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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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Diagnostic value of diffusion-weighted brain magnetic resonance imaging in patients with sporadic Creutzfeldt-Jakob disease: a systematic review and meta-analysis. Eur Radiol 2021; 31:9073-9085. [PMID: 33982159 DOI: 10.1007/s00330-021-08031-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/14/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield and performance of DWI in patients with sporadic CJD (sCJD). METHODS A systematic literature search of the MEDLINE and EMBASE databases was performed, since their inception up to July 28, 2020. Pooled diagnostic yield of diffusion-weighted imaging was calculated using DerSimonian-Laird random-effects model. Pooled diagnostic performance of DWI (sensitivity, specificity, and area under the curve) in diagnosing sCJD among patients with rapidly progressive dementia was calculated using a bivariate random-effects model. Subgroup analysis and meta-regression were performed. RESULTS Fifteen original articles with a total of 1144 patients with sCJD were included. The pooled diagnostic yield was 91% (95% confidence interval [CI], 86 to 94%); summary sensitivity, 91% (95% CI, 84 to 95%); and specificity, 97% (95% CI, 94 to 99%). The area under the hierarchical summary receiver operating characteristic curve was 0.99 (95% CI, 0.97-0.99). Simultaneous involvement of the neocortex and striatum was the most common finding, and the neocortex was the most common site to be involved on DWI followed by striatum, thalamus, and cerebellum. Subgroup analysis and meta-regression demonstrated significant heterogeneity among the studies associated with the reference standards used for diagnosis of sCJD. CONCLUSIONS DWI showed excellent diagnostic value in diagnosis of sporadic Creutzfeldt-Jakob disease among patients with rapidly progressive dementia. Simultaneous involvement of the neocortex and striatum was the most common finding, and the neocortex was the most common site to be involved on diffusion-weighted imaging followed by striatum, thalamus, and cerebellum. KEY POINTS • The pooled diagnostic yield of diffusion-weighted imaging in sporadic Creutzfeldt-Jakob disease was 91%. • The diagnostic performance of diffusion-weighted imaging for predicting sporadic Creutzfeldt-Jakob disease among patients with rapidly progressive dementia was excellent, with pooled sensitivity, 91%, and specificity, 97%. • Simultaneous involvement in the neocortex and striatum was most commonly seen on diffusion-weighted imaging (60%), followed by the neocortex without striatum (30%), thalamus (21%), cerebellum (8%), and striatum without neocortex (7%).
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Yedavalli V, Nyberg EM, Chow DS, Thaker AA. Beyond the embolus: "do not miss" diffusion abnormalities of ischaemic and non-ischaemic neurological disease. Insights Imaging 2017; 8:573-580. [PMID: 28986862 PMCID: PMC5707221 DOI: 10.1007/s13244-017-0574-1] [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: 05/30/2017] [Revised: 08/21/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022] Open
Abstract
Abstract Given the rapid evolution and technological advances in the diagnosis and treatment of acute ischaemic stroke (AIS), including the proliferation of comprehensive stroke centres and increasing emphasis on interventional stroke therapies, the need for prompt recognition of stroke due to acute large vessel occlusion has received significant attention in the recent literature. Diffusion-weighted imaging (DWI) is the gold standard for the diagnosis of acute ischaemic stroke, as images appear positive within minutes of ischaemic injury, and a high signal-to-noise ratio enables even punctate infarcts to be readily detected. DWI lesions resulting from a single arterial embolic occlusion or steno-occlusive lesion classically lateralise and conform to a specific arterial territory. When there is a central embolic source (e.g. left atrial thrombus), embolic infarcts are often found in multiple vascular territories. However, ischaemic disease arising from aetiologies other than arterial occlusion will often not conform to an arterial territory. Furthermore, there are several important entities unrelated to ischaemic disease that can present with abnormal DWI and which should not be confused with infarct. This pictorial review explores the scope and typical DWI findings of select neurologic conditions beyond acute arterial occlusion, which should not be missed or misinterpreted. Teaching points • DWI abnormalities due to acute arterial occlusion must be promptly identified. • DWI abnormalities not due to arterial occlusion will often not conform to an arterial territory. • Several important non-ischaemic entities can present on DWI and should not be confused with infarct.
