Avance hacia una detección precoz
En el futuro, las nuevas tecnologías de imagenología y los biomarcadores de enfermedades pueden ser útiles para llevar adelante la evaluación clínica de la AD, del simple descarte de la enfermedad al apoyo en la identificación de pacientes que tienen una gran probabilidad de desarrollar AD, mediante la identificación de patrones característicos de alteraciones cerebrales funcionales y estructurales.
Los lineamientos actuales para la etapa de Deterioro Cognitivo Leve (MCI) son, en gran parte, para la investigación, pero se pueden aplicar en entornos clínicos especializados. Complementan las pruebas clínicas estándar para ayudar a determinar las posibles causas de los síntomas de MCI.1 En la actualidad, la imagenenología se utiliza en la investigación para ayudar a establecer las correlaciones entre las manifestaciones fisiopatológicas, el estado clínico y su relación con otros biomarcadores y su pronóstico, así como con los estudios terapéuticos. En el futuro, la imagenología podría ser valiosa para determinar qué pacientes con MCI podrían progresar a un diagnóstico clínico de la AD y apoyar la identificación de terapias adecuadas que modifiquen la enfermedad.2
Mediante la combinación de imagenología diagnóstica y capacidades de laboratorio, Siemens Healthineers es su socio en la evaluación de la AD y en la mejora de los límites de diagnóstico en el futuro.
Enfermedad de AlzheimerSoluciones de Neurología para una mayor confianza en el diagnóstico
La imagenología y las pruebas de laboratorio apoyan la evaluación de la enfermedad de Alzheimer
Por el momento, no hay pruebas independientes para un diagnóstico definitivo de la enfermedad de Alzheimer (AD) que no sea la confirmación histopatológica en la autopsia. La evaluación completa de AD incluye una historia clínica completa, pruebas de estado mental, examen físico y neurológico, imagenología cerebral y pruebas de laboratorio.
Avance hacia una detección precoz
There are a variety of types of dementia and cognitive impairment, which can have various underlying causes, ranging from Alzheimer’s disease (AD) to vascular dementia to name but a few, requiring different therapeutical approaches. Hence various risk factors need to be assessed. While imaging and laboratory tests have traditionally been used independently on a diagnostic basis to rule out other causes of dementia, they may in the future help to assess multiple different aspects of AD pathology and have immediate prognostic importance. Siemens provides technology and laboratory equipment to help effectively differentiate AD from other dementias and venture forward in AD research.
The ɛ4 allele of the apolipoprotein E (APOE) gene has been identified as a major genetic risk factor for AD. It encodes a protein that plays a key role in cholesterol metabolism and has been found to increase the risk of developing AD. APOE-ɛ4 contributes to AD pathogenesis seems to act primarily as a risk factor in brain beta-amyloid deposition.2 Hence, screening for APOE gene mutations and micro RNA pattern indicating a risk profile will become important screening tools in the future.
In patients with suspected AD, the clinical evaluation essentially includes lab tests for a number of mimicking diseases such as hypo- and hyperthyroidism, vitamin deficiencies, and infections of the central nervous system (Creutzfeldt-Jakob disease, AIDS dementia, neurosyphilis). As your partner in thyroid testing, Siemens solutions help labs keep pace with the evolving standards in thyroid disease diagnostics.
Brain scans are used to rule out other possible causes of dementia, including brain tumors, stroke, subdural hematomas, normal-pressure hydrocephalus, and other conditions. Non-contrast and contrast-enhanced CT imaging is a highly efficient neuro-imaging technique that provides differential and cause-related information on possible causes of dementia. The unmatched soft tissue contrast of MRI and additional information gained from dedicated sequences enables to reliably rule out differential diagnoses. With state-of-theart CT and MR scanners together with software for all your clinical and research related data handling, Siemens is the ideal partner in AD image based evaluation.
The simultaneous acquisition of MR imaging (MRI)/ CT imaging and positron emission tomography (PET) data provides exceptional insights into brain anatomy, functions, and metabolism. Biograph mMR and Biograph mCT/Biograph mCT Flow have the ability to precisely visualize areas of decreased or increased glucose metabolism in the brain. This supports differentiation between AD, frontoemporal dementia and other dementias. It also allows a determination of the extent and progression of the disease. In AD, a characteristic pattern of decreased uptake can be seen in the posterior temporo parietal association cortex.2 PET imaging is utilized to estimate beta-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for AD and other causes of cognitive decline.3 Through the combination of CT or MR with PET in one modality, Siemens technology enables shorter acquisition times and optimizes accuracy with motion compensation in agitated patients. Siemens’ exceptional molecular PET/MR and PET/CT technology promises unprecedented insights into AD pathology, more comprehensive brain imaging, and improved functional analysis.
