White Matter Loss in the Splenium of the Corpus callosum in a Case of Posterior Cortical Atrophy: A Diffusion Tensor Imaging Study

There have been several functional imaging studies using PET and SPECT to investigate posterior cortical atrophy (PCA). These studies have suggested dysfunction of corticocortical connections which is consistent with the occipitoparietal stream. However, there are no reports suggesting disturbance of the white matter that interconnects the temporal, parietal and occipital cortices. We measured fractional anisotropy (FA) in the genu and splenium of the corpus callosum and created color maps using diffusion tensor imaging (DTI), which is a relatively new MRI technique that allows visualization of the directionality of water diffusion, in a patient with PCA and compared these findings with those in 5 typical Alzheimer disease (AD) patients. The PCA patient was a 75-year-old man presenting with progressive complex visual disorder who satisfied the clinical diagnostic criteria for PCA. In 5 typical AD patients, the FA index in the splenium was higher than that in the genu; however, in the PCA patient, the FA index in the splenium was significantly lower than that in the genu. A DTI-based color map of the PCA patient showed reduction of anisotropy and fiber volume in the splenium. These findings suggest that the splenium of the corpus callosum secondarily degenerated due to neuronal degeneration of the temporal, parietal and occipital cortices and suggest that reduction of the FA in the splenium is one of the characteristics of PCA.