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Affiliation(s)
- Vivek Yedavalli
- Department of Diagnostic Radiology, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA
| | - Eric M Nyberg
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Daniel S Chow
- Department of Radiological Sciences, UC Irvine Health School of Medicine, Orange, CA, 92868, USA
| | - Ashesh A Thaker
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
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Gaudino S, Gangemi E, Colantonio R, Botto A, Ruberto E, Calandrelli R, Martucci M, Vita MG, Masullo C, Cerase A, Colosimo C. Neuroradiology of human prion diseases, diagnosis and differential diagnosis. Radiol Med 2017; 122:369-385. [PMID: 28110369 DOI: 10.1007/s11547-017-0725-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/03/2017] [Indexed: 01/14/2023]
Abstract
Human transmissible spongiform encephalopathies (TSEs), or prion diseases, are invariably fatal conditions associated with a range of clinical presentations. TSEs are classified as sporadic [e.g. sporadic Creutzfeldt-Jakob disease (sCJD), which is the most frequent form], genetic (e.g. Gerstmann-Straussler-Scheinker disease, fatal familial insomnia, and inherited CJD), and acquired or infectious (e.g. Kuru, iatrogenic CJD, and variant CJD). In the past, brain imaging played a supporting role in the diagnosis of TSEs, whereas nowadays magnetic resonance imaging (MRI) plays such a prominent role that MRI findings have been included in the diagnostic criteria for sCJD. Currently, MRI is required for all patients with a clinical suspicion of TSEs. Thus, MRI semeiotics of TSEs should become part of the cultural baggage of any radiologist. The purposes of this update on the neuroradiology of CJD are to (i) review the pathophysiology and clinical presentation of TSEs, (ii) describe both typical and atypical MRI findings of CJD, and (iii) illustrate diseases mimicking CJD, underlining the MRI key findings useful in the differential diagnosis.
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Affiliation(s)
- Simona Gaudino
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Emma Gangemi
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Raffaella Colantonio
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Annibale Botto
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Emanuela Ruberto
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Rosalinda Calandrelli
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Matia Martucci
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Maria Gabriella Vita
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlo Masullo
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alfonso Cerase
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Università Senese, "Santa Maria alle Scotte" University and NHS Hospital, Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Cesare Colosimo
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
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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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Abstract
Dementia is defined as chronic deterioration of intellectual function and cognitive skills significant enough to interfere with the ability to perform daily activities. Recent advances in the treatment of dementia have renewed interest in the use of various neuroimaging techniques that can assist in the diagnosis and differentiation of various subtypes. Neuroimaging and computational techniques have helped the radiological community to monitor disease progression of various neurodegenerative conditions presenting with dementia, such as Alzheimer disease, frontotemporal lobe dementia (FTLD), progressive supranuclear palsy (PSP) and multisystem atrophy-cerebellar variant (MSA-C), and their response to newer therapies. Prompt identification of treatable or reversible forms of dementia, such as tumours, subdural haemorrhage and intracranial dAVF, is crucial for the effective management of these conditions. It is also prudent to recognize the imaging spectrum of metabolic, infective and autoimmune diseases with rapidly progressing dementia, such as methanol toxicity, central pontine myelinolysis (CPM), delayed post hypoxic leukoencephalopathy (DPHL), HIV, Creutzfeldt-Jakob Disease (CJD), Sjogren's syndrome, multiple sclerosis (MS), radiation necrosis and Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS), which are difficult to treat and often require palliative care. This pictorial review emphasizes various non-Alzheimer’s dementia entities and discusses their imaging highlights. Teaching Points • Non Alzheimer’s dementia constitutes a broad spectrum of conditions. • Neuroimaging plays an important role in differentiating treatable from irreversible dementia. • Neuroimaging is often non-specific in early stages of neurodegenerative conditions with dementia. • Neuroimaging plays an important role in the multimodal approach towards management of dementia.
