Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Tschampa, H. J. Articles by Urbach, H. Search for Related Content PubMed PubMed Citation Articles by Tschampa, H. J. Articles by Urbach, H.

Thalamic Involvement in Sporadic Creutzfeldt-Jakob Disease: A Diffusion-Weighted MR Imaging Study

Henriette J. Tschampa^a, Petra Mürtz^a, Sebastian Flacke^a, Sebastian Paus^b, Hans H. Schild^a and Horst Urbach^a

^a Department of Radiology, University of Bonn, Bonn, Germany
^b Department of Neurology, University of Bonn, Bonn, Germany

View larger version (137K): [in a new window]   FIG 1. Patient 5. DW MR images (b = 1000 s/mm2) (A and B) and corresponding ADC maps (C and D) show the level of the basal ganglia (A and C) and the hippocampus (B and D). The marked areas show the region-of-interest measurements in the head of the caudate nucleus, putamen, pulvinar thalami, and MD (A and C) and in the hippocampus (B and D).

View larger version (67K): [in a new window]   FIG 2. Patient 1, second examination. DW image (A), T2-weighted TSE (B), and FLAIR (C) images. Hyperintense SI changes in the striatum and the pulvinar thalami are discernable on the DW (A) and FLAIR (C) images bilaterally, whereas on the T2-weighted TSE image, increased SI is discernable only in the striatum bilaterally.

View larger version (66K): [in a new window]   FIG 3. Mean ADCs (± SEM) of sCJD patients (right dark columns) and controls (left bright columns). ADCs in sCJD patients are significantly reduced in the caudate nucleus, putamen, MD, and pulvinar thalami as compared with controls. In the hippocampus (last pair of columns on the right), ADCs are comparable.

View larger version (134K): [in a new window]   FIG 4. Patient 1. Serial DW images (A–C) and corresponding ADC maps (D–F) acquired 3 (A and D), 4 (B and E), and 8 (C and F) months after onset of symptoms. The DW image acquired 3 months after onset of symptoms (A) shows bilateral high SI in the caudate nucleus and the rostral part of the putamen. Four months after onset of symptoms, the DW image (B) shows high SI also in the dorsal part of the putamen and additionally in the pulvinar thalami. Eight months after onset of symptoms, the DW image (C) shows severe brain atrophy with widening of the ventricles and of the sulci. The head of the caudate nucleus on the left side totally disappeared; the right caudate nucleus and the putamen on both sides show severe atrophy. There is high SI in the right caudate nucleus and putamen bilaterally and in the frontal, parietal, and cingulate cortex. The ADC maps (D–F) show low SI in the hyperintense areas on DW images corresponding to restricted diffusion.

View larger version (67K): [in a new window]   FIG 5. Patient 1. Time courses of the ADC values in serial images. Measurements were performed in five anatomic regions: the head of the caudate nucleus (empty rectangle), the putamen (open rhomboid), the pulvinar thalami (filled triangle), the MD (filled circle), and the hippocampus (star). In all areas except for the hippocampus, ADCs were lowest in the first examination and highest in the last examination. In the caudate nucleus, the putamen, and the MD, there was a gradual increase in the ADCs during the course of the disease. In the pulvinar thalami, ADCs were lowest in the second examination; this was paralleled by an increased SI on DW images in the second examination (shown in Fig 4B, E).