In vivo MRI perfusion and structural correlates of pathology in frontotemporal lobar degeneration
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Graduate group
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frontotemporal dementia
frontotemporal lobar degeneration
magnetic resonance imaging
perfusion imaging
structural imaging
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Abstract
Brain perfusion quantified as cerebral blood flow (CBF) measured using arterial spin labeling (ASL) magnetic resonance imaging (MRI) has the potential to detect the physiological changes related to neurodegenerative disease that may precede structural changes. Frontotemporal lobar degeneration (FTLD) is a devastating early onset neurodegenerative disease that causes significant patient, caregiver, and healthcare system burden. While structural MRI is commonly used to evaluate gray matter (GM) atrophy in patients with FTLD, ASL is less commonly used but may be sensitive to neuronal disfunction prior to GM atrophy. However, interpretation of CBF is confounded by partial volume effects (PVEs) due to large voxels encompassing intracranial content with different perfusion levels and other confounds such as neurodegenerative atrophy. Partial volume correction (PVC), data cleaning, and other techniques attempt to compensate for these confounds, but validation remains to be performed against gold standard pathologic diagnosis. In this dissertation, I examine structural and functional MRI data of patients with autopsy-confirmed FTLD. I use a state-of-the-art analytic tool, event-based modeling (EBM), to examine structural measures of regional GM atrophy to generate disease stage estimates for patients and relate these to pathologic burden. I also relate regional CBF both with and without PVC to pathological burden data. In patients with autopsy-confirmed FTLD, EBM-estimated stages of disease progression based upon structural MRI measures are related to pathologic burden at autopsy. Regional measures of CBF and brain structure are also related to regional pathologic burden. Furthermore, PVC improves CBF estimates as predictors of pathologic burden relative to CBF estimates without PVC. EBM and ASL appear to be valuable tools to estimate pathologic burden in patients with FTLD for clinical treatment trials.
Advisor
Gee, James, C.