Predicting conversion from mild cognitive impairment to Alzheimer's disease using brain 1 H-MRS and volumetric changes: A two- year retrospective follow-up study

Micaela Mitolo, Michelangelo Stanzani-Maserati, Sabina Capellari, Claudia Testa, Paola Rucci, Roberto Poda, Federico Oppi, Roberto Gallassi, Luisa Sambati, Giovanni Rizzo, Piero Parchi, Stefania Evangelisti, Lia Talozzi, Caterina Tonon, Raffaele Lodi, Rocco Liguori

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Abstract

This study investigated the ability of magnetic resonance spectroscopy ( 1 H-MRS) of posterior cingulate cortex (PCC) and brain volumetry to predict the progression from mild cognitive impairment (MCI) to Alzheimer's Disease (AD) on the basis of clinical classification at 2 years follow-up. Thirty-eight MCI patients, eighteen healthy older adults and twenty-three AD patients were included in this study. All participants underwent a brain-MR protocol (1.5 T GE scanner) including high-resolution T1-weighted volumetric sequence (isotropic 1mm 3 ). Voxel-wise differences in brain volumetry were evaluated using FreeSurfer software and all volumes were normalized by the total intracranial volume (TIV). Careful localization of 1 H-MRS volume of PCC was performed and data were processed with the LCModel program. MCI patients underwent a complete neuropsychological assessment at baseline and were clinically re-evaluated after a mean of 28 months; twenty-six MCI patients (68.4%) converted to AD and twelve remained stable. At baseline these two MCI subgroups did not differ in the global cognitive level (Mini Mental State Examination, MMSE) or in any of the other cognitive domains; the NAA/ mI ratio in the PCC was able to differentiate MCI converters from those MCI that did not develop AD (p = 0.022) with a level of accuracy (AUC area) of 0.779. A significantly reduced volume of parahippocampal gyrus (p = 0.010) and fusiform gyrus (p = 0.026) were found in the converter MCI subgroup compared to the stable MCI subgroup. The combined use of both N- acetyl-aspartate (NAA)/myo-Inositol (mI) ratio and volume of parahippocampal gyrus, increases the overall accuracy (AUC = 0.910) in predicting the conversion to AD two years before the development of clinical symptoms. Additional longitudinal studies with a broader representative sample of MCI patients and longer follow-up might be helpful to confirm these results and to elucidate the role of each parameter in predicting the possible progression to AD, and also to all the other non-AD dementia subtypes.

Original languageEnglish
Article number101843
JournalNeuroImage: Clinical
Volume23
DOIs
Publication statusPublished - 2019

Fingerprint

Alzheimer Disease
Brain
Gyrus Cinguli
Parahippocampal Gyrus
Inositol
Area Under Curve
Cognitive Dysfunction
Aptitude
Temporal Lobe
Longitudinal Studies
Dementia
Magnetic Resonance Spectroscopy
Software

Keywords

  • H-MRS
  • Alzheimer's disease
  • Mild cognitive impairment
  • MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Neurology
  • Clinical Neurology
  • Cognitive Neuroscience

Cite this

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title = "Predicting conversion from mild cognitive impairment to Alzheimer's disease using brain 1 H-MRS and volumetric changes: A two- year retrospective follow-up study",
abstract = "This study investigated the ability of magnetic resonance spectroscopy ( 1 H-MRS) of posterior cingulate cortex (PCC) and brain volumetry to predict the progression from mild cognitive impairment (MCI) to Alzheimer's Disease (AD) on the basis of clinical classification at 2 years follow-up. Thirty-eight MCI patients, eighteen healthy older adults and twenty-three AD patients were included in this study. All participants underwent a brain-MR protocol (1.5 T GE scanner) including high-resolution T1-weighted volumetric sequence (isotropic 1mm 3 ). Voxel-wise differences in brain volumetry were evaluated using FreeSurfer software and all volumes were normalized by the total intracranial volume (TIV). Careful localization of 1 H-MRS volume of PCC was performed and data were processed with the LCModel program. MCI patients underwent a complete neuropsychological assessment at baseline and were clinically re-evaluated after a mean of 28 months; twenty-six MCI patients (68.4{\%}) converted to AD and twelve remained stable. At baseline these two MCI subgroups did not differ in the global cognitive level (Mini Mental State Examination, MMSE) or in any of the other cognitive domains; the NAA/ mI ratio in the PCC was able to differentiate MCI converters from those MCI that did not develop AD (p = 0.022) with a level of accuracy (AUC area) of 0.779. A significantly reduced volume of parahippocampal gyrus (p = 0.010) and fusiform gyrus (p = 0.026) were found in the converter MCI subgroup compared to the stable MCI subgroup. The combined use of both N- acetyl-aspartate (NAA)/myo-Inositol (mI) ratio and volume of parahippocampal gyrus, increases the overall accuracy (AUC = 0.910) in predicting the conversion to AD two years before the development of clinical symptoms. Additional longitudinal studies with a broader representative sample of MCI patients and longer follow-up might be helpful to confirm these results and to elucidate the role of each parameter in predicting the possible progression to AD, and also to all the other non-AD dementia subtypes.",
keywords = "H-MRS, Alzheimer's disease, Mild cognitive impairment, MRI",
author = "Micaela Mitolo and Michelangelo Stanzani-Maserati and Sabina Capellari and Claudia Testa and Paola Rucci and Roberto Poda and Federico Oppi and Roberto Gallassi and Luisa Sambati and Giovanni Rizzo and Piero Parchi and Stefania Evangelisti and Lia Talozzi and Caterina Tonon and Raffaele Lodi and Rocco Liguori",
note = "Ricercatori distaccati presso IRCCS a seguito Convenzione esclusiva con Universit{\`a} di Bologna (Capellari Sabina, Rizzo Giovanni, Parchi Piero, Tonon Caterina, Liguori Rocco)",
year = "2019",
doi = "10.1016/j.nicl.2019.101843",
language = "English",
volume = "23",
journal = "NeuroImage: Clinical",
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TY - JOUR

