1. 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

2. Guidelines: 2007  2010  2012

3. 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)

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

5. T1 coronal: correct axis!

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

7. The MTA rating scale explained

8. Early-onset AD
Karas et al, Neuroradiology 2007

9. Frontotemporal dementia

10. PSP: hummingbird sign

11. 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)

12. Normal: caps and bands

13. 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

14. Grade I, II, III (Fazekas scale)

15. VR-spaces alone and VR in combination with SAE

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

17. Medial temporal lobe infarct: DWI

18. CADASIL: temporal lobe!

19. Cerebral amyloid angiopathy(CAA)

20. Differential of round susceptibility artefacts on T2*
Trauma
Hypertensive

21. 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!

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