991; 253(5026):1380-1386.

[17] ¹⁷
Kesslak JP, Nalcioglu O, Cotman CW. Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer's disease. Neurology 1991;41:51-54.

[18] ¹⁸
Jack CR Jr, Petersen RC, O'Brien PC, Tangalos EG. MR-based hippocampal volumetry in the diagnosis of Alzheimer's disease. Neurology 1992;42:183-188.

[19] ¹⁹
Lehéricy S, Baulac M, Chiras J, et al. Amygdalohippocampal MR volume measurements in the early stages of Alzheimer disease. AJNR Am J Neuroradiol 1994;15:929-937.

[20] ²⁰
Jack CR Jr, Theodore WH, Cook M, McCarthy G. MRI-based hippocampal volumetrics: data acquisition, normal ranges, and optimal protocol. Magc Reson Imaging 1995;13:1057-1064.

[21] ²¹
Giesel FL, Thomann PA, Hahn HK, et al. Comparison of manual direct and automated indirect measurement of hippocampus using magnetic resonance imaging. Eur J Radiol 2008;66:268-273.

[22] ²²
Bottino CM, Castro CC, Gomes RL, Buchpiguel CA, Marchetti RL, Neto MR. Volumetric MRI measurements can differentiate Alzheimer's disease, mild cognitive impairment, and normal aging. Int Psychogeriatr 2002;14:59-72.

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