Dementia with Lewy bodies (DLB) while common in older age can present a diagnostic challenge to clinicians and is often misdiagnosed as Alzheimer disease (AD). Imaging studies have improved our understanding of the neurobiological changes in DLB during life and how they differ from AD. This has led to significant advances in the development of new techniques, such as dopaminergic imaging, which can aid the clinical diagnosis. Other functional imaging methods also show promise in helping to assess the influence of differing pathologies in DLB, most notably, AD-related and vascular pathology during life. This article will provide an overview of the main imaging findings in DLB.
McKeithIGDicksonDWLoweJ. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65(12):1863–1872.
2.
BurtonEJKarasGPalingSM. Patterns of cerebral atrophy in dementia with Lewy bodies using voxel-based morphometry. Neuroimage. 2002;17(2):618–630.
3.
KarasGBBurtonEJRomboutsS. A comprehensive study of gray matter loss in patients with Alzheimer’s disease using optimized voxel-based morphometry. Neuroimage. 2003;18(4):895–907.
4.
TakahashiRIshiiKMiyamotoN. Measurement of gray and white matter atrophy in dementia with Lewy bodies using diffeomorphic anatomic registration through exponentiated lie algebra: A comparison with conventional voxel-based morphometry. AJNR Am J Neuroradiol. 2010;31(10):1873–1878.
5.
WhitwellJLWeigandSDShiungMM. Focal atrophy in dementia with Lewy bodies on MRI: a distinct pattern from Alzheimer’s disease. Brain. 2007;130(pt 3):708–719.
6.
WatsonRO’BrienJTBarberRBlamireAM. Patterns of gray matter atrophy in dementia with Lewy bodies: a voxel-based morphometry study. Int Psychogeriatr. 2012;24(4):532–540.
7.
WatsonRCollobySJBlamireAMO’BrienJT. Assessment of regional gray matter loss in dementia with Lewy bodies: a surface-based MRI analysis. Am J Geriatr Psychiatry. 2015;23(1):38–46.
8.
WatsonRBlamireAMO’BrienJT. Magnetic resonance imaging in Lewy body dementias. Dement Geriatr Cogn Disord. 2009;28(6):493–506.
9.
WatsonRBlamireAMCollobySJ. Characterizing dementia with Lewy bodies by means of diffusion tensor imaging. Neurology. 2012;79(9):906–914.
10.
MakESuLWilliamsGB. Progressive cortical thinning and subcortical atrophy in dementia with Lewy bodies and Alzheimer’s disease. Neurobiol Aging. 2015;36(4):1743–1750.
11.
O’BrienJTPalingSBarberR. Progressive brain atrophy on serial MRI in dementia with Lewy bodies, AD, and vascular dementia. Neurology. 2001;56(10):1386–1388.
12.
WilliamsMMXiongCMorrisJCGalvinJE. Survival and mortality differences between dementia with Lewy bodies vs Alzheimer disease. Neurology. 2006;67(11):1935–1941.
13.
BurtonEJBarberRMukaetova-LadinskaEB. Medial temporal lobe atrophy on MRI differentiates Alzheimer’s disease from dementia with Lewy bodies and vascular cognitive impairment: a prospective study with pathological verification of diagnosis. Brain. 2009;132(pt 1):195–203.
14.
CousinsDABurtonEJBurnDGholkarAMcKeithIGO’BrienJT. Atrophy of the putamen in dementia with Lewy bodies but not Alzheimer’s disease: an MRI study. Neurology. 2003;61(9):1191–1195.
15.
HanyuHShimizuSTanakaYHiraoKIwamotoTAbeK. MR features of the substantia innominata and therapeutic implications in dementias. Neurobiol Aging. 2007;28(4):548–554.
16.
WatsonRCollobySJBlamireAMO’BrienJT. Subcortical volume changes in dementia with Lewy bodies and Alzheimer’s disease. A comparison with healthy aging. Int Psychogeriatr. 2016;28(4):529–536.
17.
ChangCCLiuJSChangYYChangWNChenSSLeeCH. (99m)Tc-ethyl cysteinate dimer brain SPECT findings in early stage of dementia with Lewy bodies and Parkinson’s disease patients: a correlation with neuropsychological tests. Eur J Neurol. 2008;15(1):61–65.
