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T.P. Tanpitukpongse and J.R. Petrella
American Journal of Neuroradiology September 2017, 38 (9) E62; DOI: https://doi.org/10.3174/ajnr.A5259
T.P. Tanpitukpongse
aUNC Rex Healthcare Raleigh, North Carolina
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J.R. Petrella
bDuke University Health System Durham, North Carolina
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We thank Dr Haller for his recent letter regarding our publication, “Predictive Utility of Marketed Volumetric Software Tools in Subjects at Risk for Alzheimer Disease: Do Regions Outside the Hippocampus Matter?”

We restricted our study to NeuroQuant (CorTechs Labs, San Diego, California) and Neuroreader (Brainreader, Horsens, Denmark) because they have received FDA 510(k) marketing clearance and physicians are likely to use them in everyday practice. Also, these packages use a probabilistic atlas-based segmentation on non-uniformity-corrected 3D T1-weighted images to derive absolute volumes of a variety of cortical and subcortical structures (and are not voxel-based morphometry–derived gray matter concentrations, as stated by Dr Haller).

We fully agree with Dr Haller that areas outside the medial temporal lobe play a role in the evolution of Alzheimer disease (AD); indeed, we and others have previously documented the value of using multiple markers, including other brain regions.1,2 Nevertheless, the earliest synaptic lesions in AD are thought to be in the medial temporal lobe, and MR imaging hippocampal volumes are one of the markers used in newer diagnostic criteria for mild cognitive impairment (MCI) due to AD.3

Clearly, MCI and dementia are heterogeneous in their pathology, presentation, and outcomes; using multiple anatomic and molecular biomarkers will no doubt help us better personalize diagnosis and therapy.4

References

  1. 1.↵
    1. Shaffer JL,
    2. Petrella JR,
    3. Sheldon FC, et al
    ; Alzheimer's Disease Neuroimaging Initiative. Predicting cognitive decline in subjects at risk for Alzheimer disease by using combined cerebrospinal fluid, MR imaging, and PET biomarkers. Radiology 2013;266:583–91 doi:10.1148/radiol.12120010 pmid:23232293
    CrossRefPubMed
  2. 2.↵
    1. Hostage CA,
    2. Choudhury KR,
    3. Murali Doraiswamy P, et al
    ; Alzheimer's Disease Neuroimaging Initiative. Mapping the effect of the apolipoprotein E genotype on 4-year atrophy rates in an Alzheimer disease-related brain network. Radiology 2014;271:211–19 doi:10.1148/radiol.13131041 pmid:24475827
    CrossRefPubMed
  3. 3.↵
    1. Albert MS,
    2. DeKosky ST,
    3. Dickson D, et al
    . The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging–Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011;7:270–79 doi:10.1016/j.jalz.2011.03.008 pmid:21514249
    CrossRefPubMed
  4. 4.↵
    1. Petrella JR
    . Neuroimaging and the search for a cure for Alzheimer disease. Radiology 2013;269:671–91 doi:10.1148/radiol.13122503 pmid:24261497
    CrossRefPubMed
  • © 2017 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 38 (9)
American Journal of Neuroradiology
Vol. 38, Issue 9
1 Sep 2017
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T.P. Tanpitukpongse, J.R. Petrella
American Journal of Neuroradiology Sep 2017, 38 (9) E62; DOI: 10.3174/ajnr.A5259

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T.P. Tanpitukpongse, J.R. Petrella
American Journal of Neuroradiology Sep 2017, 38 (9) E62; DOI: 10.3174/ajnr.A5259
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