Article Figures & Data
Figures
- 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
- Fig 2.
Examples of control (A) and AD (B) CASL images. Please refer to text for details.
- 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
Normal Cognition Probable AD χ2/T Test Valuea PValue, Cohen D or ϕ Number 19 13 Age (SD and range) 82.31 ± 3.87 83.1 ± 3.35 −.63 .53, .23 (76.17–93.34) (77.22–88.32) Male/female 8/11 8/5 1.17 .47, .28 Caucasian/AA 18/1 13/0 .71 .59, .41 Education (beyond 12th grade/12th grade) 11/8 8/5 .04 .56, .84 Modified MMSE 94.73 ± 4.44 88.9 ± 6.31 3.08 <.01, 1.11 (85–99) (76–97) Hypertension (±) 11/8 10/3 1.23 .23, .27 Heart disease 17/2 10/3 .92 .32, .34 Type II diabetes mellitus 17/2 10/2 .25 .63, .09 MRI infarcts (±) 12/7 9/4 .13 .53, .72 Small vessel ischemic disease 11/8 8/5 .04 .57, .84 -
a df = 30.
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Sensitivity (%) Specificity (%) Accuracy (area under ROC curve,%) CASL Reader 1 69 74 72 Reader 2 77 53 65 Reader 3 92 47 70 Reader 4 100 42 71 Average (%) 85 54 70 SPGR Reader 1 77 53 65 Reader 2 54 79 66 Reader 3 8 100 54 Reader 4 85 47 66 Average (%) 56 70 63 - 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) - Table 4:
Sensitivity, specificity, and accuracy values across all 4 readers based upon visual identification of lower rCBF in the frontal lobes with CASL
CASL Sensitivity (%) Specificity (%) Accuracy (area under ROC curve,%) Reader 1 69 79 74 Reader 2 92 63 78 Reader 3 92 68 80 Reader 4 100 63 82 Average (%) 88 68 79 Modality Reader 1 Reader 2 Reader 3 Reader 4 CASL r = 0.46, P = .008 r = 0.44, P = .01 r= 0.34, P = .06 r= 0.42, P = .02 SPGR r = 0.16, P = .39 r = 0.32, P = .07 r= −0.14, P= .45 r= −0.16, P= .36
