American Journal of Neuroradiology 27:1459-1462, August 2006
© 2006 American Society of Neuroradiology
BRAIN
Creutzfeldt-Jakob Disease: Comparative Analysis of MR Imaging Sequences
a Departments of Neuroradiology, Georg-August University Medical Center, Goettingen, Germany
b MR Research in Neurology and Psychiatry, Georg-August University Medical Center, Goettingen, Germany
c Neuropathology, Georg-August University Medical Center, Goettingen, Germany
d Neurology, Georg-August University Medical Center, Goettingen, Germany
e Department of Radiology, University Hospital, Bonn, Germany
Please address correspondence to: Kai Kallenberg, MD, Department of Neuroradiology, University Hospital Goettingen, Robert-Koch-Str 40, Goettingen, 37075, Germany; e-mail: kai.kallenberg{at}meduni-goettingen.de
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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