18.
ShimizuSHanyuHHiraoKSatoTIwamotoTKoizumiK. Value of analyzing deep gray matter and occipital lobe perfusion to differentiate dementia with Lewy bodies from Alzheimer’s disease. Ann Nucl Med. 2008;22(10):911–916.
19.
BarberRMcKeithIBallardCO’BrienJ. Volumetric MRI study of the caudate nucleus in patients with dementia with Lewy bodies, Alzheimer’s disease, and vascular dementia. J Neurol Neurosurg Psychiatry. 2002;72(3):406–407.
20.
PiggottMAMarshallEFThomasN. Striatal dopaminergic markers in dementia with Lewy bodies, Alzheimer’s and Parkinson’s diseases: rostrocaudal distribution. Brain. 1999;122(pt 8):1449–1468.
21.
BraakHDel TrediciKRubUde VosRAJansen SteurENBraakE. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. 2003;24(2):197–211.
22.
SeidelKMahlkeJSiswantoS. The brainstem pathologies of Parkinson’s disease and dementia with Lewy bodies. Brain Pathol. 2015;25(2):121–135.
23.
BarberRGholkarAScheltensPBallardCMcKeithIGO’BrienJT. MRI volumetric correlates of white matter lesions in dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry. 2000;15(10):911–916.
24.
OppedalKAarslandDFirbankMJ. White matter hyperintensities in mild Lewy body dementia. Dement Geriatr Cogn Dis Extra. 2012;2(1):481–495.
25.
BurtonEJMcKeithIGBurnDJFirbankMJO’BrienJT. Progression of white matter hyperintensities in Alzheimer disease, dementia with Lewy bodies, and Parkinson disease dementia: a comparison with normal aging. Am J Geriatr Psychiatry. 2006;14(10):842–849.
26.
De ReuckJDeramecourtVAugerF. Post-mortem 7.0-tesla magnetic resonance study of cortical microinfarcts in neurodegenerative diseases and vascular dementia with neuropathological correlates. J Neurol Sci. 2014;346(1-2):85–89.
27.
FukuiTOowanYYamazakiTKinnoR. Prevalence and clinical implication of microbleeds in dementia with Lewy bodies in comparison with microbleeds in Alzheimer’s disease. Dement Geriatr Cogn Dis Extra. 2013;3(1):148–160.
28.
BallardCO’BrienJBarberB. Neurocardiovascular instability, hypotensive episodes, and MRI lesions in neurodegenerative dementia. Ann N Y Acad Sci. 2000;903:442–445.
29.
DefebvreLJLeducVDuhamelA. Technetium HMPAO SPECT study in dementia with Lewy bodies, Alzheimer’s disease and idiopathic Parkinson’s disease. J Nucl Med. 1999;40(6):956–962.
30.
LobotesisKFenwickJDPhippsA. Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology. 2001;56(5):643–649.
31.
PasquierJMichelBFBrenot-RossiIHassan-SebbagNSauvanRGastautJL. Value of (99m)Tc-ECD SPET for the diagnosis of dementia with Lewy bodies. Eur J Nucl Med Mol Imaging. 2002;29(10):1342–1348.
32.
CollobySJFenwickJDWilliamsED. A comparison of (99m)Tc-HMPAO SPET changes in dementia with Lewy bodies and Alzheimer’s disease using statistical parametric mapping. Eur J Nucl Med Mol Imaging. 2002;29(5):615–622.
33.
HanyuHShimizuSHiraoK. Differentiation of dementia with Lewy bodies from Alzheimer’s disease using Mini-Mental State Examination and brain perfusion SPECT. J Neurol Sci. 2006;250(1-2):97–102.
34.
ShimizuSHanyuHKanetakaHIwamotoTKoizumiKAbeK. Differentiation of dementia with Lewy bodies from Alzheimer’s disease using brain SPECT. Dement Geriatr Cogn Disord. 2005;20(1):25–30.
35.
HanyuHShimizuSHiraoK. Comparative value of brain perfusion SPECT and [(123)I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer’s disease. Eur J Nucl Med Mol Imaging. 2006;33(3):248–253.
36.
