Features and a specific pattern of cerebral perfusion in patients with Lewy body dementia: Diagnostic ability and clinical correlations

Cerebral perfusion changes have been observed in patients with both dementia with Lewy bodies and Parkinson’s disease dementia. In this study, features of cerebral blood flow (CBF) and a specific perfusion pattern measured using arterial spin labeling (ASL) MRI for Lewy body dementia (LBD) were identified. Twenty-four patients with LBD and 32 cognitively unimpaired controls (CUCs) were enrolled to establish perfusion features and an LBD-related cerebral perfusion pattern (LBDRP) using multivariate spatial covariance analysis. The performances of the relative CBF of major brain regions, global CBF, and the LBDRP subject expression score in discriminating LBD patients from either CUCs or patients with Alzheimer’s disease (AD) were determined via receiver operating characteristic (ROC) curve analysis, and the correlations between perfusion markers and cognitive functions and hallucinations were analyzed in patients with LBD. The LBDRP was characterized by decreased loading in the bilateral middle frontal, middle temporal, and inferior temporal gyri, inferior parietal lobule, angular gyrus, middle occipital gyrus, cuneus, precuneus, pericalcarine cortex, and lingual gyrus, along with relatively positive loading in the bilateral cerebellum, putamen, middle cingulate gyrus, and hippocampus. The LBDRP subject expression score excellently discriminated patients with LBD from CUCs (area under the curve (AUC) = 0.98) and patients with AD (AUC = 0.91). Regional CBF also showed good discriminatory ability and correlations with cognitive functions and hallucinations. This characteristic perfusion pattern may serve as a potential biomarker for the clinical diagnosis and differentiation of LBD.