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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleBrain
Open Access

Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease

C.A. Raji, C. Lee, O.L. Lopez, J. Tsay, J.F. Boardman, E.D. Schwartz, W.S. Bartynski, H.M. Hefzy, H.M. Gach, W. Dai and J.T. Becker
American Journal of Neuroradiology May 2010, 31 (5) 847-855; DOI: https://doi.org/10.3174/ajnr.A1955
C.A. Raji
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C. Lee
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O.L. Lopez
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J. Tsay
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J.F. Boardman
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E.D. Schwartz
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W.S. Bartynski
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H.M. Hefzy
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H.M. Gach
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W. Dai
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J.T. Becker
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    Midaxial CASL image shows the regions assessed by the reader: 1, anterior cingulate gyrus; 2, middle frontal lobe; 3. caudate nucleus; 4, putamen and globus pallidus; 5, thalamus; 6, superior and medial temporal lobes; 7, parietal lobes; 8, posterior cingulate gyrus; 9, occipital lobes. Many of these regions, such as the cingulate gyrus, temporal lobes, and thalamus, are common targets of AD pathology. Reproduction of Fig 1 with permission from Lee et al.47

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    Fig 2.

    Examples of control (A) and AD (B) CASL images. Please refer to text for details.

  • Fig 3.
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    Fig 3.

    Axial CASL MR images obtained at the level of the thalamus. A, True-negative. B, True-positive. C, False-negative. D, false-positive. The images are obtained from the OsiriX Imaging Software with a standard Hot Iron scale of 0- to 100-mL blood/g tissue/min, the same scale used by the readers to view the scans shown in Fig 2.

Tables

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    Table 1:

    Subject characteristics

    Normal CognitionProbable ADχ2/T Test ValueaPValue, Cohen D or ϕ
    Number1913
    Age (SD and range)82.31 ± 3.8783.1 ± 3.35−.63.53, .23
    (76.17–93.34)(77.22–88.32)
    Male/female8/118/51.17.47, .28
    Caucasian/AA18/113/0.71.59, .41
    Education (beyond 12th grade/12th grade)11/88/5.04.56, .84
    Modified MMSE94.73 ± 4.4488.9 ± 6.313.08<.01, 1.11
    (85–99)(76–97)
    Hypertension (±)11/810/31.23.23, .27
    Heart disease17/210/3.92.32, .34
    Type II diabetes mellitus17/210/2.25.63, .09
    MRI infarcts (±)12/79/4.13.53, .72
    Small vessel ischemic disease11/88/5.04.57, .84
    • a df = 30.

    • View popup
    Table 2:

    Summary of individual and average reader metrics of diagnostic utility

    Sensitivity (%)Specificity (%)Accuracy (area under ROC curve,%)
    CASL
        Reader 1697472
        Reader 2775365
        Reader 3924770
        Reader 41004271
        Average (%)855470
    SPGR
        Reader 1775365
        Reader 2547966
        Reader 3810054
        Reader 4854766
        Average (%)567063
    • View popup
    Table 3:

    Most commonly identified regions in correct abnormal CASL scan classifications by reader

    Reader 1 (%)Reader 2 (%)Reader 3 (%)Reader 4 (%)
    Frontal lobes (100)Frontal lobes (100)Parietal cortex (100)Frontal lobes (100)
    Caudate (100)Caudate (100)Frontal lobes (92)Caudate (100)
    Lentiform (100)Thalamus (90)Thalamus (83)Lentiform (100)
    Thalamus (89)Lentiform (80)Medial temporal lobe (75)Thalamus (85)
    Medial temporal lobe (78)Medial temporal lobe (80)Caudate (67)Parietal cortex (85)
    Precuneus (78)Posterior cingulate (60)Lentiform (67)Precuneus (77)
    Anterior cingulate (67)Parietal cortex (50)Precuneus (33)Posterior cingulate (77)
    Posterior cingulate (67)Anterior cingulate (40)Anterior cingulate (25)Anterior cingulate (69)
    Parietal cortex (67)Precuneus (20)Posterior cingulate (25)Medial temporal lobe (38)
    • View popup
    Table 4:

    Sensitivity, specificity, and accuracy values across all 4 readers based upon visual identification of lower rCBF in the frontal lobes with CASL

    CASLSensitivity (%)Specificity (%)Accuracy (area under ROC curve,%)
    Reader 1697974
    Reader 2926378
    Reader 3926880
    Reader 41006382
    Average (%)886879
    • View popup
    Table 5:

    Correlation between reader confidence and correct image classification

    ModalityReader 1Reader 2Reader 3Reader 4
    CASLr = 0.46, P = .008r = 0.44, P = .01r= 0.34, P = .06r= 0.42, P = .02
    SPGRr = 0.16, P = .39r = 0.32, P = .07r= −0.14, P= .45r= −0.16, P= .36
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American Journal of Neuroradiology: 31 (5)
American Journal of Neuroradiology
Vol. 31, Issue 5
1 May 2010
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C.A. Raji, C. Lee, O.L. Lopez, J. Tsay, J.F. Boardman, E.D. Schwartz, W.S. Bartynski, H.M. Hefzy, H.M. Gach, W. Dai, J.T. Becker
Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease
American Journal of Neuroradiology May 2010, 31 (5) 847-855; DOI: 10.3174/ajnr.A1955

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Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease
C.A. Raji, C. Lee, O.L. Lopez, J. Tsay, J.F. Boardman, E.D. Schwartz, W.S. Bartynski, H.M. Hefzy, H.M. Gach, W. Dai, J.T. Becker
American Journal of Neuroradiology May 2010, 31 (5) 847-855; DOI: 10.3174/ajnr.A1955
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