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Perfusion CT imaging as a diagnostic and prognostic tool for dementia: prospective case–control study
  1. Sanket Dash1,
  2. Yatish Agarwal1,
  3. Swarna Jain1,
  4. Anuradha Sharma1,
  5. Neera Chaudhry2
  1. 1Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  2. 2Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  1. Correspondence to Dr Swarna Jain, Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India; drswarna007{at}gmail.com

Abstract

Background As functional changes precede structural changes in dementia, we aimed to elucidate changes on cerebral perfusion CT (PCT) for early diagnosis of dementia; and to differentiate Alzheimer’s disease (AD) from vascular dementia (VaD). We also aimed to study correlation between Montreal Cognitive Assessment (MOCA) score and PCT parameters.

Methods We conducted a prospective case–control study enrolling 25 dementia patients (15 cases of VaD, 10 cases of AD) and 25 age-matched controls. PCT was performed on a 256-slice CT scanner. Using perfusion software, colour maps were generated for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time and time-to-peak. These colour maps were first visually inspected for any abnormalities. Subsequently, quantitative assessment of perfusion parameters was done using symmetrical freehand region of interests drawn in bilateral frontal, temporal, parietal regions, basal ganglia and hippocampi.

Results Strategic infarcts were present in 93.3% cases and white matter ischaemic changes in 100% cases of VaD. A global reduction in CBF and CBV was also observed in cases of VaD; whereas these parameters were significantly lower mainly in temporoparietal regions and hippocampi of patients with AD. There was significant positive correlation between MOCA score and various perfusion parameters in both forms of dementia.

Conclusion PCT is a reliable imaging modality for early diagnosis of dementia and in differentiating VaD from AD. As perfusion parameters show positive correlation with MOCA score, they could be used as a surrogate marker of cognitive status in the follow-up of patients with dementia.

  • neuroradiology
  • diagnostic radiology
  • computed tomography
  • dementia
  • geriatric medicine

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Footnotes

  • Contributors SD and SJ conceived the idea of this study. SD, YA and SJ did literature review. SD and SJ collected and analyzed data. SD and SJ prepared tables and wrote the first draft of manuscript. NC and AS helped with writing, reviewing and editing the manuscript. SJ is the guarantor for the work. YA was responsible for the supervision of this project. All authors approved the final version of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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