title: Clinical application of 3D arterial spin-labeled brain perfusion imaging for Alzheimer disease: comparison with brain perfusion SPECT.
abstract: OBJECTIVE
  Alzheimer disease is the most common neurodegenerative disorder with dementia, and a practical and economic biomarker for diagnosis of Alzheimer disease is needed. Three-dimensional arterial spin-labeling, with its high signal-to-noise ratio, enables measurement of cerebral blood flow precisely without any extrinsic tracers. We evaluated the performance of 3D arterial spin-labeling compared with SPECT, and demonstrated the 3D arterial spin-labeled imaging characteristics in the diagnosis of Alzheimer disease.
  
  
  METHODS
  This study included 68 patients with clinically suspected Alzheimer disease who underwent both 3D arterial spin-labeling and SPECT imaging. Two readers independently assessed both images. Kendall W coefficients of concordance (K) were computed, and receiver operating characteristic analyses were performed for each reader. The differences between the images in regional perfusion distribution were evaluated by means of statistical parametric mapping, and the incidence of hypoperfusion of the cerebral watershed area, referred to as "borderzone sign" in the 3D arterial spin-labeled images, was determined.
  
  
  RESULTS
  Readers showed K = 0.82/0.73 for SPECT/3D arterial spin-labeled imaging, and the respective areas under the receiver operating characteristic curve were 0.82/0.69 for reader 1 and 0.80/0.69 for reader 2. Statistical parametric mapping showed that the perisylvian and medial parieto-occipital perfusion in the arterial spin-labeled images was significantly higher than that in the SPECT images. Borderzone sign was observed on 3D arterial spin-labeling in 70% of patients misdiagnosed with Alzheimer disease.
  
  
  CONCLUSIONS
  The diagnostic performance of 3D arterial spin-labeling and SPECT for Alzheimer disease was almost equivalent. Three-dimensional arterial spin-labeled imaging was more influenced by hemodynamic factors than was SPECT imaging.
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan. hiroto.takahashi07@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ishii
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Hosokawa
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hyodo
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kashiwagi
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Matsuki
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Ashikaga
authors.affiliation: From the Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Murakami
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D013113:Spin Labels