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Au HD, Lan NT, Binh NT, Linh LT, Hien MM, Duc NM. Sporadic Creutzfeldt-Jakob disease: Brain MRI lesion features from 2 cases reports. Radiol Case Rep 2024; 19:939-943. [PMID: 38188942 PMCID: PMC10767313 DOI: 10.1016/j.radcr.2023.11.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is an uncommon prion disease, also a fatal degenerative brain disorder. We aimed to illustrate 2 clinical cases, a 60-year-old female and a 57-year-old male, who came to the hospital due to rapidly progressive cognitive decline. A 1.5T brain MRI in both patients detected cortical and basal ganglia signal abnormalities with diffuse, asymmetrical features. The patient underwent electroencephalography and cerebrospinal fluid tests, which showed abnormal waves and a positive 14-3-3 protein test in the CSF samples of both patients. According to the 2018 US Centers for Disease Control and Prevention (CDC) diagnostic criteria, we finally diagnosed these patients with sCJD.
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Affiliation(s)
- Hoang Dinh Au
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Ha Noi, Vietnam
| | - Nguyen Thu Lan
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Ha Noi, Vietnam
| | - Nguyen Thai Binh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Ha Noi, Vietnam
| | - Le Tuan Linh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Ha Noi, Vietnam
| | - Ma Mai Hien
- Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
- Department of Radiology, Centre Hospitalière Annecy Genevois, Epagny Metz-Tessy, France
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Venkatraghavan V, Pascuzzo R, Bron EE, Moscatelli M, Grisoli M, Pickens A, Cohen ML, Schonberger LB, Gambetti P, Appleby BS, Klein S, Bizzi A. A discriminative event-based model for subtype diagnosis of sporadic Creutzfeldt-Jakob disease using brain MRI. Alzheimers Dement 2023; 19:3261-3271. [PMID: 36749840 DOI: 10.1002/alz.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Sporadic Creutzfeldt-Jakob disease (sCJD) comprises multiple subtypes (MM1, MM2, MV1, MV2C, MV2K, VV1, and VV2) with distinct disease durations and spatiotemporal cascades of brain lesions. Our goal was to establish the ante mortem diagnosis of sCJD subtype, based on patient-specific estimates of the spatiotemporal cascade of lesions detected by diffusion-weighted magnetic resonance imaging (DWI). METHODS We included 488 patients with autopsy-confirmed diagnosis of sCJD subtype and 50 patients with exclusion of prion disease. We applied a discriminative event-based model (DEBM) to infer the spatiotemporal cascades of lesions, derived from the DWI scores of 12 brain regions assigned by three neuroradiologists. Based on the DEBM cascades and the prion protein genotype at codon 129, we developed and validated a novel algorithm for the diagnosis of the sCJD subtype. RESULTS Cascades of MM1, MM2, MV1, MV2C, and VV1 originated in the parietal cortex and, following subtype-specific orderings of propagation, went toward the striatum, thalamus, and cerebellum; conversely, VV2 and MV2K cascades showed a striatum-to-cortex propagation. The proposed algorithm achieved 76.5% balanced accuracy for the sCJD subtype diagnosis, with low rater dependency (differences in accuracy of ± 1% among neuroradiologists). DISCUSSION Ante mortem diagnosis of sCJD subtype is feasible with this novel data-driven approach, and it may be valuable for patient prognostication, stratification in targeted clinical trials, and future therapeutics. HIGHLIGHTS Subtype diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) is achievable with diffusion MRI. Cascades of diffusion MRI abnormalities in the brain are subtype-specific in sCJD. We proposed a diagnostic algorithm based on cascades of diffusion MRI abnormalities and demonstrated that it is accurate. Our method may aid early diagnosis, prognosis, stratification in clinical trials, and future therapeutics. The present approach is applicable to other neurodegenerative diseases, enhancing the differential diagnoses.
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Affiliation(s)
- Vikram Venkatraghavan
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Riccardo Pascuzzo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco Moscatelli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marina Grisoli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Amy Pickens
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Mark L Cohen
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
- Department of Pathology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lawrence B Schonberger
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pierluigi Gambetti
- Department of Pathology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Brian S Appleby
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
- Department of Pathology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alberto Bizzi
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Paoletti M, Caverzasi E, Mandelli ML, Brown JA, Henry RG, Miller BL, Rosen HJ, DeArmond SJ, Bastianello S, Seeley WW, Geschwind MD. Default Mode Network quantitative diffusion and resting-state functional magnetic resonance imaging correlates in sporadic Creutzfeldt-Jakob disease. Hum Brain Mapp 2022; 43:4158-4173. [PMID: 35662331 PMCID: PMC9374887 DOI: 10.1002/hbm.25945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/14/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
Grey matter involvement is a well-known feature in sporadic Creutzfeldt-Jakob disease (sCJD), yet precise anatomy-based quantification of reduced diffusivity is still not fully understood. Default Mode Network (DMN) areas have been recently demonstrated as selectively involved in sCJD, and functional connectivity has never been investigated in prion diseases. We analyzed the grey matter involvement using a quantitatively multi-parametric MRI approach. Specifically, grey matter mean diffusivity of 37 subjects with sCJD was compared with that of 30 age-matched healthy controls with a group-wise approach. Differences in mean diffusivity were also examined between the cortical (MM(V)1, MM(V)2C, and VV1) and subcortical (VV2 and MV2K) subgroups of sCJD for those with autopsy data available (n = 27, 73%). We also assessed resting-state functional connectivity of both ventral and dorsal components of DMN in a subset of subject with a rs-fMRI dataset available (n = 17). Decreased diffusivity was predominantly present in posterior cortical regions of the DMN, but also outside of the DMN in temporal areas and in a few limbic and frontal areas, in addition to extensive deep nuclei involvement. Both subcortical and cortical sCJD subgroups showed decreased diffusivity subcortically, whereas only the cortical type expressed significantly decreased diffusivity cortically, mainly in parietal, occipital, and medial-inferior temporal cortices bilaterally. Interestingly, we found abnormally increased connectivity in both dorsal and ventral components of the DMN in sCJD subjects compared with healthy controls. The significance and possible utility of functional imaging as a biomarker for tracking disease progression in prion disease needs to be explored further.
