[Diffusion-weighted MRI in sporadic Creutzfeldt-Jakob disease]

Area of Science:

• Neurology
• Radiology
• Neuroimaging

Context:

• Conventional MRI (T1, T2, FLAIR) is crucial but insufficient for definitively excluding Creutzfeldt-Jakob disease (CJD).
• Sporadic CJD diagnosis requires advanced imaging techniques for early and accurate detection.
• Diffusion-weighted imaging (DWI) offers novel insights into brain tissue microstructure.

Purpose:

• To evaluate the utility of diffusion-weighted imaging (DWI) in the diagnostic strategy for suspected sporadic Creutzfeldt-Jakob disease (CJD).
• To compare DWI findings with conventional MRI sequences (T1, T2, FLAIR) in CJD patients.
• To identify specific patterns of restricted diffusion indicative of CJD.

Summary:

• Four patients with confirmed sporadic CJD underwent DWI. All showed restricted diffusion in the caudate and lenticular nuclei on FLAIR and T2-weighted MRI.
• DWI revealed cortical high-signal intensities in one patient, not visible on conventional sequences.
• Restricted diffusion in the thalamus was observed in two patients, a sign typically associated with the new variant CJD, suggesting thalamic involvement in sporadic CJD.

Impact:

• DWI improves the diagnostic sensitivity for Creutzfeldt-Jakob disease, particularly for subtle or early-stage changes.
• The study highlights the potential of DWI and apparent diffusion coefficient (ADC) mapping to detect thalamic involvement in sporadic CJD.
• Incorporating DWI into MRI protocols can refine CJD diagnosis and patient management.