Mild cognitive impairment: baseline and longitudinal structural MR imaging measures improve predictive prognosis.
Radiology. 2011-06-01; 259(3): 834-843
DOI: 10.1148/radiol.11101975
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McEvoy LK, Holland D, Hagler DJ Jr, Fennema-Notestine C, Brewer JB, Dale AM; Alzheimer’s Disease Neuroimaging Initiative.
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PURPOSE: To assess whether single-time-point and longitudinal volumetric magnetic
resonance (MR) imaging measures provide predictive prognostic information in
patients with amnestic mild cognitive impairment (MCI).
MATERIALS AND METHODS: This study was conducted with institutional review board
approval and in compliance with HIPAA regulations. Written informed consent was
obtained from all participants or the participants’ legal guardians.
Cross-validated discriminant analyses of MR imaging measures were performed to
differentiate 164 Alzheimer disease (AD) cases from 203 healthy control cases.
Separate analyses were performed by using data from MR images obtained at one
time point or by combining single-time-point measures with 1-year change
measures. Resulting discriminant functions were applied to 317 MCI cases to
derive individual patient risk scores. Risk of conversion to AD was estimated as
a continuous function of risk score percentile. Kaplan-Meier survival curves were
computed for risk score quartiles. Odds ratios (ORs) for the conversion to AD
were computed between the highest and lowest quartile scores.
RESULTS: Individualized risk estimates from baseline MR examinations indicated
that the 1-year risk of conversion to AD ranged from 3% to 40% (average group
risk, 17%; OR, 7.2 for highest vs lowest score quartiles). Including measures of
1-year change in global and regional volumes significantly improved risk
estimates (P = 001), with the risk of conversion to AD in the subsequent year
ranging from 3% to 69% (average group risk, 27%; OR, 12.0 for highest vs lowest
score quartiles).
CONCLUSION: Relative to the risk of conversion to AD conferred by the clinical
diagnosis of MCI alone, MR imaging measures yield substantially more informative
patient-specific risk estimates. Such predictive prognostic information will be
critical if disease-modifying therapies become available.
SUPPLEMENTAL MATERIAL:
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101975/-/DC1.
RSNA, 2011