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Affiliation(s)
- Matteo Paoletti
- Memory and Aging Center, Department of Neurology, Weill Institute for NeuroscienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of NeuroradiologyIRCCS Mondino FoundationPaviaItaly
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, Weill Institute for NeuroscienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jesse A. Brown
- Memory and Aging Center, Department of Neurology, Weill Institute for NeuroscienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Roland G. Henry
- Weill Institute for Neurosciences, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Graduate Group in BioengineeringUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for NeuroscienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, Weill Institute for NeuroscienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Stefano Bastianello
- Department of NeuroradiologyIRCCS Mondino FoundationPaviaItaly
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, Weill Institute for NeuroscienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michael D. Geschwind
- Memory and Aging Center, Department of Neurology, Weill Institute for NeuroscienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Pizzini FB, Conti E, Bianchetti A, Splendiani A, Fusco D, Caranci F, Bozzao A, Landi F, Gandolfo N, Farina L, Miele V, Trabucchi M, Frisoni GB, Bastianello S. Radiological assessment of dementia: the Italian inter-society consensus for a practical and clinically oriented guide to image acquisition, evaluation, and reporting. LA RADIOLOGIA MEDICA 2022; 127:998-1022. [PMID: 36070064 PMCID: PMC9508052 DOI: 10.1007/s11547-022-01534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Radiological evaluation of dementia is expected to increase more and more in routine practice due to both the primary role of neuroimaging in the diagnostic pathway and the increasing incidence of the disease. Despite this, radiologists often do not follow a disease-oriented approach to image interpretation, for several reasons, leading to reports of limited value to clinicians. In our work, through an intersocietal consensus on the main mandatory knowledge about dementia, we proposed a disease-oriented protocol to optimize and standardize the acquisition/evaluation/interpretation and reporting of radiological images. Our main purpose is to provide a practical guideline for the radiologist to help increase the effectiveness of interdisciplinary dialogue and diagnostic accuracy in daily practice. RESULTS We defined key clinical and imaging features of the dementias (A), recommended MRI protocol (B), proposed a disease-oriented imaging evaluation and interpretation (C) and report (D) with a glimpse to future avenues (E). The proposed radiological practice is to systematically evaluate and score atrophy, white matter changes, microbleeds, small vessel disease, consider the use of quantitative measures using commercial software tools critically, and adopt a structured disease-oriented report. In the expanding field of cognitive disorders, the only effective assessment approach is the standardized disease-oriented one, which includes a multidisciplinary integration of the clinical picture, MRI, CSF and blood biomarkers and nuclear medicine.
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Affiliation(s)
- Francesca B. Pizzini
- Radiology, Department of Diagnostic and Public Health, University of Verona, Piazzale L.A. Scuro, 10, 37100 Verona, Italy
| | - Enrico Conti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angelo Bianchetti
- Department of Medicine and Rehabilitation, Clinical Institute S. Anna-Gruppo San Donato, Brescia, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
- Italian Association of Psychogeriatrics (AIP), Brescia, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Domenico Fusco
- Foundation Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ferdinando Caranci
- Department of Medicine of Precision, School of Medicine, “Luigi Vanvitelli” University of Campania, 80147 Naples, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Francesco Landi
- Foundation Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Lisa Farina
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Vittorio Miele
- Dipartimento Di Radiodiagnostica Emergenza-Urgenza, Azienda Universitaria Careggi, Florence, Italy
| | - Marco Trabucchi
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
- Italian Association of Psychogeriatrics (AIP), Brescia, Italy
- University of “Tor Vergata”, Rome, Italy
| | - Giovanni B. Frisoni
- Centre de La Mémoire, Geneva University and University Hospitals, 1205 Geneva, Switzerland
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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5
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Ziukelis ET, Sharma VK, Gome JJ. Premortem diagnosis of pathologically confirmed sporadic Creutzfeldt-Jakob disease. Clin Case Rep 2021; 9:e04461. [PMID: 34322245 PMCID: PMC8299091 DOI: 10.1002/ccr3.4461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease should be considered in any case of rapid neuropsychiatric decline. While neuropathological examination of a brain biopsy specimen remains the only definitive diagnostic method and real-time quaking-induced conversion tests have simplified premortem diagnosis, careful evaluation of magnetic resonance imaging can provide readily accessible clues.
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Affiliation(s)
| | - Vasu Keshav Sharma
- South West HealthcareWarrnamboolVicAustralia
- Health Imaging ServicesWarrnamboolVicAustralia
| | - James J Gome
- South West HealthcareWarrnamboolVicAustralia
- Deakin UniversityBurwoodVicAustralia
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6
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Younes K, Rojas JC, Wolf A, Sheng‐Yang GM, Paoletti M, Toller G, Caverzasi E, Luisa Mandelli M, Illán‐Gala I, Kramer JH, Cobigo Y, Miller BL, Rosen HJ, Geschwind MD. Selective vulnerability to atrophy in sporadic Creutzfeldt-Jakob disease. Ann Clin Transl Neurol 2021; 8:1183-1199. [PMID: 33949799 PMCID: PMC8164858 DOI: 10.1002/acn3.51290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Identification of brain regions susceptible to quantifiable atrophy in sporadic Creutzfeldt-Jakob disease (sCJD) should allow for improved understanding of disease pathophysiology and development of structural biomarkers that might be useful in future treatment trials. Although brain atrophy is not usually present by visual assessment of MRIs in sCJD, we assessed whether using voxel-based morphometry (VBM) can detect group-wise brain atrophy in sCJD. METHODS 3T brain MRI data were analyzed with VBM in 22 sCJD participants and 26 age-matched controls. Analyses included relationships of regional brain volumes with major clinical variables and dichotomization of the cohort according to expected disease duration based on prion molecular classification (i.e., short-duration/Fast-progressors (MM1, MV1, and VV2) vs. long-duration/Slow-progressors (MV2, VV1, and MM2)). Structural equation modeling (SEM) was used to assess network-level interactions of atrophy between specific brain regions. RESULTS sCJD showed selective atrophy in cortical and subcortical regions overlapping with all but one region of the default mode network (DMN) and the insulae, thalami, and right occipital lobe. SEM showed that the effective connectivity model fit in sCJD but not controls. The presence of visual hallucinations correlated with right fusiform, bilateral thalami, and medial orbitofrontal atrophy. Interestingly, brain atrophy was present in both Fast- and Slow-progressors. Worse cognition was associated with bilateral mesial frontal, insular, temporal pole, thalamus, and cerebellum atrophy. INTERPRETATION Brain atrophy in sCJD preferentially affects specific cortical and subcortical regions, with an effective connectivity model showing strength and directionality between regions. Brain atrophy is present in Fast- and Slow-progressors, correlates with clinical findings, and is a potential biomarker in sCJD.
