Fig. 2.

Neuroradiological findings in case 2. T1-weighted magnetic resonance imaging (a) shows left-side dominant, marked focal atrophy in the anterior and inferior portions of the temporal lobes. Z-score maps (b) of gray matter loss were created by the comparison of individual gray matter images with the mean and standard deviation of gray matter images of 80 healthy controls after voxel normalization to global mean intensities, using voxel-based specific regional analysis system for AD (VSRAD) advance version. The color scale for the Z score is shown in the lower right part of the figure. Presented in color if the Z score is > 0. Brain SPECT eZIS analysis compared with 40 age-matched normal controls (c) revealed relative hypoperfusion mainly in the left anterior temporal areas. The color scale for the Z score is shown in the right of the figure. Presented in color if the Z score is > 1. [¹¹C] PiB-PET (d) revealed extremely mild accumulation confined to the left parietal lobe; however, it was atypical and, therefore, a diagnosis of Alzheimer’s disease was not considered. The color scale for the standardized uptake value ratio (SUVR) is shown in the right part of the figure. [¹⁸F]THK-5351 PET (e) revealed that [¹⁸F]THK-5351 retention was markedly elevated in the anterior and inferior portions of the left temporal lobe. The color scale for the SUVR is shown in the right part of the figure