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Oscar L. Lopez, MD; James T. Becker, PhD; Charles A. Jungreis, MD; Donald Rezek, MD, PhD; Conrado Estol, MD; François Boiler, MD, PhD; Steven T. DeKosky, MD

Arch Neurol. 1995;52(7):659-664.

Abstract
Objective
To examine the clinical consequences of periventricular white-matter lesions on computed tomography (CT) and magnetic resonance imaging (MRI) scans in probable Alzheimer's disease.

Design
Case series, 12-month follow-up.

Setting
Multidisciplinary behavioral neurology research clinic.

Patients
We longitudinally evaluated the clinical characteristics of 27 patients with probable AD for whom both CT and MRI scans had been performed at baseline.

Interventions
None.

Main Outcome Measure
The presence of abnormal neurological signs was examined at baseline and at a 12-month examination.

Results
Periventricular white-matter lesions were observed with CT in 12 patients (44%) and with MRI in 21 patients (78%). Computed tomography did not detect lesions of 1 to 3 mm, as were seen on MRI scans, and CT also did not detect lesions of 4 to 10 mm when they occurred in the deep subcortical white matter and were not part of a greater confluent lesion. There was no relationship between the severity of periventricular white-matter lesions with either neuroimaging method and the presence of abnormal neurological signs. However, there was a greater frequency of periventricular white-matter lesions shown on CT scans than on MRI scans at baseline in patients in whom abnormal neurological signs (eg, abnormal gait, asymmetric deep tendon reflexes, focal motor deficits, abnormal plantar response) developed at 12-month follow-up.

Conclusion
Although MRI may be more sensitive in detecting periventricular white-matter lesions, CT is more specific in predicting subsequent symptomatic cerebrovascular disease.

Author Affiliations
From the Departments of Neurology (Drs Lopez, Becker, Rezek, and DeKosky), Psychiatry (Drs Becker and DeKosky), Radiology (Neuroradiology) (Dr Jungreis), and Neurosurgery (Dr Jungreis) and the Alzheimer's Disease Research Center (Drs Lopez, Becker, and DeKosky), University of Pittsburgh (Pa), the Instituto Cardiovascular de Buenos Aires (Argentina) (Dr Estol), and the INSERM Unit 324, Centre Paul Broca, Paris, France (Dr Boller).

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