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Affiliation(s)
- Kyan Younes
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Julio C. Rojas
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Amy Wolf
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Goh M. Sheng‐Yang
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Matteo Paoletti
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
- Advanced Imaging and Radiomics CenterNeuroradiology DepartmentIRCCS Mondino FoundationPaviaItaly
| | - Gianina Toller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Eduardo Caverzasi
- Department of NeurologyUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Maria Luisa Mandelli
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Ignacio Illán‐Gala
- Department of NeurologyHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Joel H. Kramer
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Yann Cobigo
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Bruce L. Miller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Howard J. Rosen
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Michael D. Geschwind
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
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Tokumaru AM, Saito Y, Murayma S. Diffusion-Weighted Imaging is Key to Diagnosing Specific Diseases. Magn Reson Imaging Clin N Am 2021; 29:163-183. [PMID: 33902901 DOI: 10.1016/j.mric.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article reviews diseases for which persistent signal abnormalities on diffusion-weighted imaging are the key to their diagnosis. Specifically, updated knowledge regarding the neuroimaging patterns of the following diseases is summarized: sporadic Creutzfeldt-Jakob disease, neuronal intranuclear inclusion disease, and hereditary diffuse leukoencephalopathy with axonal spheroids-colony-stimulating factor receptors/adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. In addition, their differential diagnoses; clinical manifestations; and pathologic, genetic, and imaging correlates are discussed.
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Affiliation(s)
- Aya Midori Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Yuko Saito
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shigeo Murayma
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan; Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka-fu 565-0871, Japan
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8
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Sacco S, Paoletti M, Staffaroni AM, Kang H, Rojas J, Marx G, Goh SY, Luisa Mandelli M, Allen IE, Kramer JH, Bastianello S, Henry RG, Rosen H, Caverzasi E, Geschwind MD. Multimodal MRI staging for tracking progression and clinical-imaging correlation in sporadic Creutzfeldt-Jakob disease. Neuroimage Clin 2020; 30:102523. [PMID: 33636540 PMCID: PMC7906895 DOI: 10.1016/j.nicl.2020.102523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/02/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022]
Abstract
Diffusion imaging is very useful for the diagnosis of sporadic Creutzfeldt-Jakob disease, but it has limitations in tracking disease progression as mean diffusivity changes non-linearly across the disease course. We previously showed that mean diffusivity changes across the disease course follow a quasi J-shaped curve, characterized by decreased values in earlier phases and increasing values later in the disease course. Understanding how MRI metrics change over-time, as well as their correlations with clinical deficits are crucial steps in developing radiological biomarkers for trials. Specifically, as mean diffusivity does not change linearly and atrophy mainly occurs in later stages, neither alone is likely to be a sufficient biomarker throughout the disease course. We therefore developed a model combining mean diffusivity and Volume loss (MRI Disease-Staging) to take into account mean diffusivity's non-linearity. We then assessed the associations between clinical outcomes and mean diffusivity alone, Volume alone and finally MRI Disease-Staging. In 37 sporadic Creutzfeldt-Jakob disease subjects and 30 age- and sex-matched healthy controls, high angular resolution diffusion and high-resolution T1 imaging was performed cross-sectionally to compute z-scores for mean diffusivity (MD) and Volume. Average MD and Volume were extracted from 41 GM volume of interest (VOI) per hemisphere, within the images registered to the Montreal Neurological Institute (MNI) space. Each subject's volume of interest was classified as either "involved" or "not involved" using a statistical threshold of ± 2 standard deviation (SD) for mean diffusivity changes and/or -2 SD for Volume. Volumes of interest were MRI Disease-Staged as: 0 = no abnormalities; 1 = decreased mean diffusivity only; 2 = decreased mean diffusivity and Volume; 3 = normal ("pseudo-normalized") mean diffusivity, reduced Volume; 4 = increased mean diffusivity, reduced Volume. We correlated Volume, MD and MRI Disease-Staging with several clinical outcomes (scales, score and symptoms) using 4 major regions of interest (Total, Cortical, Subcortical and Cerebellar gray matter) or smaller regions pre-specified based on known neuroanatomical correlates. Volume and MD z-scores correlated inversely with each other in all four major ROIs (cortical, subcortical, cerebellar and total) highlighting that ROIs with lower Volumes had higher MD and vice-versa. Regarding correlations with symptoms and scores, higher MD correlated with worse Mini-Mental State Examination and Barthel scores in cortical and cerebellar gray matter, but subjects with cortical sensory deficits showed lower MD in the primary sensory cortex. Volume loss correlated with lower Mini-Mental State Examination, Barthel scores and pyramidal signs. Interestingly, for both Volume and MD, changes within the cerebellar ROI showed strong correlations with both MMSE and Barthel. Supporting using a combination of MD and Volume to track sCJD progression, MRI Disease-Staging showed correlations with more clinical outcomes than Volume or MD alone, specifically with Mini-Mental State Examination, Barthel score, pyramidal signs, higher cortical sensory deficits, as well as executive and visual-spatial deficits. Additionally, when subjects in the cohort were subdivided into tertiles based on their Barthel scores and their percentile of disease duration/course ("Time-Ratio"), subjects in the lowest (most impaired) Barthel tertile showed a much greater proportion of more advanced MRI Disease-Stages than the those in the highest tertile. Similarly, subjects in the last Time-Ratio tertile (last tertile of disease) showed a much greater proportion of more advanced MRI Disease-Stages than the earliest tertile. Therefore, in later disease stages, as measured by time or Barthel, there is overall more Volume loss and increasing MD. A combined multiparametric quantitative MRI Disease-Staging is a useful tool to track sporadic Creutzfeldt-Jakob- disease progression radiologically.