By the time a typical Alzheimer’s disease (AD) patient comes to diagnosis, atrophy is normally well established. Even in patients with mild clinical symptoms, entorhinal volumes are already reduced by around 20–30 % and hippocampal volumes by about 15–25 %.4 In particular, the assessment of medial temporal atrophy with MRI has been shown to have a predictive value for AD. Consequently, medial temporal lobe atrophy is now included as one of the biomarkers of AD in proposed criteria for diagnosing (prodromal) AD at a pre-dementia stage.
3T MRI Scanners
Structural MRI in AD can assess atrophy and changes in tissue characteristics. Also, progressive cerebral atrophy can be visualized in patients, in particular, with T1-weighted volumetric sequences. MRI offers a range of different sequences that can probe different tissue characteristics, providing multiple clinical and research measures in a single session. MRI measures of atrophy reflect cumulative neuronal damage, which in turn is directly responsible for the clinical state.
The benefits of single modality MR and PET in the study of neurological diseases such as AD are well known. Combining these modalities brings the potential for a more complete imaging picture and better understanding of AD pathologies. In addition, the current research and development of new tracers offers great promise. Biograph mMR fully integrates state-of-the-art 3T MRI and cutting-edge molecular imaging. Simultaneous acquisition of the morphology, function, and metabolism of the brain are now possible. You can obtain a comprehensive diagnostic picture with just one scan, which shows MR and PET data in virtually seamless spatial alignment. In addition, the MR acquisition can be used to correct motion-related effects in PET, greatly improving image quality.
Functional MRI (fMRI) is being increasingly used to investigate the functional integrity of brain networks in AD. In combination with other tests, the information gained from fMRI will help differentiate the diseases and determine the status of progression. Synaptic activity is measured either by the visualization of glucose metabolism of brain cells using PET or the visualization of signal changes due to changes in blood volume, blood flow, and the blood oxyhemoglobin/ deoxyhemoglobin ratio using BOLD MRI. Many fMRI studies in MCI and AD focus on the pattern of fMRI activation in the hippocampus and related structures in the medial temporal lobe. In patients with clinically diagnosed AD, the results have been quite consistent, showing decreased hippocampal activity during theencoding of new information. Furthermore, several studies report increased prefrontal cortical activity in AD patients. These results suggest that other networks may increase activity as an attempted compensatory mechanism during hippocampal failure.4 Other MRI techniques such as diffusion tensor imaging (DTI), arterial spin labeling measures of cerebral blood flow and PET tracers targeted at the cholinergic system, microglial activation and other tracers in development will also be contributing to our understanding of AD pathology in the future.
Inline BOLD Imaging
- Automatic real-time calculation of z-score (t-test) maps with inline technology for variable paradigms
- Compatible with single-shot EPI with high susceptibility contrast for fast multi-slice imaging
- ART (Advanced Retrospective Technique) for fully automatic 3D retrospective motion correction for 6 degrees of freedom (3 translations and 3 rotations)
- Mosaic images for efficient storage and transfer of large data sets
- Inline calculation of t-statistics (t-maps) based on a general linear model (GLM), including the hemodynamic response function and correction for slow drifts (GLM not available for MAGNETOM ESSENZA)
- Overlay of statistical results calculated inline onto EPI images.
syngo DTI Tractography
- Multiple parameters can be derived from the diffusion tensor, including the trace, ADC (Apparent Diffusion Coefficient), relative anisotropy, and fractional anisotropy. These secondary parameters are independent of the frame of reference and are very sensitive to white matter pathology.
- syngo DTI (Diffusion Tensor Imaging) Tractography uses diffusion tensor data and allows 3D visualization of specific white matter tracts.
- syngo DTI and syngo DTI Evaluation will help you to identify anatomical substructures, and with fiber direction maps and fiber tracts (tractography) you will be able to assess the microstructural aspects of the brain lesions.
- The Siemens Multidirectional DTI with 256 directions allows a finer and more precise visualisation of fiber tracks and direction.