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<meta name="DC.Title" content="Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1955" />
<meta name="DC.Date" content="2010-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: MR imaging of the brain has significant potential in the early detection of neurodegenerative disorders such as AD. The purpose of this work was to determine if perfusion MR imaging can be used to separate AD from normal cognition in individual subjects. We investigated the diagnostic utility of perfusion MR imaging for early detection of AD compared with structural imaging.

MATERIALS AND METHODS: Data were analyzed from 32 participants in the institutional review board−approved CHS-CS: 19 cognitively healthy individuals and 13 with clinically adjudicated AD. All subjects underwent structural T1-weighted SGPR and CASL MR imaging. Four readers with varying experience separately rated each CASL and SPGR scan finding as normal or abnormal on the basis of standardized qualitative diagnostic criteria for observed perfusion abnormalities on CASL or volume loss on SPGR and rated the confidence in their evaluation.

RESULTS: Inter-rater reliability was superior in CASL (κ = 0.7 in experienced readers) compared with SPGR (κ = 0.17). CASL MR imaging had the highest sensitivity (85%) and accuracy (70%). Frontal lobe CASL findings increased sensitivity to 88% and accuracy to 79%. Fifty-seven percent of false-positive readings with CASL were in controls with cognitive decline or instability within 5 years. Three of the 4 readers revealed a statistically significant relationship between confidence and correct classification when using CASL.

CONCLUSIONS: Readers were able to separate individuals with mild AD from those with normal cognition with high sensitivity by using CASL but not volumetric MR imaging. This initial experience suggests that CASL MR imaging may be a useful technique for detecting AD.

AA
:   African American
AD
:   Alzheimer Disease
CASL
:   continuous arterial spin-labeled
CHS
:   Cardiovascular Health Study
CHS-CS
:   Cardiovascular Health Study Cognition Study
FDG-PET
:   fluorodeoxyglucose–positron-emission tomography
L
:   left
MCI
:   mild cognitive impairment
MMSE
:   Mini-Mental State Examination
MRI
:   MR imaging
PET
:   positron-emission tomography
R
:   right
rCBF
:   regional cerebral blood flow
ROC
:   receiver operating characteristic
SPECT
:   single-photon emission computed tomography
SPGR
:   spoiled gradient-recalled echo" />
<meta name="DC.Contributor" content="C.A. Raji" />
<meta name="DC.Contributor" content="C. Lee" />
<meta name="DC.Contributor" content="O.L. Lopez" />
<meta name="DC.Contributor" content="J. Tsay" />
<meta name="DC.Contributor" content="J.F. Boardman" />
<meta name="DC.Contributor" content="E.D. Schwartz" />
<meta name="DC.Contributor" content="W.S. Bartynski" />
<meta name="DC.Contributor" content="H.M. Hefzy" />
<meta name="DC.Contributor" content="H.M. Gach" />
<meta name="DC.Contributor" content="W. Dai" />
<meta name="DC.Contributor" content="J.T. Becker" />
<meta name="article:published_time" content="2010-05-01" />
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<meta name="citation_title" content="Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;MR imaging of the brain has significant potential in the early detection of neurodegenerative disorders such as AD. The purpose of this work was to determine if perfusion MR imaging can be used to separate AD from normal cognition in individual subjects. We investigated the diagnostic utility of perfusion MR imaging for early detection of AD compared with structural imaging.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Data were analyzed from 32 participants in the institutional review board−approved CHS-CS: 19 cognitively healthy individuals and 13 with clinically adjudicated AD. All subjects underwent structural T1-weighted SGPR and CASL MR imaging. Four readers with varying experience separately rated each CASL and SPGR scan finding as normal or abnormal on the basis of standardized qualitative diagnostic criteria for observed perfusion abnormalities on CASL or volume loss on SPGR and rated the confidence in their evaluation.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Inter-rater reliability was superior in CASL (κ = 0.7 in experienced readers) compared with SPGR (κ = 0.17). CASL MR imaging had the highest sensitivity (85%) and accuracy (70%). Frontal lobe CASL findings increased sensitivity to 88% and accuracy to 79%. Fifty-seven percent of false-positive readings with CASL were in controls with cognitive decline or instability within 5 years. Three of the 4 readers revealed a statistically significant relationship between confidence and correct classification when using CASL.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Readers were able to separate individuals with mild AD from those with normal cognition with high sensitivity by using CASL but not volumetric MR imaging. This initial experience suggests that CASL MR imaging may be a useful technique for detecting AD.&lt;/p&gt;" />
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<meta name="twitter:title" content="Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: MR imaging of the brain has significant potential in the early detection of neurodegenerative disorders such as AD. The purpose of this work was to determine if perfusion MR imaging can be used to separate AD from normal cognition in individual subjects. We investigated the diagnostic utility of perfusion MR imaging for early detection of AD compared with structural imaging.