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Affiliation(s)
- Simone Sacco
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA
- Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Adam M. Staffaroni
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Huicong Kang
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Julio Rojas
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Gabe Marx
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sheng-yang Goh
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Maria Luisa Mandelli
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Isabel E. Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco San Francisco (UCSF), San Francisco, CA, USA
| | - Joel H. Kramer
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Stefano Bastianello
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Roland G. Henry
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Howie.J. Rosen
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Eduardo Caverzasi
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Michael D. Geschwind
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
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Chwalisz BK, Buchbinder BR, Schmahmann JD, Samore WR. Case 32-2019: A 70-Year-Old Woman with Rapidly Progressive Ataxia. N Engl J Med 2019; 381:1569-1578. [PMID: 31618544 DOI: 10.1056/nejmcpc1909624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bart K Chwalisz
- From the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Harvard Medical School - both in Boston
| | - Bradley R Buchbinder
- From the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Harvard Medical School - both in Boston
| | - Jeremy D Schmahmann
- From the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Harvard Medical School - both in Boston
| | - Wesley R Samore
- From the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C., J.D.S.), Radiology (B.R.B.), and Pathology (W.R.S.), Harvard Medical School - both in Boston
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10
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Lapucci C, Romano N, Boffa G, Saitta L, Nobili F, Mancardi G, Mandich P, Grandis M. E200k Familial Creutzfeldt-Jakob Disease Presenting with Subacute Multiple Cranial Neuropathy. Open Neurol J 2019. [DOI: 10.2174/1874205x01913010072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Unusual clinical presentations in patients with E200K familial Creutzfeldt-Jakob Disease (fCJD) have been rarely reported. Herein, we described a case of E200K fCJD presenting with subacute cranial multiple neuropathy, initially suspected to be paraneoplastic or due to a leptomeningeal carcinomatosis, considering the neoplastic comorbidity of the patient. Surprisingly, brain MRI was highly suggestive of CJD. Brain histological examination confirmed the diagnosis. Genetic tests led to the definite diagnosis of E200K fCJD. To the best of our knowledge, the current case provides the first report of a histologically-confirmed E200K fCJD starting with cranial multiple neuropathy and may widen the spectrum of the clinical variability of CJD, also in its genetic variant. Unusual presentations may lead, as in this case, to incorrect diagnostic hypothesis and unuseful therapeutic attempts in the first phase of the diagnostic process. Also in the genetic variant of CJD, brain MRI demonstrated a very high sensitivity to detect the typical abnormalities since the earliest phases of the disease.
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11
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Grau-Rivera O, Calvo A, Bargalló N, Monté GC, Nos C, Lladó A, Molinuevo JL, Gelpi E, Sánchez-Valle R. Quantitative Magnetic Resonance Abnormalities in Creutzfeldt-Jakob Disease and Fatal Insomnia. J Alzheimers Dis 2018; 55:431-443. [PMID: 27662320 DOI: 10.3233/jad-160750] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Quantitative neuroimaging might unveil abnormalities in prion diseases that are not perceivable at visual inspection. On the other hand, scarce studies have quantified volumetric changes in prion diseases. OBJECTIVES We aim to characterize volumetric and diffusion tensor imaging (DTI) changes in patients with prion diseases who presented with either Creutzfeldt-Jakob disease (CJD) or fatal insomnia (FI) phenotype. METHODS Twenty patients with prion diseases- 15 with CJD and 5 with fatal insomnia (FI)- and 40 healthy controls were examined with a 3-Tesla magnetic resonance imaging scanner. Images were segmented and normalized with SPM12. DTI maps were obtained with FMRIB Software Library. Whole-brain voxel-wise and region-of-interest analyses of volumetric and DTI changes were performed with SPM12. White matter (WM) changes were also analyzed with tract-based spatial statistics. Semiquantitive assessment of neuropathological parameters was compared with DTI metrics in thalamus from 11 patients. RESULTS Patients with CJD and FI presented significant atrophy in thalamus and cerebellum. In CJD, mean diffusivity (MD) was decreased in striatum and increased in subcortical WM, while both increased and decreased values were observed across different thalamic nuclei. In FI, MD was increased in thalamus and cerebellum. Spongiform change and PrPSc deposition were more intense in thalamus in CJD than in FI, although no significant correlations arose with MD values in the nuclei studied. CONCLUSION Volumetric and DTI abnormalities suggest a central common role of the thalamus in prion diseases. We report, for the first time, quantitative MRI changes in FI, and provide further evidence of WM involvement in prion diseases.
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Affiliation(s)
- Oriol Grau-Rivera
- Neurological Tissue Bank of the Biobanc-Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Calvo
- Magnetic Resonance Image core facility of IDIBAPS, Barcelona, Spain
| | - Núria Bargalló
- Magnetic Resonance Image core facility of IDIBAPS, Barcelona, Spain.,Radiology Department, Image Diagnosis Center, Hospital Clínic, Barcelona, Spain
| | - Gemma C Monté
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Carlos Nos
- General Subdirectorate of Surveillance and Response to Emergencies in Public Health, Department of Public Health in Catalonia, Barcelona, Spain
| | - Albert Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - José Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobanc-Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Raquel Sánchez-Valle
- Neurological Tissue Bank of the Biobanc-Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
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12
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Fragoso DC, Gonçalves Filho ALDM, Pacheco FT, Barros BR, Aguiar Littig I, Nunes RH, Maia Júnior ACM, da Rocha AJ. Imaging of Creutzfeldt-Jakob Disease: Imaging Patterns and Their Differential Diagnosis. Radiographics 2017; 37:234-257. [PMID: 28076012 DOI: 10.1148/rg.2017160075] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) remains a challenge because of the large variability of the clinical scenario, especially in its early stages, which may mimic several reversible or treatable disorders. The molecular basis of prion disease, as well as its brain propagation and the pathogenesis of the illness, have become better understood in recent decades. Several reports have listed recognizable clinical features and paraclinical tests to supplement the replicable diagnostic criteria in vivo. Nevertheless, we lack specific data about the differential diagnosis of CJD at imaging, mainly regarding those disorders evolving with similar clinical features (mimicking disorders). This review provides an update on the neuroimaging patterns of sCJD, emphasizing the relevance of magnetic resonance (MR) imaging, summarizing the clinical scenario and molecular basis of the disease, and highlighting clinical, genetic, and imaging correlations in different subtypes of prion diseases. A long list of differential diagnoses produces a comprehensive pictorial review, with the aim of enabling radiologists to identify typical and atypical patterns of sCJD. This review reinforces distinguishable imaging findings and confirms diffusion-weighted imaging (DWI) features as pivotal in the diagnostic workup of sCJD, as these findings enable radiologists to reliably recognize this rare but invariably lethal disease. A probable diagnosis is justified when expected MR imaging patterns are demonstrated and CJD-mimicking disorders are confidently ruled out. ©RSNA, 2017.
