Is the cerebellum the optimal reference region for intensity normalization of perfusion MR studies in early Alzheimer's disease?

PLoS One. 2013 Dec 27;8(12):e81548. doi: 10.1371/journal.pone.0081548. eCollection 2013.

Abstract

The cerebellum is the region most commonly used as a reference when normalizing the intensity of perfusion images acquired using magnetic resonance imaging (MRI) in Alzheimer's disease (AD) studies. In addition, the cerebellum provides unbiased estimations with nuclear medicine techniques. However, no reports confirm the cerebellum as an optimal reference region in MRI studies or evaluate the consequences of using different normalization regions. In this study, we address the effect of using the cerebellum, whole-brain white matter, and whole-brain cortical gray matter in the normalization of cerebral blood flow (CBF) parametric maps by comparing patients with stable mild cognitive impairment (MCI), patients with AD and healthy controls. According to our results, normalization by whole-brain cortical gray matter enables more sensitive detection of perfusion abnormalities in AD patients and reveals a larger number of affected regions than data normalized by the cerebellum or whole-brain white matter. Therefore, the cerebellum is not the most valid reference region in MRI studies for early stages of AD. After normalization by whole-brain cortical gray matter, we found a significant decrease in CBF in both parietal lobes and an increase in CBF in the right medial temporal lobe. We found no differences in perfusion between patients with stable MCI and healthy controls either before or after normalization.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alzheimer Disease / pathology*
  • Brain / pathology*
  • Cerebellum / pathology*
  • Cerebrum / blood supply
  • Cognitive Dysfunction
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Reference Values
  • Regional Blood Flow

Grants and funding

This work was funded by AMIT Project (Programa CENIT. Ministerio de Economía y Competitividad, Spain). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.