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Cohen OS, Chapman J, Korczyn AD, Nitsan Z, Appel S, Hoffmann C, Rosenmann H, Kahana E, Lee H. Familial Creutzfeldt-Jakob disease with the E200K mutation: longitudinal neuroimaging from asymptomatic to symptomatic CJD. J Neurol 2014; 262:604-13. [PMID: 25522698 DOI: 10.1007/s00415-014-7615-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 11/25/2022]
Abstract
Familial Creutzfeldt-Jakob disease (fCJD) in Jews of Libyan ancestry is caused by an E200K mutation in the PRNP gene. While carriers are born with this mutation, they usually remain asymptomatic until middle age. Early detection of conversion is crucial for understanding and eventually for the treatment of the disease. The aim of this study was to report longitudinal MRI data in E200K individuals who eventually converted from healthy mutation carriers to clinically symptomatic CJD. As a part of a prospective study, asymptomatic E200K mutation carriers were scanned annually until their conversion to symptomatic disease. Standardized diffusion and anatomical MR sequences were performed before and after clinical conversion in the subjects and those were compared to 15 non-carrier siblings ("healthy controls"). Blinded radiological readings and region of interest analyses were performed. Radiological readings of individual cases failed to detect characteristic changes in the scans taken before the conversion. Region of interest analysis of diffusion changes in pre-symptomatic stage was inconclusive; however, ADC reduction was found in early and late stages of the disease. Computerized volumetric analysis revealed monotonic volume reductions in thalamus, putamen and caudate following conversion, and the lateral ventricles showed dilatation of up to 62 % after clinical conversion. Although the clinical manifestations at disease onset are variable, the diffusion abnormalities and/or volume changes in the thalamus and basal ganglia during conversion may indicate early involvement of the thalamostriatal neuronal circuit.
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Affiliation(s)
- Oren S Cohen
- Department of Neurology and the Sagol Neuroscience Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel,
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Degnan AJ, Samtani R, Paudel K, Levy LM. Neuroimaging of epilepsy: a review of MRI findings in uncommon etiologies and atypical presentations of seizures. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: Imaging patients with seizures presents a challenge to both clinician and radiologist, especially when symptoms or EEG features are atypical, not conforming to established epilepsy syndromes or EEG patterns. Appropriate, directed use of MRI enhances the detection of underlying epileptogenic foci and can evaluate both common and unusual etiologies. This review examines imaging evaluation of epilepsies due to uncommon presentations of common conditions, unusual conditions and atypical seizure presentations. Understanding these uncommon presentations of seizures ensures optimal clinical management and can guide appropriate intervention. Advances in newer imaging methods including diffusion tensor imaging, functional connectivity MRI, magnetic source imaging and magnetic resonance spectroscopic imaging can further increase sensitivity to detect subtle structural abnormalities causing epilepsy and can also be used to plan more successful epilepsy surgery.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Rajeev Samtani
- Department of Radiology, George Washington University Medical Center, Washington, DC 20037, USA
| | - Kalyan Paudel
- Department of Radiology, George Washington University Medical Center, Washington, DC 20037, USA
| | - Lucien M Levy
- Department of Radiology, George Washington University Medical Center, Washington, DC 20037, USA
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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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10
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Added value of high-b-value (b = 3000 s/mm2) diffusion-weighted imaging at 3 T in relation to fluid-attenuated inversion recovery images for the evaluation of cortical lesions in inflammatory brain diseases. J Comput Assist Tomogr 2013; 37:338-42. [PMID: 23674002 DOI: 10.1097/rct.0b013e318288a661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine how the gray-to-white matter contrast in healthy subjects changes on high-b-value diffusion-weighted imaging (DWI) acquired at 3 T and evaluate whether high-b-value DWI at 3 T is useful for the detection of cortical lesions in inflammatory brain diseases. METHODS Ten healthy volunteers underwent DWI at b = 1000, 2000, 3000, 4000, and 5000 s/mm(2) on a 3-T MRI unit. On DW images, 1 radiologist