Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Fluid-Attenuated Inversion Recovery Hypointensity of the Pulvinar Nucleus of Patients with Alzheimer Disease: Its Possible Association with Iron Accumulation as Evidenced by the $T2^*$ Map

  • Moon, Won-Jin (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Hee-Jin (Department of Neurology, Hanyang University Medical Center, Hanyang University School of Medicine) ;
  • Roh, Hong Gee (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Choi, Jin Woo (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Han, Seol-Heui (Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine)
  • Published : 2012.12.01
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Abstract

Objective: We hypothesized that prominent pulvinar hypointensity in brain MRI represents the disease process due to iron accumulation in Alzheimer disease (AD). We aimed to determine whether or not the pulvinar signal intensity (SI) on the fluid-attenuated inversion recovery (FLAIR) sequences at 3.0T MRI differs between AD patients and normal subjects, and also whether the pulvinar SI is correlated with the $T2^*$ map, an imaging marker for tissue iron, and a cognitive scale. Materials and Methods: Twenty one consecutive patients with AD and 21 age-matched control subjects were prospectively included in this study. The pulvinar SI was assessed on the FLAIR image. We measured the relative SI ratio of the pulvinar to the corpus callosum. The $T2^*$ values were calculated from the $T2^*$ relaxometry map. The differences between the two groups were analyzed, by using a Student t test. The correlation between the measurements was assessed by the Pearson's correlation test. Results: As compared to the normal white matter, the FLAIR signal intensity of the pulvinar nucleus was significantly more hypointense in the AD patients than in the control subjects (p < 0.01). The pulvinar $T2^*$ was shorter in the AD patients than in the control subjects (51.5 ${\pm}$ 4.95 ms vs. 56.5 ${\pm}$ 5.49 ms, respectively, p = 0.003). The pulvinar SI ratio was strongly correlated with the pulvinar $T2^*$ (r = 0.745, p < 0.001). When controlling for age, only the pulvinar-to-CC SI ratio was positively correlated with that of the Mini-Mental State Examination (MMSE) score (r = 0.303, p < 0.050). Conversely, the pulvinar $T2^*$ was not correlated with the MMSE score (r = 0.277, p = 0.080). Conclusion: The FLAIR hypointensity of the pulvinar nucleus represents an abnormal iron accumulation in AD and may be used as an adjunctive finding for evaluating AD.

Keywords

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