title: (99m)Tc hexamethyl-propylene-aminoxime single-photon emission computed tomography prediction of conversion from mild cognitive impairment to Alzheimer disease.
abstract: OBJECTIVE
  To examine the utility of single-photon emission computed tomography (SPECT) to predict conversion from mild cognitive impairment (MCI) to Alzheimer disease (AD).
  
  
  METHODS
  Longitudinal, prospective study.
  
  
  METHODS
  University-based memory disorders clinic.
  
  
  METHODS
  One hundred twenty seven patients with MCI and 59 healthy comparison subjects followed up for 1-9 years.
  
  
  METHODS
  Diagnostic evaluation, neuropsychological tests, social/cognitive function, olfactory identification, apolipoprotein E genotype, magnetic resonance imaging, and brain Tc hexamethyl-propylene-aminoxime SPECT scan with visual ratings, and region of interest (ROI) analyses were done.
  
  
  RESULTS
  Visual ratings of SPECT temporal and parietal blood flow did not distinguish eventual MCI converters to AD (N = 31) from nonconverters (N = 96), but the global rating predicted conversion (41.9% sensitivity and 82.3% specificity, Fisher's exact test p = 0.013). Blood flow in each ROI was not predictive, but when dichotomized at the median value of the patients with MCI, low flow increased the hazard of conversion to AD for parietal (hazard ratio: 2.96, 95% confidence interval: 1.16-7.53, p = 0.023) and medial temporal regions (hazard ratio: 3.12, 95% confidence interval: 1.14-8.56, p = 0.027). In the 3-year follow-up sample, low parietal (p <0.05) and medial temporal (p <0.01) flow predicted conversion to AD, with or without controlling for age, Mini-Mental State Examination, and apolipoprotein E ε4 genotype. These measures lost significance when other strong predictors were included in logistic regression analyses: verbal memory, social/cognitive functioning, olfactory identification deficits, hippocampal, and entorhinal cortex volumes.
  
  
  CONCLUSIONS
  SPECT visual ratings showed limited utility in predicting MCI conversion to AD. The modest predictive utility of quantified low parietal and medial temporal flow using SPECT may decrease when other stronger predictors are available.
authors.affiliation: NYSPI, Columbia University, New York, NY 10032, USA. dpd3@columbia.edu
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Van Heertum
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Kegeles
authors.forename: Xinhua
authors.initials: X
authors.lastname: Liu
authors.forename: Zong Hao
authors.initials: ZH
authors.lastname: Jin
authors.forename: Gnanavalli
authors.initials: G
authors.lastname: Pradhaban
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.forename: Mali
authors.initials: M
authors.lastname: Pratap
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Pelton
authors.forename: Isak
authors.initials: I
authors.lastname: Prohovnik
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.forename: Ramin
authors.initials: R
authors.lastname: Parsey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D053327:Apolipoprotein E4 / Q000235:genetics; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D010091:Oximes; D011237:Predictive Value of Tests; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D053327:Apolipoprotein E4; D010091:Oximes; C068296:hexamethylpropyleneamine oxime; D019690:Technetium Tc 99m Exametazime
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