Asymmetric Cerebral Peduncle Atrophy: A Simple Diagnostic Clue for Distinguishing Frontotemporal Lobar Degeneration from Alzheimer's Disease

Keita Sakurai; Daita Kaneda; Satoru Morimoto; Yuto Uchida; Shohei Inui; Yasuyuki Kimura; Takashi Kato; Kengo Ito; Yoshio Hashizume

doi:10.3233/JAD-230441

Asymmetric Cerebral Peduncle Atrophy: A Simple Diagnostic Clue for Distinguishing Frontotemporal Lobar Degeneration from Alzheimer's Disease

J Alzheimers Dis. 2023;95(4):1657-1665. doi: 10.3233/JAD-230441.

Authors

Keita Sakurai¹, Daita Kaneda², Satoru Morimoto³, Yuto Uchida⁴, Shohei Inui⁵, Yasuyuki Kimura⁶, Takashi Kato¹, Kengo Ito¹, Yoshio Hashizume²

Affiliations

¹ Department of Radiology, National Center for Geriatrics and Gerontology, Aichi, Japan.
² Choju Medical Institute, Fukushimura Hospital, Aichi, Japan.
³ Department of Physiology, School of Medicine, Keio University, Tokyo, Japan.
⁴ Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
⁵ Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁶ Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Aichi, Japan.

PMID: 37718809
DOI: 10.3233/JAD-230441

Abstract

Background: Due to confusing clinicoradiological features such as amnestic symptoms and hippocampal atrophy in frontotemporal lobar degeneration (FTLD), antemortem differentiation between FTLD and Alzheimer's disease (AD) can be challenging. Although asymmetric atrophy of the cerebral peduncle is regarded as a representative imaging finding in some disorders of the FTLD spectrum, the utility of this finding has not been sufficiently evaluated for differentiating between FTLD and AD.

Objective: This study aimed to explore the diagnostic performance of asymmetric cerebral peduncle atrophy on axial magnetic resonance imaging as a simple radiological discriminator between FTLD and AD.

Methods: Seventeen patients with pathologically confirmed FTLD, including six with progressive supranuclear palsy, three with corticobasal degeneration, eight with TAR DNA-binding protein 43 (FTLD-TDP), and 11 with pathologically confirmed AD, were investigated. Quantitative indices representing the difference between the volumes of the bilateral cerebral peduncles (i.e., cerebral peduncular asymmetry index [CPAI]), the voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) Z-score representing the degree of hippocampal atrophy, and semiquantitative visual analysis to evaluate the asymmetry of the cerebral peduncle (visual assessment of cerebral peduncular asymmetry: VACPA) were compared between the two groups.

Results: Contrary to the VSRAD Z-score, the CPAI and VACPA scores demonstrated higher diagnostic performance in differentiating patients with FTLD from those with AD (areas under the receiver operating characteristic curve of 0.88, 082, and 0.60, respectively).

Conclusions: Quantitative and visual analytical techniques can differentiate between FTLD and AD. These simple methods may be useful in daily clinical practice.

Keywords: Alzheimer’s disease; TDP-43 proteinopathy; asymmetric atrophy; cerebral peduncle; corticobasal degeneration; frontotemporal lobar degeneration; magnetic resonance imaging; progressive supranuclear palsy.