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Table 3 Summary of [1H]magnetic resonance spectroscopy longitudinal studies

From: Role of emerging neuroimaging modalities in patients with cognitive impairment: a review from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012

Authors Year Patients Follow-up (months) Converted to AD MRI Voxel size (cm3) Brain region Results
Chao and colleagues [70] 2005 17 CIND 43 6 1.5 T, Siemens 0.9 Medial temporal lobe CIND converters had less medial temporal lobe NAA than controls. No difference between CIND stable and controls. No significant difference between CIND converters and CIND stable
Modrego and colleagues [62] 2005 55 MCI 36 29 1.5 T, GE 8 Left hippocampus, right parietal cortex, left occipital cortex Occipital cortex NAA/Cr predicted conversion to dementia. ROC analysis for NAA <1.61 predicted conversion with 100% sensitivity and 75% specificity. Area under the curve was 0.91 with positive predictive value of 83% and a negative predictive value of 100%
Metastasio and colleagues [63] 2006 25 MCI 12 5 1.5 T, GE 8 Left and right paratrigonal white matter Lower NAA/Cr at baseline for MCI converters compared with MCI stable
Rami and colleagues [64] 2007 14 MCI, 28 prodromal AD 12 3 MCI, 16 prodromal AD 1.5 T, GE 8 Posterior cingulate, left temporal pole, left temporoparietal cortex Posterior cingulate had higher Cho/Cr at baseline in MCI converters compared with MCI stable. Temperoparietal lobe showed lower NAA, Cho, and Cr at baseline in prodromal AD converters compared with nonconverters
Kantarci and colleagues [68] 2007 49 MCI 13 18 1.5 T, GE 8 Bilateral posterior cingulate and inferior precuneus No baseline 1H MRS differences between MCI stable and MCI converters
Feyed and colleagues [65] 2008 119 MCI 29 54 1.5 T, GE 8 Bilateral posterior cingulate, left occipital cortex NAA/Cr <1.40 in posterior cingulate predicted conversion of MCI to probable AD with a sensitivity of 82% and specificity of 72%. Area under the curve was 0.82
Pilatus and colleagues [69] 2009 15 MCI 42 6 1.5 T, Philips 8 Posterior cingulate, parietal white matter Did not replicate predictive power of NAA at baseline
Kantarci and colleagues [66] 2009 151 MCI 12 month evaluation 75 1.5 T, GE 8 Bilateral posterior cingulate and inferior precuneus Multivariate analysis showed that NAA/Cr added predictive value in addition to hippocampal volume and the presence of cortical infarction
Modrego and colleagues [67] 2011 71 MCI 22 27 1.5 T, GE 8 Bilateral posteromedial cortex, left medial occipital lobe Decreased NAA/Cr in converters compared with nonconverters in posteromedial cortex and occipital lobe. NAA/Cr ratio ≤ 1.43 in posteromedial parietal cortex predicted conversion to probable AD at 74.1% sensitivity and 83.7% specificity; area under curve was 0.84. In left occipital lobe, 85.2% sensitivity, 61.4% specificity; area under the curve of 0.8
  1. Since 2005, there have been nine longitudinal MRS studies performed in subjects with cognitive impairment. Subjects were typically followed for 1 to 3 years to identify a cohort that converted to dementia. AD, Alzheimer's disease; Cho, choline containing compounds; CIND, cognitively impaired not demented; Cr, creatine; GE, GE Healthcare (Waukesha, WI, USA); MCI, mild cognitive impairment; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; NAA, N-acetylaspartate; Philips, Philips Medical Solutions (Best, The Netherlands); Siemens, Siemens Medical Solutions (Erlangen, Germany).