Radiologic Assessment Recommended for Neurodegeneration in Memory Impaired Patients

Radiologists should include an evaluation of neurodegeneration when interpreting brain scans from patients with memory impairment, according to US radiology experts.

Medical specialists from the University of California, San Diego (UCSD; USA) and the University of California, San Francisco (UCSF; USA) reported their findings online, June 13, 3013, in the American Journal of Neuroradiology.

The authors described a clinical approach for newly available imaging applications, such as amyloid imaging and volumetric magnetic resonance imaging (MRI), in the workup of memory problems. They stressed that neurodegeneration findings can usefully guide additional management and testing choices while helping to avoid overuse of more expensive biomarkers.

Brain scans already gathered as part of the conventional workup of patients with cognitive complaints can now routinely be quantitatively evaluated for the probability of regional neurodegeneration at little added effort or cost. For example, when using a device that automatically quantifies the volumes of the brain’s memory structures, those volumes can be compared against volumes seen in the healthy population and used to track changes across time. Such evidence can be used to better inform patients, families, and clinicians about the health of the brain, beyond that provided by typical examination for structural lesions. The study described the way in which sophisticated neuroimaging tools such as CorTechs Labs’ (La Jolla, CA, USA) NeuroQuant volumetric MRI analysis system can provide data key to improved understanding of the patient’s clinical status.

Rahul Desikan, MD, PhD, a radiology resident and research fellow at UCSD, explained that, “In this piece, our goal was to show how automated quantitative, volumetric MRI-based methods can be incorporated clinically in the evaluation of patients with memory impairment. We discuss how volumetric MRI, used in conjunction with clinical assessments, can provide insight into the presence or absence of neurodegeneration and thus inform overall clinical impression.”

Coauthor James Brewer, MD, PhD, a neurologist and associate professor in neuroscience and radiology at UCSD added, “This paper lays out a proposed clinical decision tree that might help guide the use of newly FDA [US Food and Drug Administration]-cleared imaging biomarkers, such as Amyvid and NeuroQuant, given that they are gaining wider use well beyond the academic setting. Many centers are beginning to add amyloid PET [positron emission tomography] imaging to their approach. We describe how amyloid imaging, without a complementary measure of neurodegeneration could lead to overusage, added costs, and patient harm. On the other hand, once neurodegeneration is established as a likely cause for the patient’s complaint, the addition of amyloid imaging can be quite powerful to inform management and treatment options.”

CorTechs’ president, Michael E. Smith, PhD, noted that NeuroQuant is “intended for automatic labeling, visualization and volumetric quantification of segmentable brain structures from a set of MR images and can be performed entirely within the PACS [picture archiving and communication system] environment with less than 10 minutes of computational processing on a desktop computer.”

Using structural MRI scans sent directly from a PACS or a scanner as input, it can route the resulting age-related statistical atrophy reports and numeric and color-blended anatomic volumes to most Digital Imaging and Communications in Medicine (DICOM)-compliant viewing devices. NeuroQuant is already available at more than 50 leading clinical sites in the United States.

Related Links:
University of California, San Diego
University of California, San Francisco
CorTechs Labs