title: Morphometric characterization of Binswanger's disease: comparison with Alzheimer's disease.
abstract: OBJECTIVE
  Dementia due to hypertensive vascular disease is a potential target to treat prophylactively before it progresses insidiously. Binswanger's disease (BD) is a type of subcortical vascular dementia, but its clinical features and pathophysiology are still obscure. We therefore tried to find a topographic distribution of brain atrophy in BD by morphometric analysis.
  
  
  METHODS
  Twenty patients with BD, 50 patients with AD, and 80 elderly controls were recruited. We contrasted the gray matter atrophy of BD to that of AD to identify a pathognomic pattern using magnetic resonance imaging. We used DARTEL (diffeomorphic anatomical registration through exponential Lie algebra) for voxel-based morphometry, expecting that its sophisticated algorithm would work well to deal with the subjects with brain atrophy.
  
  
  RESULTS
  Atrophy of cortices was predominant in the posterior cortices in AD but was in the anterior cortices in BD. Atrophy of amygdala and hippocampus was similar in each disease. In contrast, thalamus, caudate nucleus, insula, anterior cingulate cortex, and frontal cortices were significantly more atrophied in BD than in AD (z-score >3).
  
  
  CONCLUSIONS
  We demonstrated topographic patterns of brain atrophy in BD. Since affected regions of BD match with the anatomical connections of frontal-subcortical circuits, it seems reasonable to suppose that BD pathology is the result of hypertensive vascular disease and subsequent regression from the white matter injuries.
authors.affiliation: Biomedical MR Science Center, Shiga University of Medical Science, Seta, Ohtsu, Shiga 520-2192, Japan. shiino@belle.shiga-med.ac.jpc.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Shiino
authors.forename: Ichiro
authors.initials: I
authors.lastname: Akiguchi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Shirakashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nozaki
authors.forename: Ikuo
authors.initials: I
authors.lastname: Tooyama
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inubushi
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D015140:Dementia, Vascular / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique