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Mattoli MV, Giancipoli RG, Cocciolillo F, Calcagni ML, Taralli S. The Role of PET Imaging in Patients with Prion Disease: A Literature Review. Mol Imaging Biol 2024; 26:195-212. [PMID: 38302686 DOI: 10.1007/s11307-024-01895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/30/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
Prion diseases are rare, rapidly progressive, and fatal incurable degenerative brain disorders caused by the misfolding of a normal protein called PrPC into an abnormal protein called PrPSc. Their highly variable clinical presentation mimics various degenerative and non-degenerative brain disorders, making diagnosis a significant challenge for neurologists. Currently, definitive diagnosis relies on post-mortem examination of nervous tissue to detect the pathogenic prion protein. The current diagnostic criteria are limited. While structural magnetic resonance imaging (MRI) remains the gold standard imaging modality for Creutzfeldt-Jakob disease (CJD) diagnosis, positron emission tomography (PET) using 18fluorine-fluorodeoxyglucose (18F-FDG) and other radiotracers have demonstrated promising potential in the diagnostic assessment of prion disease. In this context, a comprehensive and updated review exclusively focused on PET imaging in prion diseases is still lacking. We review the current value of PET imaging with 18F-FDG and non-FDG tracers in the diagnostic management of prion diseases. From the collected data, 18F-FDG PET mainly reveals cortical and subcortical hypometabolic areas in prion disease, although fails to identify typical pattern or laterality abnormalities to differentiate between genetic and sporadic prion diseases. Although the rarity of prion diseases limits the establishment of a definitive hypometabolism pattern, this review reveals some more prevalent 18F-FDG patterns associated with each disease subtype. Interestingly, in both sporadic and genetic prion diseases, the hippocampus does not show significant glucose metabolism alterations, appearing as a useful sign in the differential diagnosis with other neurodegenerative disease. In genetic prion disease forms, PET abnormality precedes clinical manifestation. Discordant diagnostic value for amyloid tracers among different prion disease subtypes was observed, needing further investigation. PET has emerged as a potential valuable tool in the diagnostic armamentarium for CJD. Its ability to visualize functional and metabolic brain changes provides complementary information to structural MRI, aiding in the early detection and confirmation of CJD.
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Affiliation(s)
- Maria Vittoria Mattoli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Nuclear Medicine Unit, Ospedale Santo Spirito, Pescara, Italy
| | - Romina Grazia Giancipoli
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, UOC Di Medicina Nucleare, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Fabrizio Cocciolillo
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, UOC Di Medicina Nucleare, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Maria Lucia Calcagni
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, UOC Di Medicina Nucleare, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy
- Dipartimento Universitario Di Scienze Radiologiche Ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Silvia Taralli
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, UOC Di Medicina Nucleare, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Habteslassie D, McMahon M, Wimaleswaran H. Can insomnia be fatal? An Australian case of fatal familial insomnia. Intern Med J 2022; 52:667-670. [PMID: 35419959 DOI: 10.1111/imj.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/28/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
Fatal familial insomnia (FFI) is a rare prion disease with autosomal dominant inheritance. Currently, there is only one published case study of FFI in Australia. FFI is universally fatal, with the disease duration ranging from 8 to 72 months. Clinically, it manifests with disordered sleep-wake cycle, dysautonomia, motor disturbances and neuropsychiatric disorders. We describe a case of FFI detailing the investigative process, including the importance of sleep assessment and polysomnography in obtaining a diagnosis.
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Affiliation(s)
- Daniel Habteslassie
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Marcus McMahon
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Hari Wimaleswaran
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Yuan J, Wang S, Hu W. Combined findings of FDG-PET and arterial spin labeling in sporadic Creutzfeldt-Jakob disease. Prion 2018; 12:310-314. [PMID: 30223705 PMCID: PMC6277194 DOI: 10.1080/19336896.2018.1525255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/27/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a fatal progressive neurodegenerative disease. Multimodal approaches, including electroencephalogram, diffusion-weighted imaging (DWI) of brain MRI, and cerebrospinal fluid biomarkers, have been applied to increase the diagnostic accuracy of sCJD. Although previous studies suggested DWI could be the most useful modality for sCJD diagnosis, whether metabolism changes underlying in sCJD are still poorly understood. To the best of our knowledge, there are only one case using the technique of arterial spin labeling (ASL) to detection and follow-up of perfusion changes in CJD. Herein, we described a 71-year-old woman presented with progressive cognitive decline, behavioral and psychological symptoms for two months. The patient died one month later after her admission. As far as we know, this is the first report using the combination of fluorodeoxyglucose positron emission tomography and ASL to explore the metabolism changes in sCJD. Our case exemplifies the difficulty clinicians may face in the diagnosis of sCJD.
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Affiliation(s)
- Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuangkun Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Kiliç AK, Kaymakamzade B, Saka E, Tan E. The Sole Initial Imaging Finding in Creutzfeldt-Jacob Disease: Focal FDG-PET Hypometabolism. Noro Psikiyatr Ars 2018; 56:226-228. [PMID: 31523152 DOI: 10.5152/npa.2017.19471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/16/2017] [Indexed: 11/22/2022] Open
Abstract
Laboratory studies such as electroencephalography, cerebrospinal fluid examination and diffusion-weighted magnetic resonance imaging (DWI-MRI) are valuable in the diagnosis of Creutzfeldt-Jacob disease (CJD),. However, these laboratory studies may not show the characteristic findings in the very early stage of the disease. Here, we present a case of CJD who had atypical neurologic presentation initially and had only a focal parietal 2-(18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) hypometabolism as the sole imaging abnormality at the beginning. The patient progressed rapidly, and showed typical neurological findings for CJD. The brain MRI was performed two weeks after the FDG-PET study, finally demonstrated increased signal intensity in DWI in caudat nucleus, putamen, and cerebral cortex, especially on left parietal region. Imaging methods demonstrating functional alterations in the brain should be obtained in the early period in patients with normal MRI suspected having CJD. Repeating DWI could also be an effective diagnostic approach.
