Multiparametric computer-aided differential diagnosis of Alzheimer\u2019s disease and frontotemporal dementia using structural and advanced MRI

Esther E Bron,Stefan Klein,John C Van Swieten,Rozanna Meijboom,Rebecca M E Steketee,Marion Smits,Marius De Groot,Wiro J Niessen,Janne M Papma

doi:10.1007/s00330-016-4691-x

Esther E Bron, Stefan Klein + Show 7 more

Open Access

https://doi.org/10.1007/s00330-016-4691-x

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Abstract

ObjectivesTo investigate the added diagnostic value of arterial spin labelling (ASL) and diffusion tensor imaging (DTI) to structural MRI for computer-aided classification of Alzheimer's disease (AD), frontotemporal dementia (FTD), and controls.MethodsThis retrospective study used MRI data from 24 early-onset AD and 33 early-onset FTD patients and 34 controls (CN). Classification was based on voxel-wise feature maps derived from structural MRI, ASL, and DTI. Support vector machines (SVMs) were trained to classify AD versus CN (AD-CN), FTD-CN, AD-FTD, and AD-FTD-CN (multi-class). Classification performance was assessed by the area under the receiver-operating-characteristic curve (AUC) and accuracy. Using SVM significance maps, we analysed contributions of brain regions.ResultsCombining ASL and DTI with structural MRI resulted in higher classification performance for differential diagnosis of AD and FTD (AUC = 84%; p = 0.05) than using structural MRI by itself (AUC = 72%). The performance of ASL and DTI themselves did not improve over structural MRI. The classifications were driven by different brain regions for ASL and DTI than for structural MRI, suggesting complementary information.ConclusionsASL and DTI are promising additions to structural MRI for classification of early-onset AD, early-onset FTD, and controls, and may improve the computer-aided differential diagnosis on a single-subject level.Key points• Multiparametric MRI is promising for computer-aided diagnosis of early-onset AD and FTD.• Diagnosis is driven by different brain regions when using different MRI methods.• Combining structural MRI, ASL, and DTI may improve differential diagnosis of dementia.

Highlights

Alzheimer's disease (AD) and frontotemporal dementia (FTD) are major diseases underlying dementia, especially in younger patients [1]
Combining arterial spin labelling (ASL) and diffusion tensor imaging (DTI) with structural MRI resulted in higher classification performance for differential diagnosis of AD and FTD (AUC = 84%; p = 0.05) than using structural MRI by itself (AUC = 72%)
The performance of ASL and DTI themselves did not improve over structural MRI

Summary

Introduction

Alzheimer's disease (AD) and frontotemporal dementia (FTD) are major diseases underlying dementia, especially in younger patients (age < 65 years) [1]. Establishing an accurate diagnosis in the early stage of the disease can be difficult. Clinical symptomatology differs between the diseases, symptoms in the early stage may be unclear and can overlap [2, 3]. The current clinical criteria, which entail qualitative inspection of neuroimaging, fail to accurately differentiate AD from FTD [4]. Early and accurate differential diagnosis of AD and FTD is very important, mainly because it gives patients access to supportive therapies [5, 6]. Early diagnosis supports new research into understanding the disease process and developing new treatments [5, 6]

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