4.2 Article

The Fornix Sign: A Potential Sign for Alzheimer's Disease Based on Diffusion Tensor Imaging

Journal

JOURNAL OF NEUROIMAGING
Volume 22, Issue 4, Pages 365-374

Publisher

WILEY
DOI: 10.1111/j.1552-6569.2011.00633.x

Keywords

Fornix sign; fractional anisotropy; diffusion tensor imaging; Alzheimer's disease; mild cognitive impairment

Funding

  1. NIH [R21AG033774, P41 RR015241, R01NS058299, R01AG20012]
  2. Johns Hopkins Alzheimer's Disease Research Center (NIH) [P50AG005146]
  3. Glaxo-Smith-Kline
  4. NIMH
  5. NIA
  6. Associated Jewish Federation of Baltimore
  7. Weinberg Foundation
  8. Forest
  9. Eisai
  10. Pfizer
  11. Astra-Zeneca
  12. Lilly
  13. Ortho-McNeil
  14. Bristol-Myers
  15. Novartis

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BACKGROUND We investigated a simple imaging sign for Alzheimer's disease (AD), using diffusion tensor imaging (DTI). We hypothesized that a reduction in fractional anisotropy (FA) in the fornix could be utilized as an imaging sign. METHODS Twenty-three patients with AD, 24 patients with amnestic mild cognitive impairment (aMCI), and 25 control participants (NC) underwent DTI at baseline and 1 year later. The diagnosis was reevaluated 1 year and 3 years after the initial scan. A color-scaled FA map was used to visually identify the FA reduction (fornix sign). We investigated whether the fornix sign could separate AD from NC, and could predict progression from aMCI to AD or NC to aMCI. We also quantified FA of the fornix to validate the fornix sign. RESULTS The fornix sign was identical to the lack of any voxels with an FA > .52 within the fornix. The fornix sign differentiated AD from NC with specificity of 1.0 and sensitivity of .56. It predicted conversion from NC to aMCI with specificity of 1.0 and sensitivity of .67, and from aMCI to AD with specificity of .94 and sensitivity of .83. CONCLUSION The fornix sign is a promising predictive imaging sign of AD.

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