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Updated: Jun 13, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Combined diffusion imaging and MR spectroscopy in the diagnosis of human prion diseases
Damien Galanaud1, S Haik, M G Linguraru
1Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France. galanaud@dat.org
Background And Purpose:
The physiopathologic bases underlying the signal intensity changes and reduced diffusibility observed in prion diseases (TSEs) are still poorly understood. We evaluated the interest of MRS combined with DWI both as a diagnostic tool and a way to understand the mechanism underlying signal intensity and ADC changes in this setting.
Materials And Methods:
We designed a prospective study of multimodal MR imaging in patients with suspected TSEs. Forty-five patients with a suspicion of TSE and 11 age-matched healthy volunteers were included. The MR imaging protocol included T1, FLAIR, and DWI sequences. MRS was performed on the cerebellum, pulvinar, right lenticular nucleus, and frontal cortex. MR images were assessed visually, and ADC values were calculated.
Results:
Among the 45 suspected cases, 31 fulfilled the criteria for probable or definite TSEs (19 sCJDs, 3 iCJDs, 2 vCJDs, and 7 genetic TSEs); and 14 were classified as AltDs. High signals in the cortex and/or basal ganglia were observed in 26/31 patients with TSEs on FLAIR and 29/31 patients on DWI. In the basal ganglia, high DWI signals corresponded to a decreased ADC. Metabolic alterations, increased mIns, and decreased NAA were observed in all patients with TSEs. ADC values and metabolic changes were not correlated; this finding suggests that neuronal stress (vacuolization), neuronal loss, and astrogliosis do not alone explain the decrease of ADC.
Conclusions:
MRS combined with other MR imaging is of interest in the diagnosis of TSE and provides useful information for understanding physiopathologic processes underlying prion diseases.
Insights
Magnetic Resonance Imaging (MRI) combined with Magnetic Resonance Spectroscopy (MRS) aids in diagnosing Transmissible Spongiform Encephalopathies (TSEs). This multimodal approach offers insights into the physiopathology of signal intensity and apparent diffusion coefficient (ADC) changes in prion diseases.
Area of Science:
- Neuroimaging
- Prion Diseases
- Biochemistry
Background:
- The physiopathologic mechanisms behind signal intensity changes and reduced diffusion in Transmissible Spongiform Encephalopathies (TSEs) remain unclear.
- Magnetic Resonance Imaging (MRI) techniques like Diffusion-Weighted Imaging (DWI) and Magnetic Resonance Spectroscopy (MRS) show promise in TSE diagnosis.
Purpose of the Study:
- To evaluate the utility of MRS combined with DWI as a diagnostic tool for TSEs.
- To elucidate the underlying mechanisms of signal intensity and apparent diffusion coefficient (ADC) changes in TSEs.
Main Methods:
- A prospective study involving 45 patients with suspected TSEs and 11 healthy volunteers.
- Multimodal MRI protocol including T1, FLAIR, DWI sequences, and MRS of specific brain regions (cerebellum, pulvinar, lenticular nucleus, frontal cortex).
- Visual assessment of MR images and calculation of ADC values.
Main Results:
- 31 patients were diagnosed with TSEs (including sporadic, iatrogenic, variant, and genetic forms), and 14 with alternative diseases.
- Abnormal FLAIR and DWI signals were observed in most TSE patients, with decreased ADC in the basal ganglia correlating with high DWI signals.
- Metabolic alterations (increased myo-inositol, decreased N-acetylaspartate) were detected in all TSE patients, but did not correlate with ADC values, suggesting factors beyond neuronal stress, loss, or astrogliosis contribute to ADC reduction.
Conclusions:
- MRS combined with other MRI techniques is valuable for diagnosing TSEs.
- This multimodal approach provides significant insights into the physiopathologic processes of prion diseases.