MATERIALS AND METHODS: Data were analyzed from 32 participants in the institutional review board−approved CHS-CS: 19 cognitively healthy individuals and 13 with clinically adjudicated AD. All subjects underwent structural T1-weighted SGPR and CASL MR imaging. Four readers with varying experience separately rated each CASL and SPGR scan finding as normal or abnormal on the basis of standardized qualitative diagnostic criteria for observed perfusion abnormalities on CASL or volume loss on SPGR and rated the confidence in their evaluation.

RESULTS: Inter-rater reliability was superior in CASL (κ = 0.7 in experienced readers) compared with SPGR (κ = 0.17). CASL MR imaging had the highest sensitivity (85%) and accuracy (70%). Frontal lobe CASL findings increased sensitivity to 88% and accuracy to 79%. Fifty-seven percent of false-positive readings with CASL were in controls with cognitive decline or instability within 5 years. Three of the 4 readers revealed a statistically significant relationship between confidence and correct classification when using CASL.

CONCLUSIONS: Readers were able to separate individuals with mild AD from those with normal cognition with high sensitivity by using CASL but not volumetric MR imaging. This initial experience suggests that CASL MR imaging may be a useful technique for detecting AD.

AA
:   African American
AD
:   Alzheimer Disease
CASL
:   continuous arterial spin-labeled
CHS
:   Cardiovascular Health Study
CHS-CS
:   Cardiovascular Health Study Cognition Study
FDG-PET
:   fluorodeoxyglucose–positron-emission tomography
L
:   left
MCI
:   mild cognitive impairment
MMSE
:   Mini-Mental State Examination
MRI
:   MR imaging
PET
:   positron-emission tomography
R
:   right
rCBF
:   regional cerebral blood flow
ROC
:   receiver operating characteristic
SPECT
:   single-photon emission computed tomography
SPGR
:   spoiled gradient-recalled echo" />
<meta name="og-title" property="og:title" content="Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/5/847" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: MR imaging of the brain has significant potential in the early detection of neurodegenerative disorders such as AD. The purpose of this work was to determine if perfusion MR imaging can be used to separate AD from normal cognition in individual subjects. We investigated the diagnostic utility of perfusion MR imaging for early detection of AD compared with structural imaging.

MATERIALS AND METHODS: Data were analyzed from 32 participants in the institutional review board−approved CHS-CS: 19 cognitively healthy individuals and 13 with clinically adjudicated AD. All subjects underwent structural T1-weighted SGPR and CASL MR imaging. Four readers with varying experience separately rated each CASL and SPGR scan finding as normal or abnormal on the basis of standardized qualitative diagnostic criteria for observed perfusion abnormalities on CASL or volume loss on SPGR and rated the confidence in their evaluation.

RESULTS: Inter-rater reliability was superior in CASL (κ = 0.7 in experienced readers) compared with SPGR (κ = 0.17). CASL MR imaging had the highest sensitivity (85%) and accuracy (70%). Frontal lobe CASL findings increased sensitivity to 88% and accuracy to 79%. Fifty-seven percent of false-positive readings with CASL were in controls with cognitive decline or instability within 5 years. Three of the 4 readers revealed a statistically significant relationship between confidence and correct classification when using CASL.

CONCLUSIONS: Readers were able to separate individuals with mild AD from those with normal cognition with high sensitivity by using CASL but not volumetric MR imaging. This initial experience suggests that CASL MR imaging may be a useful technique for detecting AD.

