Conspicuity and evolution of lesions in Creutzfeldt-Jakob disease at diffusion-weighted imaging

Diffusion-weighted imaging can disclose distinct hyperintense lesions in Creutzfeldt-Jakob disease (CJD). However, these findings and chronologic changes of CJD at diffusion-weighted imaging have not been fully investigated. Our purpose was to assess the diagnostic value of diffusion-weighted imaging in depicting CJD-related lesions and in tracking the evolution of these lesions. We also compared the sensitivity of diffusion-weighted imaging in depicting CJD-related lesions to that of fluid-attenuated inversion recovery (FLAIR) imaging.

We reviewed findings in 13 patients with a diagnosis of CJD who underwent MR imaging, including diffusion-weighted imaging. Nine patients were initially examined within 4 months of onset of symptoms (early stage), and eight were examined 4 months or later (late stage). We evaluated four items: 1) distribution of lesions at diffusion-weighted imaging, 2) conspicuity of lesions at diffusion-weighted imaging and FLAIR imaging, 3) chronologic changes in lesions at diffusion-weighted imaging, and 4) chronologic changes in lesions revealed by apparent diffusion coefficient (ADC) maps.

Patients had striatal lesions or cerebral cortical lesions or both. The thalamus was involved in only one patient, and the globus pallidus was spared in all patients. The sensitivity of diffusion-weighted imaging in depicting lesions was superior or at least equal to that of FLAIR imaging. Hyperintense lesions at diffusion-weighted imaging changed in extent and intensity over time. Unlike infarction, lesional ADC decreased for 2 weeks or longer.

The progressively hyperintense changes in the striata and cerebral cortices at diffusion-weighted imaging are considered characteristic of CJD. Diffusion-weighted imaging may be useful for the early diagnosis of CJD.