CollobySJFirbankMJPakrasiS. A comparison of 99mTc-exametazime and 123I-FP-CIT SPECT imaging in the differential diagnosis of Alzheimer’s disease and dementia with Lewy bodies. Int Psychogeriatr. 2008;20(6):1124–1140.
37.
GilmanSKoeppeRALittleR. Differentiation of Alzheimer’s disease from dementia with Lewy bodies utilizing positron emission tomography with [18F]fluorodeoxyglucose and neuropsychological testing. Exp Neurol. 2005;191(suppl 1):S95–S103.
38.
IshiiKImamuraTSasakiM. Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer’s disease. Neurology. 1998;51(1):125–130.
39.
MinoshimaSFosterNLSimaAAFFreyKAAlbinRLKuhlDE. Alzheimer’s disease versus dementia with Lewy bodies: Cerebral metabolic distinction with autopsy confirmation. Ann Neurol. 2001;50(3):358–365.
40.
LimSMKatsifisAVillemagneVL. 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(10):1638–1645.
41.
Graff-RadfordJMurrayMELoweVJ. Dementia with Lewy bodies: basis of cingulate island sign. Neurology. 2014;83(9):801–809.
42.
O’BrienJTCollobySJFenwickJ. Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy bodies. Arch Neurol. 2004;61(6):919–925.
43.
WalkerZCostaDCWalkerRWH. Differentiation of dementia with Lewy bodies from Alzheimer’s disease using a dopaminergic presynaptic ligand. J Neurol Neurosurg Psychiatry. 2002;73(2):134–140.
44.
WalkerZJarosEWalkerRW. Dementia with Lewy bodies: a comparison of clinical diagnosis, FP-CIT single photon emission computed tomography imaging and autopsy. J Neurol Neurosurg Psychiatry. 2007;78(11):1176–1181.
45.
McKeithIO’BrienJWalkerZ. Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study. Lancet Neurol. 2007;6(4):305–313.
46.
PapathanasiouNDBoutsiadisADicksonJBomanjiJB. Diagnostic accuracy of 123I-FP-CIT (DaTSCAN) in dementia with Lewy bodies: a meta-analysis of published studies. Parkinsonism Relat Disord. 2012;18(3):225–229.
47.
BrigoFTurriGTinazziM. 123I-FP-CIT SPECT in the differential diagnosis between dementia with Lewy bodies and other dementias. J Neurol Sci. 2015;359(1-2):161–171.
48.
InuiYToyamaHManabeYSaraiMIwataN. Comparison of (123)I-MIBG myocardial scintigraphy, brain perfusion SPECT, and voxel-based MRI morphometry for distinguishing between dementia with Lewy bodies and Alzheimer’s disease. Ann Nucl Med. 2014;28(8):796–804.
49.
ShimizuSHiraoKKanetakaH. Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer’s disease. Eur J Nucl Med Mol Imaging. 2016;43(1):184–192.
50.
TregliaGCasonE. Diagnostic performance of myocardial innervation imaging using MIBG scintigraphy in differential diagnosis between dementia with Lewy bodies and other dementias: a systematic review and a meta-analysis. J Neuroimaging. 2012;22(2):111–117.
51.
YoshitaMAraiHAraiH. Diagnostic accuracy of 123I-meta-iodobenzylguanidine myocardial scintigraphy in dementia with Lewy bodies: a multicenter study. PLoS One. 2015;10(3):e0120540.
52.
OdaHIshiiKTerashimaA. Myocardial scintigraphy may predict the conversion to probable dementia with Lewy bodies. Neurology. 2013;81(20):1741–1745.
53.
McKhannGMKnopmanDSChertkowH. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):263–269.
54.
BallardCZiabrevaIPerryR. Differences in neuropathologic characteristics across the Lewy body dementia spectrum. Neurology. 2006;67(11):1931–1934.
55.
EdisonPRoweCCRinneJO. Amyloid load in Parkinson’s disease dementia and Lewy body dementia measured with [11C]PIB positron emission tomography. J Neurol Neurosurg Psychiatry. 2008;79(12):1331–1338.
56.
GompertsSNRentzDMMoranE. Imaging amyloid deposition in Lewy body diseases. Neurology. 2008;71(12):903–910.
57.
RoweCCNgSAckermannU. Imaging beta-amyloid burden in aging and dementia. Neurology. 2007;68(20):1718–1725.