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Affiliation(s)
- Diego Cardoso Fragoso
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Augusto Lio da Mota Gonçalves Filho
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Felipe Torres Pacheco
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Bernardo Rodi Barros
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Ingrid Aguiar Littig
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Renato Hoffmann Nunes
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Antônio Carlos Martins Maia Júnior
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Antonio J da Rocha
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
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13
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De Vita E, Ridgway GR, White MJ, Porter MC, Caine D, Rudge P, Collinge J, Yousry TA, Jager HR, Mead S, Thornton JS, Hyare H. Neuroanatomical correlates of prion disease progression - a 3T longitudinal voxel-based morphometry study. Neuroimage Clin 2016; 13:89-96. [PMID: 27942451 PMCID: PMC5133666 DOI: 10.1016/j.nicl.2016.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/19/2016] [Accepted: 10/28/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE MRI has become an essential tool for prion disease diagnosis. However there exist only a few serial MRI studies of prion patients, and these mostly used whole brain summary measures or region of interest based approaches. We present here the first longitudinal voxel-based morphometry (VBM) study in prion disease. The aim of this study was to systematically characterise progressive atrophy in patients with prion disease and identify whether atrophy in specific brain structures correlates with clinical assessment. METHODS Twenty-four prion disease patients with early stage disease (3 sporadic, 2 iatrogenic, 1 variant and 18 inherited CJD) and 25 controls were examined at 3T with a T1-weighted 3D MPRAGE sequence at multiple time-points (2-6 examinations per subject, interval range 0.1-3.2 years). Longitudinal VBM provided intra-subject and inter-subject image alignment, allowing voxel-wise comparison of progressive structural change. Clinical disease progression was assessed using the MRC Prion Disease Rating Scale. Firstly, in patients, we determined the brain regions where grey and white matter volume change between baseline and final examination correlated with the corresponding change in MRC Scale score. Secondly, in the 21/24 patients with interscan interval longer than 3 months, we identified regions where annualised rates of regional volume change in patients were different from rates in age-matched controls. Given the heterogeneity of the cohort, the regions identified reflect the common features of the different prion sub-types studied. RESULTS In the patients there were multiple regions where volume loss significantly correlated with decreased MRC scale, partially overlapping with anatomical regions where yearly rates of volume loss were significantly greater than controls. The key anatomical areas involved included: the basal ganglia and thalamus, pons and medulla, the hippocampal formation and the superior parietal lobules. There were no areas demonstrating volume loss significantly higher in controls than patients or negative correlation between volume and MRC Scale score. CONCLUSIONS Using 3T MRI and longitudinal VBM we have identified key anatomical regions of progressive volume loss which correlate with an established clinical disease severity index and are relevant to clinical deterioration. Localisation of the regions of progressive brain atrophy correlating most strongly with clinical decline may help to provide more targeted imaging endpoints for future clinical trials.
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Affiliation(s)
- Enrico De Vita
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 65, Queen Square, London WC1N 3BG, United Kingdom
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Gerard R Ridgway
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, 12 Queen Square, London WC1N 3BG, United Kingdom
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Mark J White
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 65, Queen Square, London WC1N 3BG, United Kingdom
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Marie-Claire Porter
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 98, Queen Square, London WC1N 3BG, United Kingdom
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, United Kingdom
| | - Diana Caine
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 98, Queen Square, London WC1N 3BG, United Kingdom
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, United Kingdom
| | - Peter Rudge
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 98, Queen Square, London WC1N 3BG, United Kingdom
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, United Kingdom
| | - John Collinge
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 98, Queen Square, London WC1N 3BG, United Kingdom
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, United Kingdom
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 65, Queen Square, London WC1N 3BG, United Kingdom
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Hans Rolf Jager
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 65, Queen Square, London WC1N 3BG, United Kingdom
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Simon Mead
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 98, Queen Square, London WC1N 3BG, United Kingdom
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, United Kingdom
| | - John S Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 65, Queen Square, London WC1N 3BG, United Kingdom
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Harpreet Hyare
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCLH Hospitals NHS Foundation Trust, Box 98, Queen Square, London WC1N 3BG, United Kingdom
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, United Kingdom
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14
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Cohen OS, Chapman J, Korczyn AD, Siaw OL, Warman-Alaluf N, Nitsan Z, Appel S, Kahana E, Rosenmann H, Hoffmann C. Clinical radiological correlation in E200K familial Creutzfeldt-Jakob disease. J Neural Transm (Vienna) 2016; 123:1457-1462. [PMID: 27624725 DOI: 10.1007/s00702-016-1617-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
The use of diffusion MRI improved the accuracy of diagnosis in Creutzfeldt-Jakob disease (CJD) and expanded our knowledge of the changes occurring in the brain during the disease. The aim of this study was to test whether in patients with E200K familial CJD (fCJD) the clinical severity correlates with the disease burden as reflected by the extent of cortical involvement in DWI MRI. Consecutive fCJD patients were examined by a neurologist who performed several tests including the CJD neurological scale (CJD-NS), MiniMental status examination (MMSE), Frontal Assessment Battery (FAB), NIH Stroke Scale (NIHSS), and the expanded disability status scale (EDSS). A simultaneously acquired MRI was analyzed by measuring the extent of cortical involvement in the DWI axial sequence. Correlations were tested for using Pearson test. Fifty-two fCJD patients (35 males, mean age 59.4 ± 5.7 years) were recruited to the study. Significant negative correlation was found between the extent of cortical involvement and the cognitive performance of the patients as reflected by their MMSE and FAB scores. In addition, a significant positive correlation was found between the MRI and the clinical disease severity scales CJD-NS and EDSS. The correlation between clinical scales of severity and cognitive dysfunction and the disease burden confirms the reliability of the CJD-NS scale. Further studies are warranted to examine whether MRI may serve not only for diagnosis but also as a biomarker for follow-up of disease progression and the efficacy of potential treatments.
