Sint Lucas-Andreas Hospital, Amsterdam

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Presentation transcript:

Sint Lucas-Andreas Hospital, Amsterdam A practical MRI-dementia protocol and structured reporting of MRI scans in dementia Giorgos Karas, MD, PhD Radiologist Dept. Radiology Sint Lucas-Andreas Hospital, Amsterdam XIX Symposium Neuroradiologicum, Bologna, 2010

Guidelines: 2007  2010  2012

Keypoints Imaging at least once with dual purpose: Exclude surgical causes (e.g. tumor, subdural hematoma) Evaluate dementia-specific findings Integration with: clinic, neuropsychology, EEG, CSF findings Next step: functional imaging (SPECT-PET)

Karas et al, Handbook of Clinical Neurology, 2008 MRI protocol: 25 min Karas et al, Handbook of Clinical Neurology, 2008

T1 coronal: correct axis!

Visual rating score for medial temporal lobe atrophy (MTA) 1 2 3 4 Scheltens et al, 1992

The MTA rating scale explained

Early-onset AD Karas et al, Neuroradiology 2007

Frontotemporal dementia

PSP: hummingbird sign

FLAIR, T2 and T2*: vascular changes – Vascular dementia (VaD) Large vessel dementia (multiple infarcts) Small vessel dementia (small vessel disease and microinfarction) Strategic infarct dementia Hypoperfusive dementia Dementia related to angiopathies Haemorrhagic dementia Other causes (vasculitis) Hereditary VaD (CADASIL)

Normal: caps and... bands

1: some lesions, no confluence 2: more lesions, some confluence White matter rating scales: high correlation, simple scale: Fazekas Subcortical arteriosclerotic encephalopathy (SAE) 0: no lesions 1: some lesions, no confluence 2: more lesions, some confluence 3: a lot of lesions, more confluence

Grade I, II, III (Fazekas scale)

VR-spaces alone and VR in combination with SAE

FLAIR not very sensitive for thalamic lesions Bastos-Leite, Stroke 2004

Medial temporal lobe infarct: DWI

CADASIL: temporal lobe!

Cerebral amyloid angiopathy(CAA)

Differential of round susceptibility artefacts on T2* Trauma Hypertensive

Structured Reporting Agree with clinician on scales used! – Multidisciplinary meetings! T1: hippocampal atrophy, other focal atrophy patterns T2: thalamic infarcts FLAIR: infarcts (SVD – LVD) T2*: microbleeds DWI: CJD Conclusion: Summarize the findings, suggest a possible pattern but no hard diagnosis– dementia is a clinical diagnosis – imaging is only one of the markers!

Acknowledgements Prof. Dr. Frederik Barkhof Prof. Dr. Philip Scheltens