performed region-of-interest measurements of the signal intensity of 8 gray matter structures. The gray-to-white matter contrast ratio (GWCR) was calculated. Ten patients with inflammatory cortical lesions were also included. All patients underwent conventional MRI and DWI at b = 1000 and 3000 s/mm(2). Using a 4-point grading system, 2 radiologists independently assessed the presence of additional information on DW images compared with fluid-attenuated inversion recovery images. Interobserver agreement was assessed by κ statistics. RESULTS In the healthy subjects, the b value increased as the GWCR decreased in all evaluated gray matter structures. On DW images acquired at b = 3000 s/mm(2), mean GWCR was less than 1.0 in 7 of 8 structures. For both reviewers, DWI at b = 3000 s/mm(2) yielded significantly more additional information than did DWI at b = 1000 s/mm(2) (P < 0.05). Interobserver agreement for DWI at b = 1000 s/mm(2) and b = 3000 s/mm(2) was fair (κ = 0.35) and excellent (κ = 1.0), respectively. CONCLUSIONS At 3-T DWI, the gray-to-white matter contrast in most gray matter structures reverses at b = 3000 s/mm. In the evaluation of cortical lesions in patients with inflammatory brain diseases, 3-T DWI at b = 3000 s/mm was more useful than b = 1000 s/mm(2).
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Degnan AJ, Levy LM. Imaging of the 6-OPRI mutation prion disease: an entity distinct from typical Creutzfeldt-Jakob disease? AJNR Am J Neuroradiol 2013; 34:1731-2. [PMID: 23538413 DOI: 10.3174/ajnr.a3490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Degnan AJ, Levy LM. Neuroimaging of rapidly progressive dementias, part 2: prion, inflammatory, neoplastic, and other etiologies. AJNR Am J Neuroradiol 2013; 35:424-31. [PMID: 23413251 DOI: 10.3174/ajnr.a3455] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most dementias begin insidiously, developing slowly and generally occurring in the elderly age group. The so-called rapidly progressive dementias constitute a different, diverse collection of conditions, many of which are reversible or treatable. For this reason, accurate identification and assessment of acute and subacute forms of dementia are critical to effective treatment; neuroimaging aids greatly in narrowing the diagnosis of these conditions. This second installment of a 2-part review of rapidly progressive dementias examines the use of imaging in an assortment of other etiologies in the differential diagnosis, from prion disease and neoplastic-related conditions to rare metabolic and other conditions such as Wernicke encephalopathy. In these clinical conditions, MR imaging has the potential to narrow this broad differential diagnosis and, at times, can definitively aid in the diagnosis of certain conditions on the basis of typical imaging patterns.
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Affiliation(s)
- A J Degnan
- From the University of Pittsburgh Medical Center (A.J.D.), Pittsburgh, Pennsylvania
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Hoogenboom TCH, van Beurden RMJ, van Teylingen B, Schenk B, Willems PWA. Optimization of the reconstruction interval in neurovascular 4D-CTA imaging. A technical note. Interv Neuroradiol 2012; 18:377-9. [PMID: 23217631 DOI: 10.1177/159101991201800402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/03/2012] [Indexed: 11/15/2022] Open
Abstract
Time resolved whole brain CT angiography (4D-CTA) is a novel imaging technology providing information regarding blood flow. One of the factors that influence the diagnostic value of this examination is the temporal resolution, which is affected by the gantry rotation speed during acquisition and the reconstruction interval during post-processing. Post-processing determines the time spacing between two reconstructed volumes and, unlike rotation speed, does not affect radiation burden. The data sets of six patients who underwent a cranial 4D-CTA were used for this study. Raw data was acquired using a 320-slice scanner with a rotation speed of 2 Hz. The arterial to venous passage of an intravenous contrast bolus was captured during a 15 s continuous scan. The raw data was reconstructed using four different reconstruction-intervals: 0.2, 0.3, 0.5 and 1.0 s. The results were rated by two observers using a standardized score sheet. The appearance of each lesion was rated correctly in all readings. Scoring for quality of temporal resolution revealed a stepwise improvement from the 1.0 s interval to the 0.3 s interval, while no discernable improvement was noted between the 0.3 s and 0.2 s interval. An increase in temporal resolution may improve the diagnostic quality of cranial 4D-CTA. Using a rotation speed of 0.5 s, the optimal reconstruction interval appears to be 0.3 s, beyond which, changes can no longer be discerned.
