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A Clinical-Anatomic Correlation

Duk L. Na, MD; Chung Kyu Suh, MD; Seong Hye Choi, MD; Heui Soo Moon, MD; Dae Won Seo, MD; Sang Eun Kim, MD; Dong Gyu Na, MD; John C. Adair, MD

Arch Neurol. 1999;56:951-957.

Background  Creutzfeldt-Jakob disease (CJD) is a rare transmissible disease that typically causes a rapidly progressive dementia and leads to death in less than 1 year. Although a few anecdotal reports suggest that diffusion-weighted magnetic resonance imaging may help substantiate premortem diagnosis of CJD, detailed correlation between radiographic data and clinical, electrophysiologic, and metabolic parameters is not available.

Methods  Signal abnormalities on diffusion-weighted images in 3 consecutive patients with probable CJD were correlated with psychometric features, electroencephalographic findings, and functional images with either positron emission tomography or single photon emission computed tomography.

Results  Focality of abnormalities on diffusion-weighted image, not apparent on routine magnetic resonance images, correlated closely with clinical manifestations of CJD. The topographic distribution of signal abnormality on diffusion-weighted image corresponded with abnormal metabolism or perfusion on positron emission and single photon emission computed tomographic scans. In 2 cases, the laterality of diffusion abnormalities correlated with periodic sharp wave activity on electroencephalograms.

Conclusion  These findings extend previous observations that suggested a diagnostic and localizing utility of diffusion-weighted imaging in CJD.

From the Departments of Neurology (Drs D. L. Na, Choi, Moon, and Seo), Nuclear Medicine (Dr Kim), and Diagnostic Radiology (Dr D. G. Na), College of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea; Department of Neurology, Kyungpook University, Taegu, Korea (Dr Suh); and Neurology Service, Albuquerque Veterans Affairs Medical Center, and Department of Neurology, University of New Mexico, Albuquerque (Dr Adair).

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