Medial temporal atrophy predicts the limbic comorbidities in lewy body disease

Keita Sakurai; Daita Kaneda; Satoru Morimoto; Yuto Uchida; Shohei Inui; Cong Shang; Yasuyuki Kimura; Chang Cai; Takashi Kato; Kengo Ito; Yoshio Hashizume

doi:10.1007/s00234-024-03502-z

Medial temporal atrophy predicts the limbic comorbidities in lewy body disease

Neuroradiology. 2024 Nov 12. doi: 10.1007/s00234-024-03502-z. Online ahead of print.

Authors

Keita Sakurai¹, Daita Kaneda², Satoru Morimoto³, Yuto Uchida^{4

5}, Shohei Inui⁶, Cong Shang^{7

8}, Yasuyuki Kimura⁹, Chang Cai⁹, Takashi Kato¹⁰, Kengo Ito¹⁰, Yoshio Hashizume²

Affiliations

¹ Department of Radiology, National Center for Geriatrics and Gerontology, 7-430 Morioka-Cho, Obu, Aichi, 474-8511, Japan. ksak666@yahoo.co.jp.
² Choju Medical Institute, Fukushimura Hospital, Aichi, Japan.
³ Keio University Regenerative Medicine Research Center, Kanagawa, Japan.
⁴ Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
⁵ Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Radiology, The University of Tokyo, Tokyo, Japan.
⁷ Department of Radiology, Fujita Health University, Aichi, Japan.
⁸ Department of Radiology, Fujita Health University, Toyoake, Aichi, Japan.
⁹ Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Aichi, Japan.
¹⁰ Department of Radiology, National Center for Geriatrics and Gerontology, 7-430 Morioka-Cho, Obu, Aichi, 474-8511, Japan.

PMID: 39531077
DOI: 10.1007/s00234-024-03502-z

Abstract

Purpose: Although neuropathological comorbidities, including Alzheimer's disease neuropathological change (AD-NC) and limbic-predominant age-related TAR DNA-binding protein 43encephalopathy neuropathological change (LATE-NC), are associated with medial temporal atrophy in patients with Lewy body disease (LBD), the diagnostic performance of magnetic resonance imaging (MRI)-derived indices remains unclear. This study aimed to investigate the diagnostic performance of MRI-derived indices representing medial temporal atrophy in differentiating between LBD with AD-NC and/or LATE-NC (mixed LBD [mLBD]) and without these comorbidities (pure LBD [pLBD]).

Methods: This study included 24 and 16 patients with pathologically confirmed mLBD and pLBD, respectively. In addition to the well-known medial temporal atrophy and entorhinal cortex atrophy (ERICA) scores, the cross-sectional areas of the bilateral entorhinal cortices/parahippocampal gyri (ABEP) were segmented manually.

Results: Even incorporating various covariates such as age at MRI examination, sex, argyrophilic grain, the MRI-derived indices, especially ABEP, significantly correlated with the severity of AD-NC, and showed a trend of correlation with LATE-NC. For the differentiation between all mLBD and pLBD, the ERICA score and ABEP demonstrated higher diagnostic performance (area under the receiver-operating-characteristic curve [AUC] of 0.80 and 0.87, respectively). Additionally, the highest diagnostic performance for ABEP (AUC, 0.94; sensitivity, 100%; specificity, 88.9%; accuracy, 96%) was observed in differentiating between pLBD and mLBD with two comorbidities (AD-NC and LATE-NC).

Conclusion: In patients with pathologically confirmed LBD, medial temporal atrophy was significantly correlated with AD-NC, and showed a trend of correlation with LATE-NC. Moreover, MRI-derived indices indicative of medial temporal atrophy were useful in diagnosing these comorbidities.

Keywords: Alzheimer’s disease; Comorbidity; Lewy body disease; Limbic-predominant age-related TDP-43 encephalopathy; Magnetic resonance imaging; Medial temporal atrophy; Neurofibrillary tangle.

Grants and funding

16H06277/Japan Society for the Promotion of Science