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Affiliation(s)
- Oren S Cohen
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, 70300, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Joab Chapman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Robert and Martha Harden Chair in Mental and Neurological Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos D Korczyn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Zeev Nitsan
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
| | - Shmuel Appel
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
| | - Esther Kahana
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
| | - Hanna Rosenmann
- Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Chen Hoffmann
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Radiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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15
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Cohen OS, Kimiagar I, Korczyn AD, Nitsan Z, Appel S, Hoffmann C, Rosenmann H, Kahana E, Chapman J. Unusual presentations in patients with E200K familial Creutzfeldt-Jakob disease. Eur J Neurol 2016; 23:871-7. [PMID: 26806765 DOI: 10.1111/ene.12955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PROPOSE Familial Creutzfeldt-Jakob disease (fCJD) in Jews of Libyan ancestry is caused by an E200K mutation in the PRNP gene. The typical presenting symptoms include cognitive decline, behavioral changes and gait disturbances; however, some patients may have an unusual presentation such as a stroke-like presentation, alien hand syndrome or visual disturbances. The aim of this paper is to describe uncommon presentations in our series of consecutive patients with E200K fCJD. METHODS The study group included consecutive fCJD patients followed up as part of a longitudinal prospective study ongoing since 2003 or hospitalized since 2005. The clinical diagnosis of probable CJD was based on accepted diagnostic criteria and supported by typical magnetic resonance imaging, electroencephalographic findings, elevated cerebrospinal fluid tau protein levels and by genetic testing for the E200K mutation. Disease symptoms and signs were retrieved from the medical files. RESULTS The study population included 77 patients (42 men) with a mean age of disease onset of 60.6 ± 7.2 years. The most prevalent presenting symptoms were cognitive decline followed by gait impairment and behavioral changes. However, six patients had an unusual presentation including auditory agnosia, monoparesis, stroke-like presentation, facial nerve palsy, pseudobulbar syndrome and alien hand syndrome. CONCLUSIONS Our case series illustrates the wide phenotypic variability of the clinical presentation of patients with fCJD and widens the clinical spectrum of the disease. A high level of clinical suspicion may prove useful in obtaining early diagnosis and therefore avoiding costly and inefficient diagnostic and therapeutic strategies.
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Affiliation(s)
- O S Cohen
- Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - I Kimiagar
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A D Korczyn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Z Nitsan
- Barzilai Medical Center, Ashkelon, Israel
| | - S Appel
- Barzilai Medical Center, Ashkelon, Israel
| | - C Hoffmann
- Department of Radiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - H Rosenmann
- Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - E Kahana
- Barzilai Medical Center, Ashkelon, Israel
| | - J Chapman
- Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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16
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Baldarçara L, Currie S, Hadjivassiliou M, Hoggard N, Jack A, Jackowski AP, Mascalchi M, Parazzini C, Reetz K, Righini A, Schulz JB, Vella A, Webb SJ, Habas C. Consensus paper: radiological biomarkers of cerebellar diseases. THE CEREBELLUM 2015; 14:175-96. [PMID: 25382714 DOI: 10.1007/s12311-014-0610-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine.
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17
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Caverzasi E, Henry RG, Vitali P, Lobach IV, Kornak J, Bastianello S, Dearmond SJ, Miller BL, Rosen HJ, Mandelli ML, Geschwind MD. Application of quantitative DTI metrics in sporadic CJD. NEUROIMAGE-CLINICAL 2014; 4:426-35. [PMID: 24624328 PMCID: PMC3950558 DOI: 10.1016/j.nicl.2014.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/13/2013] [Accepted: 01/17/2014] [Indexed: 11/28/2022]
Abstract
Diffusion Weighted Imaging is extremely important for the diagnosis of probable sporadic Jakob-Creutzfeldt disease, the most common human prion disease. Although visual assessment of DWI MRI is critical diagnostically, a more objective, quantifiable approach might more precisely identify the precise pattern of brain involvement. Furthermore, a quantitative, systematic tracking of MRI changes occurring over time might provide insights regarding the underlying histopathological mechanisms of human prion disease and provide information useful for clinical trials. The purposes of this study were: 1) to describe quantitatively the average cross-sectional pattern of reduced mean diffusivity, fractional anisotropy, atrophy and T1 relaxation in the gray matter (GM) in sporadic Jakob-Creutzfeldt disease, 2) to study changes in mean diffusivity and atrophy over time and 3) to explore their relationship with clinical scales. Twenty-six sporadic Jakob-Creutzfeldt disease and nine control subjects had MRIs on the same scanner; seven sCJD subjects had a second scan after approximately two months. Cortical and subcortical gray matter regions were parcellated with Freesurfer. Average cortical thickness (or subcortical volume), T1-relaxiation and mean diffusivity from co-registered diffusion maps were calculated in each region for each subject. Quantitatively on cross-sectional analysis, certain brain regions were preferentially affected by reduced mean diffusivity (parietal, temporal lobes, posterior cingulate, thalamus and deep nuclei), but with relative sparing of the frontal and occipital lobes. Serial imaging, surprisingly showed that mean diffusivity did not have a linear or unidirectional reduction over time, but tended to decrease initially and then reverse and increase towards normalization. Furthermore, there was a strong correlation between worsening of patient clinical function (based on modified Barthel score) and increasing mean diffusivity.
