Diagnosed mild cognitive impairment due to Alzheimer's disease with PET biomarkers of beta amyloid and neuronal dysfunction.

The aim of this study is to identify mild cognitive impairment (MCI) due to Alzheimer's disease (AD) using amyloid imaging of beta amyloid (Aβ) deposition and FDG imaging of reflecting neuronal dysfunction as PET biomarkers. Sixty-eight MCI patients underwent cognitive testing, [11C]-PIB PET and [18F]-FDG PET at baseline and follow-up. Regions of interest were defined on co-registered MRI. PIB distribution volume ratio (DVR) was calculated using Logan graphical analysis, and the standardized uptake value ratio (SUVR) on the same regions was used as quantitative analysis for [18F]-FDG. Thirty (44.1%) of all 68 MCI patients converted to AD over 19.2±7.1 months. The annual rate of MCI conversion was 23.4%. A positive Aβ PET biomarker significantly identified MCI due to AD in individual MCI subjects with a sensitivity (SS) of 96.6% and specificity (SP) of 42.1%. The positive predictive value (PPV) was 56.8%. A positive Aβ biomarker in APOE ε4/4 carriers distinguished with a SS of 100%. In individual MCI subjects who had a prominent impairment in episodic memory and aged older than 75 years, an Aβ biomarker identified MCI due to AD with a greater SS of 100%, SP of 66.6% and PPV of 80%, compared to FDG biomarker alone or both PET biomarkers combined. In contrast, when assessed in precuneus, both Aβ and FDG biomarkers had the greatest level of certainty for MCI due to AD with a PPV of 87.8%. The Aβ PET biomarker primarily defines MCI due to AD in individual MCI subjects. Furthermore, combined FDG biomarker in a cortical region of precuneus provides an added diagnostic value in predicting AD over a short period

Dissecting Aneurysms of Bilateral Anterior Cerebral Artery Complicated by Subarachnoid Hemorrhage after Cerebral Infarction: A Case Report

Introduction Intracranial dissecting aneurysms have been increased due to recent advancements in diagnostic imaging. However there have been little article with subarachnoid hemorrhage and cerebral infarction occurring almost at the same time. We performed the surgical treatment and obtained good result. Case presentation A 47-year-old male presented to our hospital with chief complaints of sudden headache and mild paralysis of the left lower extremity. Brain imaging at admission revealed cerebral infarction in the right frontal lobe and subarachnoid hemorrhage in the frontal convexy and anterior interhemispheric fissure. The left and right internal carotid angiography showed a bulging cerebral aneurysm at the left A1–A2 junction and stenosis and arterial dissections in the peripheral of the bilateral anterior cerebral artery. Wrapping was performed for the dissecting aneurysm of the left anterior cerebral artery. For the right anterior cerebral artery, trapping was performed at the A2 segment without vascular anastomosis. The patient's postoperative course was uneventful. Conclusion A consensus has not been reached on the treatment for intracranial dissecting aneurysms. Proximal trapping without vascular reconstruction was performed for the right anterior cerebral artery without vascular anastomosis to prevent rebleeding. However no symptoms of neurological deficiency were observed. Proximal trapping of dissecting aneurysm seems to be a good option when patient's functional and life prognosis are taken into account in case that vascular reconstruction will be anticipated difficulty

PIB-PET DVR images from 4 representative MCI converters and stable patients with (+) and without amyloid deposition (−) at baseline.

<p>PIB-PET DVR images from 4 representative MCI converters and stable patients with (+) and without amyloid deposition (−) at baseline.</p

Demographic Characteristics of Patients With MCI.

<p>MCI: mild cognitive impairment, MMSE: Mini-Mental State Examination, CDR: Clinical Dementia Rating, CDR SB: Clinical Dementia Rating sum of boxes score, study popu: number of patients in the study population, yr: years. Rec: WMS-R recall scores, APOE: apolipoprotein E, Data are presented as means ± SD, * Statistically significant difference from stable patients by multiple comparisons post hoc tests (<i>p</i><0.05).</p

The cortical PIB DVR values in PIB-positive MCI converters (closed circles, n = 29), PIB-negative MCI converter (open circles, n = 1), PIB-positive stable MCI patients (closed triangles, n = 22), and PIB-negative stable MCI patients (open triangles, n = 16) at baseline and follow-up.

<p>Data are presented as mean ± SD. *Statistically significant difference from the PIB-negative stable MCI patients by multiple comparisons post hoc tests (<i>p</i><0.01).</p

Scatter plot of the relationship between cortical PIB DVR and FDG SUVR values in individual MCI converters (closed circles, n = 30) and stable patients (open circles, n = 38).

<p><b>The horizontal dotted line indicates the greatest value of PIB DVR (≥1.49).</b> The vertical dotted line indicates the lower value of FDG SUVR (≤0.99).</p

Regional FDG SUVR values in the lateral temporal cortex, frontal cortex, precuneus and parietal cortex of MCI converters (closed circles, n = 30) and stable patients (open circles, n = 38) at baseline.

<p>Data are presented as means ± SD. *Statistically significant difference from the stable patients by multiple comparisons post hoc tests (p<0.05).</p