"Cingulate island sign"

Cingulate island sign temporally changes in dementia with Lewy bodies The cingulate island sign (CIS) that reflects sparing of the posterior cingulate cortex (PCC) relative to the precuneus plus cuneus on FDG-PET and brain perfusion SPECT, has been proposed as a feature of dementia with Lewy bodies (DLB). As the CIS is influenced by concomitant Alzheimer's disease (AD)-type neurofibrillary

Validation of the cingulate island sign with optimized ratios for discriminating dementia with Lewy bodies from Alzheimer’s disease using brain perfusion SPECT Dementia with Lewy bodies (DLB) is often cited as the second most common dementia after Alzheimer's disease (AD). It is clinically important to distinguish DLB from AD because specific side effects of antipsychotic drugs are limited to DLB. The relative preservation of cingulate glucose metabolism in the posterior cingulate gyri versus that in the precuni, known as the cingulate island sign (CIS), in patients with DLB compared with AD is supposed to be highly specific for diagnosing DLB. In a previous study, using brain perfusion SPECT, the largest value (0.873) for the area under the receiver operating characteristic (ROC) curve

The cingulate island sign within early Alzheimer’s disease-specific hypoperfusion volumes of interest is useful for differentiating Alzheimer’s disease from dementia with Lewy bodies In addition to occipital hypoperfusion, preserved metabolism of the posterior cingulate gyri (PCG) relative to the precunei is known as the cingulate island sign (CIS) in the patients with dementia with Lewy

Dementia with Lewy bodies: Basis of cingulate island sign. To investigate clinical, imaging, and pathologic associations of the cingulate island sign (CIS) in dementia with Lewy bodies (DLB). We retrospectively identified and compared patients with a clinical diagnosis of DLB (n=39); patients with Alzheimer disease (AD) matched by age, sex, and education (n=39); and cognitively normal controls (n=78) who underwent 18F-fluorodeoxyglucose (FDG) and C11 Pittsburgh compound B (PiB)-PET scans. Among these patients, we studied those who came to autopsy and underwent Braak neurofibrillary tangle (NFT) staging (n=10). Patients with a clinical diagnosis of DLB had a higher ratio of posterior cingulate to precuneus plus cuneus metabolism, cingulate island sign (CIS), on FDG-PET than patients

been shown to distinguish between AD and DLB. Relative preservation of posterior or midcingulate metabolism on FDG-PET/CT—the cingulate island sign—has been described in DLB. However, most studies are hampered by small sample size, and FDG-PET/CT is a second-level examination for the evaluation of DLB. Ioflupane SPECT or SPECT/CT Brain In the present guidelines, decreased dopamine transporter

assessed striatal dopaminergic and cardiac adrenergic integrity, respectively. Clinical evaluation revealed a history of REM sleep behavior disorder and parkinsonism induced by antipsychotics. The patient's cognitive function was normal. Conventional MRI showed parieto-occipital atrophy, and posterior hypoperfusion was revealed by ASL-MRI. Of note, the "cingulate island sign" was present. FP-CIT SPECT and I-Metaiodobenzylguanidine endorsed the suspicion of α-synucleinopathy. The patient fulfils the recently proposed key features of psychiatric-onset Prodromal DLB. Prodromal DLB is an emerging concept. Biomarkers have not been yet established. We propose that nuclear imaging and advanced MRI technics showing posterior hypoperfusion and the presence of the "cingulate island sign" could be promising

FDG-PET hypometabolism in patients with a clinical AD presentation. Twenty-one patients with autopsy-confirmed AD ('pure-AD'), 24 with AD and LB co-pathology ('AD-LB'), and 7 with LB but no or low evidence of AD pathology ('pure-LB') were studied. Pathologic groups were compared on regional and voxel-wise FDG-PET patterns, the cingulate island sign ratio (CISr), and neuropathological ratings

the ‘Cingulate Island Sign’ and has been found to be more specific than occipital hypometabolism for DLB in a separate clinically diagnosed cohort.43 In summary, there is good evidence for occipital hypometabolism as a marker of Lewy body pathology in patients with dementia. However, studies have been small and the sensitivity and specificity inconsistent, meaning that the accuracy of this finding is unclear =ISI) 43. 43. Lim SM , Katsifis A , Villemagne VL , et al . The 18F-FDG PET cingulate island sign and comparison to 123I-beta-CIT SPECT for diagnosis of dementia with Lewy bodies. J Nucl Med 2009;50:1638–45.[doi:10.2967/jnumed.109.065870](http://dx.doi.org/10.2967/jnumed.109.065870) [Abstract/FREE Full Text](http://ebmh.bmj.com/lookup/ijlink

, anterior and posterior cingulate, reducing the expression of the DLB-typical cingulate island sign (CIS). Education negatively covaried with metabolism in the left inferior parietal cortex and precuneus (making the CIS more prominent). These findings point out the importance of tailoring interpretation of DLB biomarkers considering the concomitant effect of individual, non-disease-related variables