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Affiliation(s)
- E Caverzasi
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA ; Department of Neuroradiology, C. Mondino National Neurological Institute, Pavia. University of Pavia, Italy
| | - R G Henry
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA ; Graduate Group in Bioengineering, UCSF, San Francisco, CA, USA ; Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - P Vitali
- Brain MRI 3T Mondino Research Center C. Mondino National Neurological Institute, Pavia, Italy
| | - I V Lobach
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - J Kornak
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - S Bastianello
- Department of Neuroradiology, C. Mondino National Neurological Institute, Pavia. University of Pavia, Italy
| | - S J Dearmond
- Institute for Neurodegenerative Diseases, University of California, San Francisco (UCSF), USA ; Department of Pathology, University of California, San Francisco (UCSF), USA
| | - B L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, (UCSF), USA
| | - H J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, (UCSF), USA
| | - M L Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, (UCSF), USA
| | - M D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, (UCSF), USA
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18
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De Vita E, Ridgway GR, Scahill RI, Caine D, Rudge P, Yousry TA, Mead S, Collinge J, Jäger HR, Thornton JS, Hyare H. Multiparameter MR imaging in the 6-OPRI variant of inherited prion disease. AJNR Am J Neuroradiol 2013; 34:1723-30. [PMID: 23538406 DOI: 10.3174/ajnr.a3504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Inherited prion diseases represent over 15% of human prion cases and are a frequent cause of early onset dementia. The purpose of this study was to define the distribution of changes in cerebral volumetric and microstructural parenchymal tissues in a specific inherited human prion disease mutation combining VBM with VBA of cerebral MTR and MD. MATERIALS AND METHODS VBM and VBA of cerebral MTR and MD were performed in 16 healthy control participants and 9 patients with the 6-OPRI mutation. An analysis of covariance consisting of diagnostic grouping with age and total intracranial volume as covariates was performed. RESULTS On VBM, there was a significant reduction in gray matter volume in patients compared with control participants in the basal ganglia, perisylvian cortex, lingual gyrus, and precuneus. Significant MTR reduction and MD increases were more anatomically extensive than volume differences on VBM in the same cortical areas, but MTR and MD changes were not seen in the basal ganglia. CONCLUSIONS Gray matter and WM changes were seen in brain areas associated with motor and cognitive functions known to be impaired in patients with the 6-OPRI mutation. There were some differences in the anatomic distribution of MTR-VBA and MD-VBA changes compared with VBM, likely to reflect regional variations in the type and degree of the respective pathophysiologic substrates. Combined analysis of complementary multiparameter MR imaging data furthers our understanding of prion disease pathophysiology.
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Affiliation(s)
- E De Vita
- Lysholm Department of Neuroradiology
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19
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Nagy SA, Aradi M, Orsi G, Perlaki G, Kamson DO, Mike A, Komaromy H, Schwarcz A, Kovacs A, Janszky J, Pfund Z, Illes Z, Bogner P. Bi-exponential diffusion signal decay in normal appearing white matter of multiple sclerosis. Magn Reson Imaging 2013; 31:286-95. [DOI: 10.1016/j.mri.2012.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 07/03/2012] [Accepted: 07/15/2012] [Indexed: 10/28/2022]
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20
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Magnetic Resonance Imaging in E200K and V210I Mutations of the Prion Protein Gene. Alzheimer Dis Assoc Disord 2013; 27:87-90. [DOI: 10.1097/wad.0b013e31824d578a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Wang LH, Bucelli RC, Patrick E, Rajderkar D, Alvarez Iii E, Lim MM, Debruin G, Sharma V, Dahiya S, Schmidt RE, Benzinger TS, Ward BA, Ances BM. Role of magnetic resonance imaging, cerebrospinal fluid, and electroencephalogram in diagnosis of sporadic Creutzfeldt-Jakob disease. J Neurol 2012; 260:498-506. [PMID: 22968768 DOI: 10.1007/s00415-012-6664-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/25/2012] [Accepted: 08/25/2012] [Indexed: 11/28/2022]
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly progressive dementia (RPD) that can be difficult to identify antemortem, with definitive diagnosis requiring tissue confirmation. We describe the clinical, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), and electroencephalogram (EEG) measures of a small cohort of 30 patients evaluated for RPD. Clinical and diagnostic measures were cross-sectionally obtained from 17 sCJD patients (15 definite, two probable), 13 non-prion rapidly progressive dementia patients (npRPD), and 18 unimpaired controls. In a subset of patients (nine sCJD and nine npRPD) diffusion tensor imaging (DTI) measures [fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD)] were also obtained for the caudate, corpus callosum, posterior limb of the internal capsule, pulvinar, precuneus, and frontal lobe. Differences among groups were assessed by an analysis of variance. Compared to npRPD individuals, sCJD patients had cerebellar dysfunction, significantly higher CSF tau, "positive" CSF 14-3-3, and hyperintensities on diffusion-weighted imaging (DWI) that met previously established imaging criteria for sCJD. EEG changes were similar for the two groups. In addition, sCJD patients had significant decreases in DTI measures (MD, AD, RD but not FA) within the caudate and pulvinar compared to either npRPD patients or unimpaired controls. Our results confirm that CSF abnormalities and MRI (especially DWI) can assist in distinguishing sCJD patients from npRPD patients. Future longitudinal studies using multiple measures (including CSF and MRI) are needed for evaluating pathological changes seen in sCJD patients.
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Affiliation(s)
- Leo H Wang
- Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO 63110, USA
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Lee H, Cohen OS, Rosenmann H, Hoffmann C, Kingsley PB, Korczyn AD, Chapman J, Prohovnik I. Cerebral white matter disruption in Creutzfeldt-Jakob disease. AJNR Am J Neuroradiol 2012; 33:1945-50. [PMID: 22576896 DOI: 10.3174/ajnr.a3125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Human prion diseases are known to cause gray matter degeneration in specific cerebral structures, but evidence for white matter involvement is scarce. We used DTI to test the hypothesis that white matter integrity is disrupted in human CJD during the early stages of the disease. MATERIALS AND METHODS Twenty-one patients with the E200K variant of CJD and 19 controls participated in DTI studies conducted on a 1.5T MR imaging scanner. The data were quantitatively analyzed and mapped with a voxelwise TBSS method. RESULTS We found significant reductions of FA in patients with CJD in distinct and functionally relevant white matter pathways, including the corticospinal tract, internal capsule, external capsule, fornix, and posterior thalamic radiation. Moreover, these FA deficits increased with disease duration, and were mainly determined by increase of radial diffusivity, suggesting elevated permeability of axonal membranes. CONCLUSIONS The findings suggest that some of the symptoms of CJD may be caused by a functional dysconnection syndrome, and that the leukoencephalopathy is progressive and detectable fairly early in the course of the disease.
