A multicenter in vivo proton-MRS study of HIV-associated dementia and its relationship to age

Chang, Linda; Lee, P. L.; Yiannoutsos, Constantin T.; Ernst, Thomas; Marra, Christina M.; Richards, Todd; Kolson, Dennis L.; Schifitto, Giovanni; Jarvik, Jeffrey G.; Miller, Eric N.; Lenkinski, Robert E.; González, Gilberto; Navia, Bradford

doi:10.1016/j.neuroimage.2004.07.067

Cited by 171 publications

(127 citation statements)

References 60 publications

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“…As demonstrated in a previous analysis (Chang et al 2004), the age of each individual has a significant effect on the level of the MRS-measured metabolite, in addition to the overall group effect. Thus, estimates of the VUS were adjusted for the age of each individual.…”

Section: Volume Under the Three-dimensional Roc Surfacesupporting

confidence: 55%

“…In our case we added age to the diagnostic index derived from each metabolite ratio. The reason is that age is a potentially significant factor associated with brain as changes in metabolites reflecting aging are similar to those related to HIV (Chang et al 1996;Schuff et al 1999;Chang et al 2004). Incorporation of aging into the diagnostic procedure, slightly increased the accuracy of the combined index although this increase did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…The specifics of this study have been presented in more detail elsewhere (Lee et al 2003;Chang et al 2004). Briefly, data were collected at 11 participating imaging centers: Massachusetts General Hospital (MGH, the central site), University of California Los Angeles, Harbor-UCLA Medical Center, University of Pennsylvania, University of Washington, University of Rochester, Mt.…”

Section: Study Subjects and Imaging Protocolsmentioning

confidence: 99%

“…In a recent publication from our consortium (Chang et al, 2004) it was suggested that the levels of these metabolites are ordered with MRS measurements obtained from NEG and ADC subjects at the two extremes and those acquired from NAS subjects always between them. Generally, increasing trends were observed with respect to Cho/Cr and MI/Cr while a decreasing trend was evident with respect to NAA/Cr levels, particularly in the white matter.…”

Section: Volume Under the Three-dimensional Roc Surfacementioning

confidence: 99%

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Assessing multiple-group diagnostic problems with multi-dimensional receiver operating characteristic surfaces: Application to proton MR Spectroscopy (MRS) in HIV-related neurological injury

2008

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We present the multi-dimensional Receiver Operating Characteristic (ROC) surface, a plot of the true classification rates of tests based on levels of biological markers, for multi-group discrimination, as an extension of the ROC curve, commonly used in two-group diagnostic testing. The volume under this surface (VUS) is a global accuracy measure of a test to classify subjects in multiple groups and useful to detect trends in marker measurements. We used three-dimensional ROC surfaces, and associated VUS, to discriminate between HIV-negative (NEG), HIV-positive neurologically asymptomatic (NAS) subjects and patients with AIDS demential complex (ADC), using brain metabolites measured by proton MRS. These were ratios of markers of inflammation, Choline (Cho) and myoinositol (MI), and brain injury, N-acetyl aspartate (NAA), divided by Creatine (Cr), measured in the basal ganglia and the frontal white matter. Statistically significant trends were observed in the three groups with respect to MI/Cr (VUS=0.43; 95% confidence interval (CI) 0.33-0.53), Cho/Cr (0.36; 0.27-0.45) in the basal ganglia and NAA/Cr in the frontal white matter (FWM) (0.29; 0.20-0.38), suggesting a continuum of injury during the neurologically asymptomatic stage of HIV infection, particularly with respect to brain inflammation. Adjusting for age increased the combined classification accuracy of age and NAA/Cr (p=0.053). Pairwise comparisons suggested that neuronal damage associated with NAA/Cr decreases was mainly observed in individuals with ADC, raising issues of synergism between HIV infection and age and possible acceleration of neurological deterioration in an aging HIV-positive population. The threedimensional ROC surface and its associated VUS are useful for assessing marker accuracy, detecting data trends and offering insight in disease processes affecting multiple groups.

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Section: Volume Under the Three-dimensional Roc Surfacesupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Study Subjects and Imaging Protocolsmentioning

confidence: 99%

Section: Volume Under the Three-dimensional Roc Surfacementioning

confidence: 99%

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Assessing multiple-group diagnostic problems with multi-dimensional receiver operating characteristic surfaces: Application to proton MR Spectroscopy (MRS) in HIV-related neurological injury

2008

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“…38,39 Measurements of the basal ganglia acquired with diffusion-tensor imaging demonstrate significant relationships with cognitive and clinical parameters in HIV-infected patients. 40 MTR may have considerable practical significance for studying changes in these subcortical gray matter regions.…”

Section: Correlations Of Mtr Measurements and Cognitive Status Measuresmentioning

confidence: 99%

Whole Brain and Localized Magnetization Transfer Measurements Are Associated with Cognitive Impairment in Patients Infected with Human Immunodeficiency Virus

Storey

Carrillo

et al. 2007

AJNR Am J Neuroradiol

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Putamen Hypertrophy in Nondemented Patients With Human Immunodeficiency Virus Infection and Cognitive Compromise

Castelo

Courtney²,

Melrose³

et al. 2007

Arch Neurol

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A multicenter in vivo proton-MRS study of HIV-associated dementia and its relationship to age

Cited by 171 publications

References 60 publications

Assessing multiple-group diagnostic problems with multi-dimensional receiver operating characteristic surfaces: Application to proton MR Spectroscopy (MRS) in HIV-related neurological injury

Assessing multiple-group diagnostic problems with multi-dimensional receiver operating characteristic surfaces: Application to proton MR Spectroscopy (MRS) in HIV-related neurological injury

Whole Brain and Localized Magnetization Transfer Measurements Are Associated with Cognitive Impairment in Patients Infected with Human Immunodeficiency Virus

Putamen Hypertrophy in Nondemented Patients With Human Immunodeficiency Virus Infection and Cognitive Compromise

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