AA
:   African American
AD
:   Alzheimer Disease
CASL
:   continuous arterial spin-labeled
CHS
:   Cardiovascular Health Study
CHS-CS
:   Cardiovascular Health Study Cognition Study
FDG-PET
:   fluorodeoxyglucose–positron-emission tomography
L
:   left
MCI
:   mild cognitive impairment
MMSE
:   Mini-Mental State Examination
MRI
:   MR imaging
PET
:   positron-emission tomography
R
:   right
rCBF
:   regional cerebral blood flow
ROC
:   receiver operating characteristic
SPECT
:   single-photon emission computed tomography
SPGR
:   spoiled gradient-recalled echo" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node9885--5" data-node-nid="9885" id="top-node-9885--61882630211" data-pisa="ajnr;31/5/847" data-pisa-master="ajnr;ajnr.A1955" data-apath="/ajnr/31/5/847.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">C.A. Raji</span>, <span class="highwire-citation-author" data-delta="1">C. Lee</span>, <span class="highwire-citation-author" data-delta="2">O.L. Lopez</span>, <span class="highwire-citation-author" data-delta="3">J. Tsay</span>, <span class="highwire-citation-author" data-delta="4">J.F. Boardman</span>, <span class="highwire-citation-author" data-delta="5">E.D. Schwartz</span>, <span class="highwire-citation-author" data-delta="6">W.S. Bartynski</span>, <span class="highwire-citation-author" data-delta="7">H.M. Hefzy</span>, <span class="highwire-citation-author" data-delta="8">H.M. Gach</span>, <span class="highwire-citation-author" data-delta="9">W. Dai</span> and <span class="highwire-citation-author" data-delta="10">J.T. Becker</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">847-855; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1955 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9885--61882630211" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">C.A. Raji </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.A.%2BRaji%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Raji%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.A.%2BRaji%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">C. 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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> MR imaging of the brain has significant potential in the early detection of neurodegenerative disorders such as AD. The purpose of this work was to determine if perfusion MR imaging can be used to separate AD from normal cognition in individual subjects. We investigated the diagnostic utility of perfusion MR imaging for early detection of AD compared with structural imaging.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> Data were analyzed from 32 participants in the institutional review board−approved CHS-CS: 19 cognitively healthy individuals and 13 with clinically adjudicated AD. All subjects underwent structural T1-weighted SGPR and CASL MR imaging. Four readers with varying experience separately rated each CASL and SPGR scan finding as normal or abnormal on the basis of standardized qualitative diagnostic criteria for observed perfusion abnormalities on CASL or volume loss on SPGR and rated the confidence in their evaluation.</p>
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<p id="p-4"><strong>RESULTS:</strong> Inter-rater reliability was superior in CASL (κ = 0.7 in experienced readers) compared with SPGR (κ = 0.17). CASL MR imaging had the highest sensitivity (85%) and accuracy (70%). Frontal lobe CASL findings increased sensitivity to 88% and accuracy to 79%. Fifty-seven percent of false-positive readings with CASL were in controls with cognitive decline or instability within 5 years. Three of the 4 readers revealed a statistically significant relationship between confidence and correct classification when using CASL.</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> Readers were able to separate individuals with mild AD from those with normal cognition with high sensitivity by using CASL but not volumetric MR imaging. This initial experience suggests that CASL MR imaging may be a useful technique for detecting AD.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">AA<span class="def-item-dt-sep"></span></dt><dd>African American<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">AD<span class="def-item-dt-sep"></span></dt><dd>Alzheimer Disease<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CASL<span class="def-item-dt-sep"></span></dt><dd>continuous arterial spin-labeled<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">CHS<span class="def-item-dt-sep"></span></dt><dd>Cardiovascular Health Study<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">CHS-CS<span class="def-item-dt-sep"></span></dt><dd>Cardiovascular Health Study Cognition Study<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">FDG-PET<span class="def-item-dt-sep"></span></dt><dd>fluorodeoxyglucose–positron-emission tomography<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">L<span class="def-item-dt-sep"></span></dt><dd>left<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">MCI<span class="def-item-dt-sep"></span></dt><dd>mild cognitive impairment<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">MMSE<span class="def-item-dt-sep"></span></dt><dd>Mini-Mental State Examination<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">MRI<span class="def-item-dt-sep"></span></dt><dd>MR imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">PET<span class="def-item-dt-sep"></span></dt><dd>positron-emission tomography<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">R<span class="def-item-dt-sep"></span></dt><dd>right<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">rCBF<span class="def-item-dt-sep"></span></dt><dd>regional cerebral blood flow<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">ROC<span class="def-item-dt-sep"></span></dt><dd>receiver operating characteristic<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">SPECT<span class="def-item-dt-sep"></span></dt><dd>single-photon emission computed tomography<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">SPGR<span class="def-item-dt-sep"></span></dt><dd>spoiled gradient-recalled echo</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/5/847.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2010 </div></div>
      
      
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      <div class="highwire-cite-title">Initial Experience in Using Continuous Arterial Spin-Labeled MR Imaging for Early Detection of Alzheimer Disease</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">C.A.</span> <span class="nlm-surname">Raji</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">O.L.</span> <span class="nlm-surname">Lopez</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Tsay</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.F.</span> <span class="nlm-surname">Boardman</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">E.D.</span> <span class="nlm-surname">Schwartz</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">W.S.</span> <span class="nlm-surname">Bartynski</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">H.M.</span> <span class="nlm-surname">Hefzy</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">H.M.</span> <span class="nlm-surname">Gach</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Dai</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">J.T.</span> <span class="nlm-surname">Becker</span></span></span></div>
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">C.A.</span> <span class="nlm-surname">Raji</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">O.L.</span> <span class="nlm-surname">Lopez</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Tsay</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.F.</span> <span class="nlm-surname">Boardman</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">E.D.</span> <span class="nlm-surname">Schwartz</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">W.S.</span> <span class="nlm-surname">Bartynski</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">H.M.</span> <span class="nlm-surname">Hefzy</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">H.M.</span> <span class="nlm-surname">Gach</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Dai</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">J.T.</span> <span class="nlm-surname">Becker</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">847-855; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1955 </span></div>
  
  
  
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