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Clinical Trial
. 2010 Mar;31(3):521-6.
doi: 10.3174/ajnr.A1860. Epub 2009 Dec 10.

High-b-value diffusion MR imaging and basal nuclei apparent diffusion coefficient measurements in variant and sporadic Creutzfeldt-Jakob disease

H Hyare  1 , J Thornton, J Stevens, S Mead, P Rudge, J Collinge, T A Yousry, H R Jäger
Affiliations
Clinical Trial

High-b-value diffusion MR imaging and basal nuclei apparent diffusion coefficient measurements in variant and sporadic Creutzfeldt-Jakob disease

H Hyare et al. AJNR Am J Neuroradiol. 2010 Mar.

Abstract

Background and purpose: DWI using a standard b-value of 1000 s/mm(2) has emerged as the most sensitive sequence for the diagnosis of CJD. The purpose of this study was to investigate whether DWI at a high b-value (b = 3000 s/mm(2)) and ADC measurements in the basal nuclei improve the diagnosis of vCJD and sCJD compared with visual assessment of DWI at a standard b-value (b = 1000 s/mm(2)).

Materials and methods: Eight patients with vCJD, 9 patients with sCJD, and 5 healthy volunteers underwent DWI at b = 1000 s/mm(2), and 5 vCJD patients, 4 sCJD patients, and 1 growth hormone-related CJD patient underwent DWI at b = 3000 s/mm(2). Two consultant neuroradiologists performed a visual comparison of the b = 1000 and b = 3000 images. Mean MR SI and ADC values were determined for C, P, and DM thalamus ROIs bilaterally at each b-value. SI ratios for each ROI relative to white matter were calculated.

Results: In 9 out of 10 patients, the higher b-value images were more sensitive to SI change, particularly in cortex and thalamus, with higher SI ratios at b = 3000 in the DM thalamus. For sCJD at b = 1000, we found significantly lower ADC values in the C and P compared with controls (mean C ADC = 587.3 +/- 84.7 mm(2)/s in sCJD patients versus 722.7 +/- 16.6 mm(2)/s in controls; P = .007), and at b = 3000, the differences were more pronounced. In comparison, in vCJD at b = 1000, ADC values were elevated in the Pu (mean Pu ADC = 837.6 +/- 33.0 mm/s(2) in vCJD patients versus 748.0 +/- 17.3 mm/s(2) in controls; P < .001) but failed to reach significance at b = 3000.

Conclusions: Our results demonstrate that b = 3000 DWI, being more sensitive to slowly diffusing tissue water, is more sensitive to pathology in sCJD than is conventional DWI. High-b-value DWI increases confidence in the radiologic diagnosis of human prion disease.

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Figures

Fig 1.
Fig 1.
The position of the key ROIs on (A) b = 0, (B) b = 1000, and (C) b = 3000 ADC map.
Fig 2.
Fig 2.
Differences in SIs in the basal ganglia in sCJD at (A) b = 1000 and (B) b = 3000 and in vCJD at (C) b = 1000 and (D) b = 3000.
Fig 3.
Fig 3.
Bar charts showing ROI ADC values in sCJD (hashed bars) and controls (solid bars) at (A) b = 1000 s/mm2 and (B) b = 3000 s/mm2.
See this image and copyright information in PMC

References

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