Korean J Radiol.  2021 May;22(5):770-781. 10.3348/kjr.2020.0700.

Added Value of Chemical Exchange-Dependent Saturation Transfer MRI for the Diagnosis of Dementia

Affiliations
  • 1Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea.
  • 2Department of Biomedical Engineering, Undergraduate School, College of Electronics and Information, Kyung Hee University, Yongin, Korea.
  • 3Department of Neurology, Kyung Hee University Hospital at Gangdong, College of Medicine Kyung Hee University, Seoul, Korea.
  • 4Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
  • 5Department of Radiology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
  • 6Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine Kyung Hee University, Seoul, Korea
  • 7Department of Psychiatry, Kyung Hee University Hospital at Gangdong, College of Medicine Kyung Hee University, Seoul, Korea.

Abstract


Objective
Chemical exchange-dependent saturation transfer (CEST) MRI is sensitive for detecting solid-like proteins and may detect changes in the levels of mobile proteins and peptides in tissues. The objective of this study was to evaluate the characteristics of chemical exchange proton pools using the CEST MRI technique in patients with dementia.
Materials and Methods
Our institutional review board approved this cross-sectional prospective study and informed consent was obtained from all participants. This study included 41 subjects (19 with dementia and 22 without dementia). Complete CEST data of the brain were obtained using a three-dimensional gradient and spin-echo sequence to map CEST indices, such as amide, amine, hydroxyl, and magnetization transfer ratio asymmetry (MTR asym) values, using six-pool Lorentzian fitting. Statistical analyses of CEST indices were performed to evaluate group comparisons, their correlations with gray matter volume (GMV) and Mini-Mental State Examination (MMSE) scores, and receiver operating characteristic (ROC) curves.
Results
Amine signals (0.029 for non-dementia, 0.046 for dementia, p = 0.011 at hippocampus) and MTR asym values at 3 ppm (0.748 for non-dementia, 1.138 for dementia, p = 0.022 at hippocampus), and 3.5 ppm (0.463 for non-dementia, 0.875 for dementia, p = 0.029 at hippocampus) were significantly higher in the dementia group than in the non-dementia group. Most CEST indices were not significantly correlated with GMV; however, except amide, most indices were significantly correlated with the MMSE scores. The classification power of most CEST indices was lower than that of GMV but adding one of the CEST indices in GMV improved the classification between the subject groups. The largest improvement was seen in the MTR asym values at 2 ppm in the anterior cingulate (area under the ROC curve = 0.981), with a sensitivity of 100 and a specificity of 90.91.
Conclusion
CEST MRI potentially allows noninvasive image alterations in the Alzheimer’s disease brain without injecting isotopes for monitoring different disease states and may provide a new imaging biomarker in the future.

Keyword

Chemical exchange saturation transfer; Alzheimer’s disease; Lorentzian fitting; Memory correlation; Added value
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