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All Journal Sriwijaya Journal of Forensic and Medicolegal Sriwijaya Journal of Radiology and Imaging Research
Jason Willmare
Department of Neurology, Diffa State Hospital, Diffa, Niger
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Physics

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Diffusion Tensor Imaging and Resting-State Functional MRI Reveal Coupled Microstructural and Default-Mode Network Alterations in Mild Cognitive Impairment: A Diagnostic Accuracy Study Taryudi Suharyana; Akmal Hasan; Jason Willmare
Sriwijaya Journal of Radiology and Imaging Research Vol. 3 No. 2 (2025): Sriwijaya Journal of Radiology and Imaging Research
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjrir.v3i2.285

Abstract

Introduction: Early-stage neurodegeneration — clinically expressed as mild cognitive impairment (MCI) — lacks accessible imaging biomarkers that link microstructural white-matter injury to functional network disruption. We evaluated whether integrating diffusion tensor imaging (DTI) and resting-state functional MRI (rs-fMRI) at 3.0-Tesla improves detection of MCI and substantiates a structural-to-functional disconnection mechanism. Methods: In this STARD-2015-compliant, prospective cross-sectional diagnostic accuracy study at a tertiary hospital in Palembang, Indonesia, 85 participants (45 MCI, 40 age-, sex- and education-matched controls) underwent single-scanner 3.0-T MRI. DTI metrics (fractional anisotropy [FA], mean diffusivity [MD]) were derived by tract-based spatial statistics and posterior-cingulate-seeded Default Mode Network (DMN) connectivity by CONN. Consensus clinical diagnosis (Petersen criteria) was the blinded reference standard. Diagnostic accuracy used ROC/DeLong AUC, Wilson 95% confidence intervals (CIs), Cohen κ, and multivariable logistic regression. Results: Posterior-cingulum FA was lower (0.399 ± 0.058 vs 0.489 ± 0.052, p<0.001) and MD higher in MCI; PCC–mPFC connectivity was reduced (0.392 ± 0.124 vs 0.586 ± 0.136, p<0.001). FA discriminated MCI with AUC 0.903 (95% CI 0.831–0.974; sensitivity 82.2%, specificity 90.0%); a combined FA+FC model reached AUC 0.901 with sensitivity 95.6% and NPV 93.8% but did not exceed FA alone (DeLong p=0.90). FA and connectivity were strongly correlated (r=0.79, 95% CI 0.69–0.86, p<0.001). Inter-reader agreement was substantial (κ=0.74 and 0.67). Conclusion: Multimodal 3.0-T DTI and rs-fMRI provides an accurate, radiation-free signature of early-stage neurodegeneration; the coupling between cingulum microstructure and DMN connectivity is consistent with structural disconnection being associated with functional decoupling and offers a deployable tool for tertiary referral centres.
Post-Mortem High-Anion-Gap Metabolic Acidosis and Blood Formate Quantitation as Diagnostic Markers of Fatal Oplosan Intoxication: A Retrospective Diagnostic Accuracy Study at a Tertiary Forensic Center in Indonesia Bambang Sutrisno; Sri Mulyati; Karina Chandra; Jason Willmare
Sriwijaya Journal of Forensic and Medicolegal Vol. 4 No. 1 (2026): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v4i1.257

Abstract

Introduction: Bootleg liquor (oplosan) containing illicit methanol remains a leading cause of preventable forensic death in Indonesia, yet objective post-mortem biochemical diagnostic criteria are incompletely standardised. Methods: This retrospective diagnostic accuracy study evaluated post-mortem high-anion-gap metabolic acidosis (HAGMA) and blood formate quantitation as confirmatory markers of fatal methanol intoxication at Hospital X, Central Java, between January 2019 and December 2023. Medical examiner records, autopsy reports, and post-mortem biochemistry data from 120 adult decedents were reviewed: 74 confirmed methanol (oplosan) fatalities and 46 non-methanol metabolic acidosis deaths as the comparison group. The reference standard was post-mortem blood methanol >20 mg/dL with documented oplosan exposure history. Post-mortem blood formate was quantified by gas chromatography–flame ionisation detection (GC-FID). Sensitivity, specificity, PPV, NPV, and ROC analysis were performed with 95% confidence intervals by the Wilson score method. Results: Mean blood formate was 18.8 ± 4.9 mmol/L in the methanol group versus 1.2 ± 0.8 mmol/L in controls (p < 0.001). Post-mortem albumin-corrected anion gap was 28.7 ± 5.1 versus 14.2 ± 4.6 mmol/L (p < 0.001). Blood formate >2.0 mmol/L achieved sensitivity 100% (95% CI 95.1–100%), specificity 80.4% (95% CI 65.9–90.1%), and AUC 0.989 (95% CI 0.971–0.998). HAGMA achieved sensitivity 94.6% (95% CI 86.4–98.0%), specificity 91.3% (95% CI 78.2–97.0%), and AUC 0.976. Combined positivity yielded a specificity 100% and a PPV 100%. Multivariable logistic regression identified formate as the dominant independent predictor (OR 123.8, 95% CI 21.6–709.3). Conclusion: Post-mortem blood formate and HAGMA are highly accurate complementary markers for confirming fatal oplosan intoxication and should be incorporated into standardised Indonesian forensic autopsy protocols.
Co-Authors Akmal Hasan Bambang Sutrisno Karina Chandra Sri Mulyati Taryudi Suharyana