, orthostatic hypotension, urinary incontinence.Hypersomnia.Hyposmia.Hallucinations in other modalities.Systematised delusions.Apathy, anxiety and depression.Supportive biomarkers:Relative preservation of medial temporal lobe structures on CT/MRI scan.Generalised low uptake on SPECT/PET perfusion/metabolism scan with reduced occipital activity +/- the cingulate island sign on FDG-PET imaging.Prominent

was defined in Delphi Round IV, with five panellists recommending clinical use of FDG‐PET. Besides its NPV, the presence of the posterior cingulate island sign (i.e. relatively preserved metabolism in the posterior cingulate area) and occipital hypometabolism , at the stage of MCI support a diagnosis of DLB. However, in the first instance dopamine transporter brain single‐photon emission computed tomography % sensitivity range, 74%–100% specificity range, 72%–96% accuracy range , - , 0.77–0.91 AUC range , , - and 86% PPV, 85% NPV and 4.46 LH+ value . A similar profile of cerebral hypometabolism was observed in AD and DLB, with the exception of the marked hypometabolism in the visual cortex in DLB and the relative posterior cingulate preservation (cingulate island sign). The consensual recommendation was defined

) values have been associated with a higher Braak neurofibrillary tangle stage in autopsied DLB. Using voxel-wise analysis, we assessed the patterns of regional cortical perfusion and metabolism, and using an atlas-based approach, we measured perfusion cingulate island sign ratio on arterial spin labeling MRI (ASL-CISr), and its associations with FDG-CISr, uptake on tau-PET and clinical severity in DLB cingulate island sign ratios correlate with each other in DLB. Non-invasive and radiotracer-free ASL-MRI may be further developed as a tool for the screening and diagnostic evaluation of DLB patients in a variety of clinical settings where FDG-PET is not accessible.

18F-FDG PET in Posterior Cortical Atrophy and Dementia with Lewy Bodies Posterior cortical atrophy (PCA) and dementia with Lewy bodies (DLB) have both been associated with occipital lobe hypometabolism on F-FDG PET, whereas relative sparing of posterior cingulate metabolism compared with precuneus/cuneus (i.e., cingulate island sign) is a feature of DLB. We aimed to determine whether patterns of hypometabolism or the cingulate island sign differed between PCA and DLB. Sixteen clinically diagnosed PCA and 13 probable DLB subjects underwent F-FDG PET. All PCA subjects showed β-amyloid deposition on PET scanning. Regional hypometabolism was assessed compared with a control cohort ( = 29) using voxel- and region-level analyses in statistical parametric mapping. A ratio of metabolism in the posterior

, Katsifis A, Villemagne VL, Best R, Jones G, Saling M, et al. The 18F-FDG PET cingulate island sign and comparison to 123I-beta-CIT SPECT for diagnosis of dementia with Lewy bodies. J Nucl Med. 2009 Oct. 50(10):1638-45. [QxMD MEDLINE Link]. 18. Brooks DJ. Imaging amyloid in Parkinson's disease dementia and dementia with Lewy bodies with positron emission tomography. Mov Disord. 2009. 24 Suppl 2

, Katsifis A, Villemagne VL, Best R, Jones G, Saling M, et al. The 18F-FDG PET cingulate island sign and comparison to 123I-beta-CIT SPECT for diagnosis of dementia with Lewy bodies. J Nucl Med. 2009 Oct. 50(10):1638-45. [QxMD MEDLINE Link]. 18. Brooks DJ. Imaging amyloid in Parkinson's disease dementia and dementia with Lewy bodies with positron emission tomography. Mov Disord. 2009. 24 Suppl 2

. 24 Suppl 2:S754-9. [QxMD MEDLINE Link]. 17. Lim SM, Katsifis A, Villemagne VL, Best R, Jones G, Saling M, et al. The 18F-FDG PET cingulate island sign and comparison to 123I-beta-CIT SPECT for diagnosis of dementia with Lewy bodies. J Nucl Med. 2009 Oct. 50(10):1638-45. [QxMD MEDLINE Link]. 18. Brooks DJ. Imaging amyloid in Parkinson's disease dementia and dementia with Lewy

. 24 Suppl 2:S754-9. [QxMD MEDLINE Link]. 17. Lim SM, Katsifis A, Villemagne VL, Best R, Jones G, Saling M, et al. The 18F-FDG PET cingulate island sign and comparison to 123I-beta-CIT SPECT for diagnosis of dementia with Lewy bodies. J Nucl Med. 2009 Oct. 50(10):1638-45. [QxMD MEDLINE Link]. 18. Brooks DJ. Imaging amyloid in Parkinson's disease dementia and dementia with Lewy

are: a. MRI/CT scans showing neuronal structural modifications with relative preservation of medial temporal lobe structures. b. Generalized low uptake on SPECT/PET perfusion/metabolism scan with reduced occipital activity +/- the cingulate island sign on 18F-fludeoxyglucose (FDG) PET imaging. c. Prominent posterior slow wave activity on EEG with periodic fluctuations in the pre-alpha/theta

is not as severely affected as in AD.[145]Medical imaging in AD and DLBMRI of brain showing hippocampus atrophy (red rectangles), more prominent in AD than DLB, compared to normal control (NC)FDG-PET horizontal cross section of brain, with brighter areas indicating higher metabolism. The cingulate island sign is indicated by the arrowhead.FDG-PET of brain surface, with the color red indicating areas of high with DLB often show a cingulate island sign.[33]In East Asia, particularly Japan,123I-MIBG is used in the differential diagnosis of DLB and AD, because reduced labeling of cardiac nerves is seen only in Lewy body disorders.[114][136] Other indicative and supportive biomarkers are useful in distinguishing DLB and AD (preservation of medial temporal lobe structures, reduced occipital activity, and slow