Department of Neurology, General Hospital of the Peoples' Liberation Army, 28 Fu Xing Road, Hai dian District, Beijing 100853, China.
J Clin Neurosci. 2010 Nov;17(11):1378-80. doi: 10.1016/j.jocn.2010.03.032. Epub 2010 Aug 19.
MRI has had an important role in the diagnosis of Creutzfeldt-Jakob disease (CJD). The aim of our study was to compare the efficacy of different MRI sequences among six biopsy-proven patients with sporadic CJD (sCJD) and seven patients with probable sCJD. These 13 patients with CJD aged from 36 years to 75 years (mean age: 55.5 years) were evaluated with T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) MRI and diffusion-weighted imaging (DWI). The characteristic MRI lesion pattern was found to be bilateral, symmetric and hyperintense signal changes in the basal ganglia and cortical regions. Two major lesion patterns were identified in all patients involving the cortex and basal ganglia. No signal abnormality was found in the thalamus. We found lesions in the cortex and basal ganglia in 7/13 patients (54%), isolated cortical involvement in 2/13 patients (15%), and isolated basal ganglia lesions in 4/13 patients (31%). The cortical involvement was widespread (in at least two regions) and usually included the frontal or occipital lobes (9/13, 69%) on DWI. Only one patient showed moderate high-signal intensity in the basal ganglia on T2-weighted MRI. T1-weighted MRI revealed no signal intensity abnormalities. We conclude that high signal changes in the basal ganglia and cerebral cortex on FLAIR and DWI are useful in the diagnosis of sCJD. Isolated cortical involvement on DWI and FLAIR should lead to a suspicion of CJD. DWI is the most sensitive MRI technique in the diagnosis of CJD, which supports an amendment to the clinical diagnostic criteria for sCJD to include findings from MRI.
磁共振成像（MRI）在克雅氏病（CJD）的诊断中发挥了重要作用。我们的研究目的是比较六例经活检证实的散发型克雅氏病（sCJD）患者和七例可能的 sCJD 患者之间不同 MRI 序列的疗效。这 13 例 CJD 患者年龄 36 岁至 75 岁（平均年龄：55.5 岁），进行了 T1 加权、T2 加权、液体衰减反转恢复（FLAIR）MRI 和弥散加权成像（DWI）检查。特征性 MRI 病变模式为双侧、对称和基底节和皮质区域高信号改变。所有患者均发现两种主要病变模式，涉及皮质和基底节。丘脑无信号异常。我们发现 13 例患者中有 7 例（54%）存在皮质和基底节病变，2 例（15%）为孤立性皮质受累，4 例（31%）为孤立性基底节病变。皮质受累广泛（至少累及两个区域），通常包括额或枕叶（13 例中有 9 例，69%），DWI 上有高信号。只有一名患者在 T2 加权 MRI 上基底节有中度高信号。T1 加权 MRI 未显示信号强度异常。我们得出结论，FLAIR 和 DWI 上基底节和大脑皮质的高信号变化有助于 sCJD 的诊断。DWI 上孤立性皮质受累应提示 CJD。DWI 是诊断 CJD 最敏感的 MRI 技术，支持对 sCJD 的临床诊断标准进行修订，包括 MRI 结果。
