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From the Departments of Psychiatry (Drs. Mosconi, Tsui, De Santi, J. Li, Convit, Y. Li, Boppana, and de Leon) and Radiology (Dr. Rusinek), New York University School of Medicine, New York; Nathan Kline Institute (Drs. Tsui, Convit, and de Leon), Orangeburg, NY; and Department of Clinical Pathophysiology (Dr. Mosconi), Nuclear Medicine Unit, University of Florence, Italy.
Address correspondence and reprint requests to Dr. Mony J. de Leon, Center for Brain Health, MHL400, NY University School of Medicine, 560 First Avenue, New York, NY 10016; e-mail: mony.deleon{at}med.nyu.edu
Background: To facilitate image analysis, most recent 2-[18F]fluoro-2-deoxy-d-glucose PET (FDG-PET) studies of glucose metabolism (MRglc) have used automated voxel-based analysis (VBA) procedures but paradoxically none reports hippocampus MRglc reductions in mild cognitive impairment (MCI) or Alzheimer disease (AD). Only a few studies, those using regions of interest (ROIs), report hippocampal reductions. The authors created an automated and anatomically valid mask technique to sample the hippocampus on PET (HipMask).
Methods: Hippocampal ROIs drawn on the MRI of 48 subjects (20 healthy elderly [NL], 16 MCI, and 12 AD) were used to develop the HipMask. The HipMask technique was applied in an FDG-PET study of NL (n = 11), MCI (n = 13), and AD (n = 12), and compared to both MRI-guided ROIs and VBA methods.
Results: HipMask and ROI hippocampal sampling produced significant and equivalent MRglc reductions for contrasts between MCI and AD relative to NL. The VBA showed typical cortical effects but failed to show hippocampal MRglc reductions in either clinical group. Hippocampal MRglc was the only discriminator of NL vs MCI (78% accuracy) and added to the cortical MRglc in classifying NL vs AD and MCI vs AD.
Conclusions: The new HipMask technique provides accurate and rapid assessment of the hippocampus on PET without the use of regions of interest. Hippocampal glucose metabolism reductions are found in both mild cognitive impairment and Alzheimer disease and contribute to their diagnostic classification. These results suggest re-examination of prior voxel-based analysis 2-[18F]fluoro-2-deoxy-d-glucose PET studies that failed to report hippocampal effects.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 14 issue to find the title link for this article.
Supported by NIH-NIA grants AG12101, AG13613, and AG08051.
Received October 1, 2004. Accepted in final form February 8, 2005.
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