Diagnostic imaging of dementia with Lewy bodies by susceptibility-weighted imaging of nigrosomes versus striatal dopamine transporter single-photon emission computed tomography: a retrospective observational study

Neuroradiology. 2017 Jan;59(1):89-98. doi: 10.1007/s00234-016-1773-z. Epub 2016 Dec 29.


Introduction: The characteristics of dementia with Lewy bodies (DLB), Alzheimer's disease (AD) and amnestic mild cognitive impairment (a-MCI) overlap but require different treatments; therefore, it is important to differentiate these pathologies. Assessment of dopamine uptake in the striatum using dopamine transporter (DaT) single-photon emission computed tomography (SPECT) is the gold standard for diagnosing DLB; however, this modality is expensive, time consuming and involves radiation exposure. Degeneration of the substantia nigra nigrosome-1, which occurs in DLB, but not in AD/a-MCI, can be identified by 3T susceptibility-weighted imaging (SWI). Therefore, the aim of this retrospective observational study was to compare SWI with DaT-SPECT for differentiation of DLB from AD/a-MCI.

Methods: SWI data were acquired for patients with clinically diagnosed DLB (n = 29), AD (n = 18), a-MCI (n = 13) and healthy controls (n = 26). Images were analysed for nigrosome-1 degeneration. Diagnostic accuracy was evaluated for DLB, AD and a-MCI compared with striatal dopamine uptake using DaT-SPECT.

Results: SWI achieved 90% diagnostic accuracy (93% sensitivity, 87% specificity) for the detection of nigrosome-1 degeneration in DLB and not in AD/a-MCI as compared with 88.3% accuracy (93% sensitivity, 84% specificity) using DaT-SPECT.

Conclusions: SWI nigrosome-1 evaluation was useful in differentiating DLB from AD/a-MCI, with high accuracy. This less invasive and less expensive method is a potential alternative to DaT-SPECT for the diagnosis of DLB.

Keywords: Alzheimer’s disease; Dementia; Dopamine; Lewy bodies; Parkinson disease.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Mapping / methods*
  • Case-Control Studies
  • Female
  • Humans
  • Lewy Body Disease / diagnostic imaging*
  • Lewy Body Disease / pathology*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sensitivity and Specificity
  • Substantia Nigra / diagnostic imaging*
  • Substantia Nigra / pathology*
  • Tomography, Emission-Computed, Single-Photon / methods*