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Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Diffusion-weighted MRI abnormalities as an early diagnostic marker for Creutzfeldt-Jakob disease
1Department of Neurology, Tohoku University School of Medicine, Sendai, Japan. yshiga@em.neurol.med.tohoku.ac.jp
Objective:
To evaluate the usefulness of diffusion-weighted MRI (DWI) for the early diagnosis of Creutzfeldt-Jakob disease (CJD).
Methods:
Thirty-six consecutive patients (age 56 to 82 years) were enrolled, and 26 were examined by DWI. Nine were definite based on the World Health Organization criteria, and 27 were probable. The percentages of DWI abnormalities, periodic sharp wave complexes (PSWCs) on the EEG, detection of CSF 14-3-3 protein, and increase of CSF neuron-specific enolase (>25 ng/mL) on the first examination were compared. For DWI, 32 patients (age 31 to 84 years) who showed progressive dementia or impaired consciousness served as disease controls.
Results:
The percentage of DWI abnormalities was 92.3%, of PSWCs 50.0%, of 14-3-3 protein detection 84.0%, and of NSE increase 73.3%. Two of the 32 control subjects were falsely positive on DWI. The sensitivity of DWI was 92.3% (95% CI 74.8 to 99.5%) and specificity 93.8% (95% CI 79.2 to 99.2%). In 17 patients who did not show PSWCs on the first EEG, abnormal DWI findings were still clearly detected. Four patients who were negative for 14-3-3 protein also showed DWI abnormalities. DWI abnormalities were detected as early as at 3 weeks of symptom duration in four patients in whom PSWCs were not yet evident.
Conclusions:
DWI can detect characteristic lesions in the majority of patients with CJD regardless of the presence of PSWCs. DWI was the most sensitive test for the early clinical diagnosis of CJD; consideration should be given to its inclusion in the clinical diagnostic criteria of CJD.
Insights
Diffusion-weighted MRI (DWI) is highly effective for early Creutzfeldt-Jakob disease (CJD) diagnosis. This sensitive imaging technique detects characteristic lesions, aiding in timely identification of CJD, even before other markers appear.
Area of Science:
- Neurology
- Radiology
- Neuroscience
Background:
- Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive neurodegenerative disorder.
- Early and accurate diagnosis of CJD is crucial for patient management and research.
- Current diagnostic methods have limitations in sensitivity and specificity, especially in early stages.
Purpose of the Study:
- To assess the utility of diffusion-weighted magnetic resonance imaging (DWI) in the early diagnosis of CJD.
- To compare the sensitivity and specificity of DWI with other established CJD diagnostic markers.
Main Methods:
- A study involving 36 patients suspected of CJD, with 26 undergoing DWI.
- Comparison of DWI findings with electroencephalogram (EEG) for periodic sharp wave complexes (PSWC), CSF 14-3-3 protein, and CSF neuron-specific enolase (NSE).
- Inclusion of 32 patients with progressive dementia as disease controls for DWI analysis.
Main Results:
- DWI demonstrated abnormalities in 92.3% of CJD patients, significantly higher than PSWCs (50.0%), 14-3-3 protein (84.0%), and NSE (73.3%).
- DWI exhibited high sensitivity (92.3%) and specificity (93.8%) for CJD diagnosis.
- Abnormal DWI findings were detected early, even in patients without PSWCs or 14-3-3 protein positivity, and as early as 3 weeks from symptom onset.
Conclusions:
- Diffusion-weighted MRI is a highly sensitive tool for the early clinical diagnosis of CJD.
- DWI can identify characteristic CJD lesions irrespective of the presence of PSWCs.
- The high diagnostic performance suggests DWI should be considered for inclusion in CJD diagnostic criteria.