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Affiliation(s)
- H Lee
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10029, USA
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23
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Cohen OS, Chapman J, Lee H, Nitsan Z, Appel S, Hoffman C, Rosenmann H, Korczyn AD, Prohovnik I. Pruritus in familial Creutzfeldt-Jakob disease: a common symptom associated with central nervous system pathology. J Neurol 2010; 258:89-95. [PMID: 20725737 DOI: 10.1007/s00415-010-5694-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 07/24/2010] [Accepted: 07/26/2010] [Indexed: 01/12/2023]
Abstract
Pruritus, a common feature of animal prion diseases such as scrapie, is rarely reported in humans with Creutzfeldt-Jakob disease (CJD), and its anatomical background is not well defined. The present study was undertaken to carry out a methodical prospective search for the prevalence of pruritus in CJD patients and investigate its anatomical substrate by MRI. The study group included consecutive familial and sporadic CJD patients carrying the E200K PRNP mutation followed up in a longitudinal prospective study between the years 2005 and 2008. Pruritus was prospectively screened for and diffusion-weighted imaging (DWI) was used to correlate brain diffusion abnormalities with pruritus in CJD patients. Pruritus was present in 6/31 (19.35%) patients with familial disease (fCJD) and in none of the patients with sporadic disease (sCJD). Pruritus was a presenting symptom in one patient and evolved during the course of the disease in the other five patients. The pruritus was generalized in three patients, regional in two and localized in one patient. It was transient in one patient and continued throughout the disease in five patients. DWI showed that pruritus was significantly associated with reduced diffusion in the several areas known to be affected by CJD, but most significantly in the midbrain periaqueductal grey matter. Pruritus is relatively common in patients with familial CJD carrying the E200K mutation. Our findings point to a central origin that involves damage to the inhibitory gating mechanism for itch in the periaqueductal grey matter.
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Affiliation(s)
- Oren S Cohen
- Department of Neurology, The Sagol Center for Neuroscience, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
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Seror I, Lee H, Cohen OS, Hoffmann C, Prohovnik I. Putaminal volume and diffusion in early familial Creutzfeldt-Jakob disease. J Neurol Sci 2010; 288:129-34. [PMID: 19828153 PMCID: PMC2789847 DOI: 10.1016/j.jns.2009.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 08/17/2009] [Accepted: 09/22/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND The putamen is centrally implicated in the pathophysiology of Creutzfeldt-Jakob Disease (CJD). To our knowledge, its volume has never been measured in this disease. We investigated whether gross putaminal atrophy can be detected by MRI in early stages, when the diffusion is already reduced. METHODS Twelve familial CJD patients with the E200K mutation and 22 healthy controls underwent structural and diffusion MRI scans. The putamen was identified in anatomical scans by two methods: manual tracing by a blinded investigator, and automatic parcellation by a computerized segmentation procedure (FSL FIRST). For each method, volume and mean Apparent Diffusion Coefficient (ADC) were calculated. RESULTS ADC was significantly lower in CJD patients (697+/-64 microm(2)/s vs. 750+/-31 microm(2)/s, p<0.005), as expected, but the volume was not reduced. The computerized FIRST delineation yielded comparable ADC values to the manual method, but computerized volumes were smaller than manual tracing values. CONCLUSIONS We conclude that significant diffusion reduction in the putamen can be detected by delineating the structure manually or with a computerized algorithm. Our findings confirm and extend previous voxel-based and observational studies. Putaminal volume was not reduced in our early-stage patients, thus confirming that diffusion abnormalities precede detectible atrophy in this structure.
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Affiliation(s)
- Ilana Seror
- Department of Psychiatry, Mount Sinai School of Medicine, New York
| | - Hedok Lee
- Department of Psychiatry, Mount Sinai School of Medicine, New York
| | - Oren S. Cohen
- Department of Neurology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Chen Hoffmann
- Department of Radiology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Isak Prohovnik
- Department of Psychiatry, Mount Sinai School of Medicine, New York
- Department of Radiology, Mount Sinai School of Medicine, New York
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Lee H, Rosenmann H, Chapman J, Kingsley PB, Hoffmann C, Cohen OS, Kahana E, Korczyn AD, Prohovnik I. Thalamo-striatal diffusion reductions precede disease onset in prion mutation carriers. ACTA ACUST UNITED AC 2009; 132:2680-7. [PMID: 19321460 DOI: 10.1093/brain/awp064] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Human prion diseases present substantial scientific and public health challenges. They are unique in being sporadic, infectious and inherited, and their pathogen is distinct from all other pathogens in lacking nucleic acids. Despite progress in understanding the molecular structure of prions, their initial cerebral pathophysiology and the loci of cerebral injury are poorly understood. As part of a large prospective study, we analysed early diffusion MRI scans of 14 patients with the E200K genetic form of Creutzfeldt-Jakob Disease, 20 healthy carriers of this mutation that causes the disease and 20 controls without the mutation from the same families. Cerebral diffusion was quantified by the Apparent Diffusion Coefficient, and analysed by voxel-wise statistical parametric mapping technique. Compared to the mutation-negative controls, diffusion was significantly reduced in a thalamic-striatal network, comprising the putamen and mediodorsal, ventrolateral and pulvinar thalamic nuclei, in both the patients and the healthy mutation carriers. With disease onset, these diffusion reductions intensified, but did not spread to other areas. The caudate nucleus was reduced only after symptomatic onset. These findings indicate that cerebral diffusion reductions can be detected early in the course of Creutzfeldt-Jakob Disease, and years before symptomatic onset in mutation carriers, in a distinct subcortical network. We suggest that this network is centrally involved in the pathogenesis of Creutzfeldt-Jakob Disease, and its anatomical connections are sufficient to account for the common symptoms of this disease. Further, we suggest that the abnormalities in healthy mutation-carrying subjects may reflect the accumulation of abnormal prion protein and/or associated vacuolation at this time, temporally close to disease onset.
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Affiliation(s)
- Hedok Lee
- MIRECC, Bronx VAMC, 130 W Kingsbridge Road, NY 10468, USA.
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