High-b-Value Diffusion MR Imaging and Basal Nuclei Apparent Diffusion Coefficient Measurements in Variant and Sporadic Creutzfeldt-Jakob Disease

• Published in: American journal of neuroradiology : AJNR Vol. 31; no. 3; pp. 521 - 526
• Main Authors: HYARE, H, THORNTON, J, STEVENS, J, MEAD, S, RUDGE, P, COLLINGE, J, YOUSRY, T. A, JÄGER, H. R
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL American Society of Neuroradiology 01.03.2010
• Subjects: Adult; Aged; Basal Ganglia - metabolism; Basal Ganglia - pathology; Biological and medical sciences; Brain; Cerebral Cortex - metabolism; Cerebral Cortex - pathology; Creutzfeldt-Jakob Syndrome - metabolism; Creutzfeldt-Jakob Syndrome - pathology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Neurology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sensitivity and Specificity; Thalamus - metabolism; Thalamus - pathology; Water - metabolism; Young Adult; Prion disease; Nervous system diseases; Radiodiagnosis; Sporadic; Creutzfeldt-Jakob disease; Diffusion imaging; Nuclear magnetic resonance imaging; Cerebral disorder; Infection; Central nervous system disease; Degenerative disease; Prion; Diffusion coefficient
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a1860

DWI using a standard b-value of 1000 s/mm(2) has emerged as the most sensitive sequence for the diagnosis of CJD. The purpose of this study was to investigate whether DWI at a high b-value (b = 3000 s/mm(2)) and ADC measurements in the basal nuclei improve the diagnosis of vCJD and sCJD compared with visual assessment of DWI at a standard b-value (b = 1000 s/mm(2)). Eight patients with vCJD, 9 patients with sCJD, and 5 healthy volunteers underwent DWI at b = 1000 s/mm(2), and 5 vCJD patients, 4 sCJD patients, and 1 growth hormone-related CJD patient underwent DWI at b = 3000 s/mm(2). Two consultant neuroradiologists performed a visual comparison of the b = 1000 and b = 3000 images. Mean MR SI and ADC values were determined for C, P, and DM thalamus ROIs bilaterally at each b-value. SI ratios for each ROI relative to white matter were calculated. In 9 out of 10 patients, the higher b-value images were more sensitive to SI change, particularly in cortex and thalamus, with higher SI ratios at b = 3000 in the DM thalamus. For sCJD at b = 1000, we found significantly lower ADC values in the C and P compared with controls (mean C ADC = 587.3 +/- 84.7 mm(2)/s in sCJD patients versus 722.7 +/- 16.6 mm(2)/s in controls; P = .007), and at b = 3000, the differences were more pronounced. In comparison, in vCJD at b = 1000, ADC values were elevated in the Pu (mean Pu ADC = 837.6 +/- 33.0 mm/s(2) in vCJD patients versus 748.0 +/- 17.3 mm/s(2) in controls; P < .001) but failed to reach significance at b = 3000. Our results demonstrate that b = 3000 DWI, being more sensitive to slowly diffusing tissue water, is more sensitive to pathology in sCJD than is conventional DWI. High-b-value DWI increases confidence in the radiologic diagnosis of human prion disease.