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AJNR - American Journal of Neuroradiology

Published ahead of print on October 9, 2007
doi: 10.3174/ajnr.A0687

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American Journal of Neuroradiology 28:1938-1942, November-December 2007
© 2007 American Society of Neuroradiology

BRAIN

Lobar Distribution of Changes in Gray Matter and White Matter in Memory Clinic Patients: Detected Using Magnetization Transfer Imaging

A.C.G.M. van Es^a, W.M. van der Flier^e, F. Admiraal–Behloul^d, H. Olofsen^d, E.L.E.M. Bollen^b, H.A.M. Middelkoop^b, A.W.E. Weverling-Rijnsburger^c, J. van der Grond^a, R.G.J. Westendorp^c and M.A. van Buchem^a

^a Departments of Radiology, Leiden University Medical Center, Leiden, the Netherlands
^b Neurology, Leiden University Medical Center, Leiden, the Netherlands
^c Section of Gerontology and Geriatrics of the Department of General Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
^d Section of Image Processing of the Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands, Leiden University Medical Center, Leiden, the Netherlands
^e Department of Neurology and Alzheimer Center, Vrije Universiteit Medical Center, Amsterdam, the Netherlands

Please address correspondence to A.C.G.M. van Es, MD, Department of Radiology, C2-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: A.C.G.M.van_Es{at}LUMC.nl

BACKGROUND AND PURPOSE: Previous studies have shown involvement of both gray matter (GM) and white matter (WM) in mild cognitive impairment (MCI) and Alzheimer disease (AD). In this study, we assessed the lobar distribution of the GM and WM pathology over the brain and the association of lobar distribution with global cognitive decline.

MATERIALS AND METHODS: Fifty-five patients with AD, 19 patients with MCI, and 43 subjects with normal cognitive function participated in this study. GM and WM were segmented on dual fast spin-echo and fluid-attenuated inversion recovery MR images. A custom template representing anatomic areas was applied. Magnetization transfer imaging (MTI) peak height and mean magnetization transfer ratio (MTR) provided measures for structural brain damage.

RESULTS: Both mean MTR and MTI peak height showed that patients with AD had more structural brain damage in the GM of all lobes compared with controls. Patients with MCI had lower GM peak height compared with controls for the temporal and frontal lobe. WM peak height was lower for all lobes investigated for patients with both AD and MCI. WM mean MTR was lower in the frontal, parietal, and temporal lobes for patients with AD compared with controls. Age and both temporal GM peak height and mean MTR were the only parameters that predicted cognition.

CONCLUSION: This study shows that in addition to more focal GM MTI changes in the temporal and frontal lobes, widespread WM changes are present in the earliest stages of AD. This might point to an important role for WM pathology in the earliest stage of AD.