490 radiology.rsna.org n Radiology: Volume 274: Number 2—February 2015 ORIGINAL RESEARCH n NEURORADIOLOGY 1 From the Department of Mental Health and Psychiatry (A.X., C.R., M.L.M., S.T., E.T., P.G.), Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriat- rics (F.R.H., D.Z.), and Department of Imaging and Medical Informatics (K.O.L., S.H.), University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland; and Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands (F.B.). Received March 24, 2014; revision requested May 8; revision received June 7; accepted June 17; final version accepted July 14. Supported by the Swiss National Foundation (grants SNF 320030-129690/1 and SPUM 33CM30-124111). Address correspondence to S.H. (e-mail: sven.haller@hcuge.ch). q RSNA, 2014 Purpose: To explore whether arterial spin labeling (ASL) imaging in cognitively intact elderly individuals may be used to pre- dict subsequent early neuropsychological decline. Materials and Methods: The local ethics committee approved this prospective study, and written informed consent was obtained from all participants. A total of 148 consecutive control sub- jects were included, 75 of whom had stable cognitive function (sCON) (mean age, 75.9 years 6 3.4 [standard deviation]; 43 female) and 73 of whom had deteriorated cognitive function (dCON) at 18-month clinical follow-up (mean age, 76.8 years 6 4.1; 44 female). An additional 65 patients with mild cognitive impairment (MCI) (mean age, 76.2 years 6 6.1; 25 female) were also included. Two-dimensional pulsed ASL was performed at the base- line visit. Statistical analysis included whole-brain vox- elwise analysis of the ASL relative cerebral blood flow (CBF) data, receiver operating characteristic (ROC) curve analysis of the posterior cingulate cortex (PCC), and vox- el-based morphometry analysis of gray matter. Results: The voxelwise comparison of ASL revealed decreased rel- ative CBF in the dCON group compared with that in the sCON group and slightly more pronounced relative CBF in the MCI group compared with that in the sCON group, most notably in the PCC (P , .05 corrected). Comparison of the dCON group with the MCI group revealed no signif- icant differences. ROC analysis of relative CBF in the PCC enabled discrimination of dCON (P , .001; area under the ROC curve, 0.66). There was no confounding focal gray matter atrophy. Conclusion: Reduced ASL in the PCC at baseline is associated with the development of subsequent subtle neuropsychological def- icits in healthy elderly control subjects. At a group level, ASL patterns in subjects with dCON are similar to those in patients with MCI at baseline, indicating that these subjects may initially maintain their cognitive status via mobilization of their neurocognitive reserve at baseline; however, they are likely to develop subsequent subtle cog- nitive deficits. q RSNA, 2014 Online supplemental material is available for this article. Aikaterini Xekardaki, MD Cristelle Rodriguez, MSc Marie-Louise Montandon, PhD Simona Toma, MSc Eline Tombeur, BSc François R. Herrmann, MD Dina Zekry, MD Karl-Olof Lovblad, MD Frederik Barkhof, MD Panteleimon Giannakopoulos, MD Sven Haller, MD Arterial Spin Labeling May Contribute to the Prediction of Cognitive Deterioration in Healthy Elderly Individuals 1 Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.