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Comparative Study
. 2006 Aug;27(7):1459-62.

Creutzfeldt-Jakob disease: comparative analysis of MR imaging sequences

K Kallenberg  1 , W J Schulz-Schaeffer, U Jastrow, S Poser, B Meissner, H J Tschampa, I Zerr, M Knauth
Affiliations
Comparative Study

Creutzfeldt-Jakob disease: comparative analysis of MR imaging sequences

K Kallenberg et al. AJNR Am J Neuroradiol. 2006 Aug.

Abstract

Background and purpose: MR imaging has played an increasingly important role in the diagnosis of Creutzfeldt-Jakob disease (CJD) since basal ganglia abnormalities on T2-weighted images have been described; thus, the aim of our study was to compare the value of different MR images in the diagnosis of CJD.

Methods: One hundred fifty-seven patients with CJD underwent MR imaging examinations. Ninety-two patients were neuropathologically confirmed, and 65 were clinically classified as having CJD through the CJD Surveillance Unit (probability of 95%). There was no standardized MR imaging protocol; thus, the examinations included 143 T2-weighted, 43 proton attenuation (PD)-weighted, 84 fluid-attenuated inversion recovery (FLAIR), and 44 diffusion-weighted images (DWI). The MR images were reviewed for pathologic changes of the basal ganglia, thalamus, and cerebral cortex.

Results: Cortical abnormalities were present in 70 patients (45%) and were visible in 80% (35/44) of all available DWI examinations. The basal ganglia were affected in 94 patients (60%), in particular in the caudate nucleus; the most sensitive sequences were DWI (64%) and PD-weighted (63%). A thalamic involvement was more frequently diagnosed on PD-weighted images (19%) and DWI (14%) than on FLAIR or T2-weighted images.

Conclusion: PD-weighted images and DWI showed better results in the diagnosis of signal intensity changes in the basal ganglia compared with T2-weighted or FLAIR images; however, in the diagnosis of cortical changes, DWI was clearly superior. Our data suggest that DWI is the most sensitive MR imaging technique in the diagnosis of CJD.

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Figures

Fig 1.
Fig 1.
T2-weighted, PD-weighted, FLAIR, and DWI images showing cortical abnormalities in the right parietal lobe; FLAIR and DWI also show abnormalities in the left hemisphere and the dorsal part of the cingulate gyrus.
Fig 2.
Fig 2.
Relative distribution of signal abnormalities of particular MR sequences in specified anatomical regions.
Fig 3.
Fig 3.
DWI and ADC showing decreased diffusivity in the basal ganglia and the thalamus as well as in the cortex.
Fig 4.
Fig 4.
Progression of decreased diffusivity in the basal ganglia (especially the putamen), thalamus, and cortex (time course, 3 months).
See this image and copyright information in PMC

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