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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).