A practical MRI-dementia protocol and structured reporting of MRI scans in

dementia

Giorgos Karas, MD, PhDRadiologist

Dept. RadiologySint 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)

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)

0 1

3 4

2

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

White matter rating scales: high correlation, simple scale: FazekasSubcortical 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*

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