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Affiliation(s)
- T C H Hoogenboom
- Division of Medical Technology, Inholland University of Applied Sciences; Haarlem, The Netherlands
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Abstract
Domestic and nondomestic cats have been shown to be susceptible to feline spongiform encephalopathy (FSE), almost certainly caused by consumption of bovine spongiform encephalopathy (BSE)-contaminated meat. Because domestic and free-ranging nondomestic felids scavenge cervid carcasses, including those in areas affected by chronic wasting disease (CWD), we evaluated the susceptibility of the domestic cat (Felis catus) to CWD infection experimentally. Cohorts of 5 cats each were inoculated intracerebrally (i.c.) or orally (p.o.) with CWD-infected deer brain. At 40 and 42 months postinoculation, two i.c.-inoculated cats developed signs consistent with prion disease, including a stilted gait, weight loss, anorexia, polydipsia, patterned motor behaviors, head and tail tremors, and ataxia, and the cats progressed to terminal disease within 5 months. Brains from these two cats were pooled and inoculated into cohorts of cats by the i.c., p.o., and intraperitoneal and subcutaneous (i.p./s.c.) routes. Upon subpassage, feline CWD was transmitted to all i.c.-inoculated cats with a decreased incubation period of 23 to 27 months. Feline-adapted CWD (Fel(CWD)) was demonstrated in the brains of all of the affected cats by Western blotting and immunohistochemical analysis. Magnetic resonance imaging revealed abnormalities in clinically ill cats, which included multifocal T2 fluid attenuated inversion recovery (FLAIR) signal hyperintensities, ventricular size increases, prominent sulci, and white matter tract cavitation. Currently, 3 of 4 i.p./s.c.- and 2 of 4 p.o. secondary passage-inoculated cats have developed abnormal behavior patterns consistent with the early stage of feline CWD. These results demonstrate that CWD can be transmitted and adapted to the domestic cat, thus raising the issue of potential cervid-to-feline transmission in nature.
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Letourneau-Guillon L, Wada R, Kucharczyk W. Imaging of prion diseases. J Magn Reson Imaging 2012; 35:998-1012. [PMID: 22499277 DOI: 10.1002/jmri.23504] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Prion diseases are caused by self-replicating proteins that induce lethal neurodegenerative disorders. In the last decade, the understanding of the different clinical, pathological, and neuroimaging phenotypes of this group of disorders has evolved paralleling the advances in prion molecular biology. From an imaging standpoint, the implementation of diffusion-weighted imaging in routine practice has markedly facilitated the detection of prion diseases, especially Creutzfeldt-Jakob. Less frequent prion-related disorders, including genetic diseases, may also benefit from progresses in the field of quantitative diffusion-weighted imaging, MR spectroscopy or molecular imaging. Herein, we present a review of the neuroimaging features of the prion disorders known to affect humans emphasizing the important contribution of MRI in the diagnosis of this group of disorders.