T1 - Predicting conversion from mild cognitive impairment to Alzheimer's disease using brain 1 H-MRS and volumetric changes

T2 - A two- year retrospective follow-up study

AU - Mitolo, Micaela

AU - Stanzani-Maserati, Michelangelo

AU - Capellari, Sabina

AU - Testa, Claudia

AU - Rucci, Paola

AU - Poda, Roberto

AU - Oppi, Federico

AU - Gallassi, Roberto

AU - Sambati, Luisa

AU - Rizzo, Giovanni

AU - Parchi, Piero

AU - Evangelisti, Stefania

AU - Talozzi, Lia

AU - Tonon, Caterina

AU - Lodi, Raffaele

AU - Liguori, Rocco

N1 - Ricercatori distaccati presso IRCCS a seguito Convenzione esclusiva con Università di Bologna (Capellari Sabina, Rizzo Giovanni, Parchi Piero, Tonon Caterina, Liguori Rocco)

PY - 2019

Y1 - 2019

N2 - This study investigated the ability of magnetic resonance spectroscopy ( 1 H-MRS) of posterior cingulate cortex (PCC) and brain volumetry to predict the progression from mild cognitive impairment (MCI) to Alzheimer's Disease (AD) on the basis of clinical classification at 2 years follow-up. Thirty-eight MCI patients, eighteen healthy older adults and twenty-three AD patients were included in this study. All participants underwent a brain-MR protocol (1.5 T GE scanner) including high-resolution T1-weighted volumetric sequence (isotropic 1mm 3 ). Voxel-wise differences in brain volumetry were evaluated using FreeSurfer software and all volumes were normalized by the total intracranial volume (TIV). Careful localization of 1 H-MRS volume of PCC was performed and data were processed with the LCModel program. MCI patients underwent a complete neuropsychological assessment at baseline and were clinically re-evaluated after a mean of 28 months; twenty-six MCI patients (68.4%) converted to AD and twelve remained stable. At baseline these two MCI subgroups did not differ in the global cognitive level (Mini Mental State Examination, MMSE) or in any of the other cognitive domains; the NAA/ mI ratio in the PCC was able to differentiate MCI converters from those MCI that did not develop AD (p = 0.022) with a level of accuracy (AUC area) of 0.779. A significantly reduced volume of parahippocampal gyrus (p = 0.010) and fusiform gyrus (p = 0.026) were found in the converter MCI subgroup compared to the stable MCI subgroup. The combined use of both N- acetyl-aspartate (NAA)/myo-Inositol (mI) ratio and volume of parahippocampal gyrus, increases the overall accuracy (AUC = 0.910) in predicting the conversion to AD two years before the development of clinical symptoms. Additional longitudinal studies with a broader representative sample of MCI patients and longer follow-up might be helpful to confirm these results and to elucidate the role of each parameter in predicting the possible progression to AD, and also to all the other non-AD dementia subtypes.

AB - This study investigated the ability of magnetic resonance spectroscopy ( 1 H-MRS) of posterior cingulate cortex (PCC) and brain volumetry to predict the progression from mild cognitive impairment (MCI) to Alzheimer's Disease (AD) on the basis of clinical classification at 2 years follow-up. Thirty-eight MCI patients, eighteen healthy older adults and twenty-three AD patients were included in this study. All participants underwent a brain-MR protocol (1.5 T GE scanner) including high-resolution T1-weighted volumetric sequence (isotropic 1mm 3 ). Voxel-wise differences in brain volumetry were evaluated using FreeSurfer software and all volumes were normalized by the total intracranial volume (TIV). Careful localization of 1 H-MRS volume of PCC was performed and data were processed with the LCModel program. MCI patients underwent a complete neuropsychological assessment at baseline and were clinically re-evaluated after a mean of 28 months; twenty-six MCI patients (68.4%) converted to AD and twelve remained stable. At baseline these two MCI subgroups did not differ in the global cognitive level (Mini Mental State Examination, MMSE) or in any of the other cognitive domains; the NAA/ mI ratio in the PCC was able to differentiate MCI converters from those MCI that did not develop AD (p = 0.022) with a level of accuracy (AUC area) of 0.779. A significantly reduced volume of parahippocampal gyrus (p = 0.010) and fusiform gyrus (p = 0.026) were found in the converter MCI subgroup compared to the stable MCI subgroup. The combined use of both N- acetyl-aspartate (NAA)/myo-Inositol (mI) ratio and volume of parahippocampal gyrus, increases the overall accuracy (AUC = 0.910) in predicting the conversion to AD two years before the development of clinical symptoms. Additional longitudinal studies with a broader representative sample of MCI patients and longer follow-up might be helpful to confirm these results and to elucidate the role of each parameter in predicting the possible progression to AD, and also to all the other non-AD dementia subtypes.

KW - H-MRS

KW - Alzheimer's disease

KW - Mild cognitive impairment

KW - MRI

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