Cingulate island sign on FDG-PET is associated with medial temporal lobe atrophy in dementia with Lewy bodies.
OBJECTIVE
The cingulate island sign (CIS), which refers to sparing of the posterior cingulate relative to the precuneus and cuneus, has been proposed as an FDG-PET imaging feature of dementia with Lewy bodies (DLB). The sign is reportedly associated with Alzheimer's disease (AD) type neurofibrillary tangle (NFT) pathology in autopsy cases. To confirm this relationship using neuroimaging modalities in vivo, we investigated associations between CIS and the medial temporal lobe (MTL) atrophy in DLB.


METHODS
Twenty-four patients each of DLB and AD underwent both (18)F-FDG-PET and MRI with voxel-based morphometry. Dopamine transporter (DAT) density was also measured by DAT-SPECT in all those with DLB and in five with AD. The accumulation of FDG in the posterior cingulate ROI was divided by that in the precuneus plus cuneus ROI to derive the CIS ratio from the FDG-PET images. Values for cognitive function of Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Ray Auditory Verbal Learning Test (RAVLT) and scores for the core-feature triad of fluctuation, hallucination and parkinsonism were also statistically analyzed.


RESULTS
The CIS ratio was higher in DLB than in AD (p < 0.001). The degree of MTL atrophy was lower in DLB than in AD (p < 0.001). The CIS ratio and the degree of MTL atrophy were inversely correlated with DLB (p < 0.001) and with AD (p < 0.05). The CIS ratio did not significantly correlate with DAT density in DLB or with MMSE, FAB, fluctuation score and parkinsonism score. However, the CIS ratio significantly correlated with RAVLT and hallucination scores (both, p < 0.05).


CONCLUSIONS
The CIS on FDG-PET in DLB was associated with MTL atrophy but not with striatal DAT density, suggesting that the CIS is a useful neuroimaging biomarker to evaluate coexisting AD-type NFT pathology in vivo. The CIS was also associated with memory impairment and visual hallucination in DLB.
Department of Neurology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 24-1-3, Matsuyama, Kiyose, Tokyo, 204-8522, Japan. iizukat@fukujuji.org.
Tomomichi
T
Iizuka
Division of Nuclear Medicine, Department of Radiology School of Medicine, Keio University, Tokyo, Japan.|Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Masashi
M
Kameyama
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging*; D006801:Humans; D020961:Lewy Body Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D013702:Temporal Lobe / Q000473:pathology*; D015899:Tomography, Emission-Computed, Single-Photon
D050483:Dopamine Plasma Membrane Transport Proteins; D019788:Fluorodeoxyglucose F18
Cingulate island sign; Dementia with Lewy bodies; Dopamine transporter; Medial temporal lobe