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Affiliation(s)
- Ahmet Kasım Kiliç
- Neurology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bahar Kaymakamzade
- Neurology Department, Near East University Faculty of Medicine, Lefkoşa, Cyprus
| | - Esen Saka
- Neurology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ersin Tan
- Neurology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Matías-Guiu JA, Guerrero-Márquez C, Cabrera-Martín MN, Gómez-Pinedo U, Romeral M, Mayo D, Porta-Etessam J, Moreno-Ramos T, Carreras JL, Matías-Guiu J. Amyloid- and FDG-PET in sporadic Creutzfeldt-Jakob disease: Correlation with pathological prion protein in neuropathology. Prion 2017; 11:205-213. [PMID: 28509609 DOI: 10.1080/19336896.2017.1314427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The role of positron emission tomography (PET) in Creutzfeldt-Jakob disease is less defined than in other neurodegenerative diseases. We studied the correlation between the uptake of 18F-florbetaben and 18F-fluorodeoxyglucose with pathological prion protein deposition in histopathology in a case. METHODS A patient with 80 y old with a rapid neurological deterioration with a confirmed diagnosis of CJD was studied. PET and MRI studies were performed between 13-20 d before the death. A region of interest analysis was performed using Statistical Parametric Mapping. RESULTS MRI showed atrophy with no other alterations. FDG-PET showed extensive areas of hypometabolism including left frontoparietal lobes as well as bilateral thalamus. Correlation between uptake of 18F-florbetaben and pathological prion protein deposition was r = 0.786 (p < 0.05). Otherwise, correlation between uptake of 18F-FDG and pathological prion protein was r = 0.357 (p = 0.385). Immunohistochemistry with β-amyloid did not show amyloid deposition or neuritic plaques. CONCLUSIONS Our study supports the use of FDG-PET in the assessment of CJD. FDG-PET may be especially useful in cases of suspected CJD and negative MRI. Furthermore, this case report provides more evidence about the behavioral of amyloid tracers, and the possibility of a low-affinity binding to other non-amyloid proteins, such as the pathological prion protein, is discussed.
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Affiliation(s)
- Jordi A Matías-Guiu
- a Department of Neurology, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - Carmen Guerrero-Márquez
- b Laboratory of Neuropathology, Brain Bank, Department of Pathology , Hospital Universitario Fundación Alcorcón , Madrid , Spain
| | - María Nieves Cabrera-Martín
- c Department of Nuclear Medicine, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - Ulises Gómez-Pinedo
- a Department of Neurology, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain.,d Laboratory of Regenerative Medicine, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - María Romeral
- a Department of Neurology, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - Diego Mayo
- a Department of Neurology, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - Jesús Porta-Etessam
- a Department of Neurology, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - Teresa Moreno-Ramos
- a Department of Neurology, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - José Luis Carreras
- c Department of Nuclear Medicine, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
| | - Jorge Matías-Guiu
- a Department of Neurology, Hospital Clínico San Carlos, San Carlos Institute for Health Research (IdISSC) , Universidad Complutense , Madrid , Spain
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Liu L, Li C, Yang Q, Zhang W, Liu Y, Zhu H. Clinical and neuroimaging features of a Chinese patient with fatal familial insomnia. Sleep Med 2017; 32:280-281. [PMID: 28057496 DOI: 10.1016/j.sleep.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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Jena A, Renjen PN, Taneja S, Gambhir A, Negi P. Integrated (18)F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging ((18)F-FDG PET/MRI), a multimodality approach for comprehensive evaluation of dementia patients: A pictorial essay. Indian J Radiol Imaging 2016; 25:342-52. [PMID: 26752814 PMCID: PMC4693381 DOI: 10.4103/0971-3026.169449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dementia, caused by irreversible neurodegenerative disorders such as Alzheimer's disease or reversible non-degenerative conditions, is rapidly becoming one of the most alarming health problems in our aging society. This cognitive disorder associated with a multitude of clinical differentials with overlapping clinical, pathological, and imaging features is difficult to diagnose and treat, as it often presents late after significant neuronal damage has already occurred. Novel disease-modifying treatments being developed will have to be corroborated with innovative imaging biomarkers so that earlier reliable diagnosis can be made and treatment initiated upon. Along with new specific PET radiotracers, integrated PET/MRI with combined methodological advantage and simultaneously acquired structural-cum-functional information may help achieve this goal. The present pictorial essay details our experiences with PET/MRI in dementing disorders, along with reviewing recent advances and future scope.
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Affiliation(s)
- Amarnath Jena
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Sangeeta Taneja
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Aashish Gambhir
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Pradeep Negi
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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Prieto E, Domínguez-Prado I, Riverol M, Ortega-Cubero S, Ribelles MJ, Luquin MR, de Castro P, Arbizu J. Metabolic patterns in prion diseases: an FDG PET voxel-based analysis. Eur J Nucl Med Mol Imaging 2015; 42:1522-9. [DOI: 10.1007/s00259-015-3090-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/19/2015] [Indexed: 11/25/2022]
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