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Affiliation(s)
- Laurent Letourneau-Guillon
- Department of Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Patenaude B, Smith SM, Kennedy DN, Jenkinson M. A Bayesian model of shape and appearance for subcortical brain segmentation. Neuroimage 2011; 56:907-22. [PMID: 21352927 DOI: 10.1016/j.neuroimage.2011.02.046] [Citation(s) in RCA: 1672] [Impact Index Per Article: 128.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 02/13/2011] [Accepted: 02/15/2011] [Indexed: 12/16/2022] Open
Abstract
Automatic segmentation of subcortical structures in human brain MR images is an important but difficult task due to poor and variable intensity contrast. Clear, well-defined intensity features are absent in many places along typical structure boundaries and so extra information is required to achieve successful segmentation. A method is proposed here that uses manually labelled image data to provide anatomical training information. It utilises the principles of the Active Shape and Appearance Models but places them within a Bayesian framework, allowing probabilistic relationships between shape and intensity to be fully exploited. The model is trained for 15 different subcortical structures using 336 manually-labelled T1-weighted MR images. Using the Bayesian approach, conditional probabilities can be calculated easily and efficiently, avoiding technical problems of ill-conditioned covariance matrices, even with weak priors, and eliminating the need for fitting extra empirical scaling parameters, as is required in standard Active Appearance Models. Furthermore, differences in boundary vertex locations provide a direct, purely local measure of geometric change in structure between groups that, unlike voxel-based morphometry, is not dependent on tissue classification methods or arbitrary smoothing. In this paper the fully-automated segmentation method is presented and assessed both quantitatively, using Leave-One-Out testing on the 336 training images, and qualitatively, using an independent clinical dataset involving Alzheimer's disease. Median Dice overlaps between 0.7 and 0.9 are obtained with this method, which is comparable or better than other automated methods. An implementation of this method, called FIRST, is currently distributed with the freely-available FSL package.
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Affiliation(s)
- Brian Patenaude
- FMRIB Centre, Department of Clinical Neurology, University of Oxford, Oxford, UK
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Sameti M, Smith S, Patenaude B, Fein G. Subcortical volumes in long-term abstinent alcoholics: associations with psychiatric comorbidity. Alcohol Clin Exp Res 2011; 35:1067-80. [PMID: 21332530 DOI: 10.1111/j.1530-0277.2011.01440.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research in chronic alcoholics on memory, decision-making, learning, stress, and reward circuitry has increasingly highlighted the importance of subcortical brain structures. In addition, epidemiological studies have established the pervasiveness of co-occurring psychiatric diagnoses in alcoholism. Subcortical structures have been implicated in externalizing pathology, including alcohol dependence, and in dysregulated stress and reward circuitry in anxiety and mood disorders and alcohol dependence. Most studies have focused on active or recently detoxified alcoholics, while subcortical structures in long-term abstinent alcoholics (LTAA) have remained relatively uninvestigated. METHODS Structural MRI was used to compare volumes of 8 subcortical structures (lateral ventricles, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens) in 24 female and 28 male LTAA (mean abstinence=6.3 years, mean age= 46.6 years) and 23 female and 25 male nonalcoholic controls (NAC) (mean age=45.6 years) to explore relations between subcortical brain volumes and alcohol use measures in LTAA and relations between subcortical volumes and psychiatric diagnoses and symptom counts in LTAA and NAC. RESULTS We found minimal differences between LTAA and NAC in subcortical volumes. However, in LTAA, but not NAC, volumes of targeted subcortical structures were smaller in individuals with versus without comorbid lifetime or current psychiatric diagnoses, independent of lifetime alcohol consumption. CONCLUSIONS Our finding of minimal differences in subcortical volumes between LTAA and NAC is consistent with LTAA never having had volume deficits in these regions. However, given that imaging studies have frequently reported smaller subcortical volumes in active and recently detoxified alcoholics compared to controls, our results are also consistent with the recovery of subcortical volumes with sustained abstinence. The finding of persistent smaller subcortical volumes in LTAA, but not NAC, with comorbid psychiatric diagnoses, suggests that the smaller volumes are a result of the combined effects of chronic alcohol dependence and psychiatric morbidity and suggests that a comorbid psychiatric disorder (even if not current) interferes with the recovery of subcortical volumes.
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Affiliation(s)
- Mohammad Sameti
- Neurobehavioral Research, Inc., 1585 Kapiolani Blvd., Honolulu, HI 96814, USA
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Avances en neurorradiología diagnóstica. RADIOLOGIA 2010; 52 Suppl 2:36-45. [DOI: 10.1016/j.rx.2010.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 11/19/2022]
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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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