According to the current WHO criteria, technical investigations included in the clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) are electroencephalogram (EEG) and CSF-analysis for 14-3-3 proteins. MRI ...According to the current WHO criteria, technical investigations included in the clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) are electroencephalogram (EEG) and CSF-analysis for 14-3-3 proteins. MRI is not a criterion for the diagnosis of sCJD, although typical changes have been described. We investigated the reliability of MRI in the sCJD diagnosis, evaluated MRI sequences and compared MRI with EEG and 14-3-3. This study includes 193 consecutive suspected sCJD patients who had been referred to the German CJD Surveillance Unit from 2001 to 2003. Three observers independently analysed MRI scans, blinded to clinical data. MRI was rated as “typical for sCJD”if increased signal intensity was detected in the caudate nucleus and putamen. We analysed 442 MRI scans [184 T2-weighted sequences, 132 fluid attenuated inversion recovery (FLAIR) sequences, 75 diffusion-weighted sequences and 51 proton-density weighted sequences]. Inter-observer agreement was 123 of 193 patients or 63.7%(overall κ= 0.53). Sensitivity of MRI in clinically probable or autopsyproven sCJD was 59.7%for Observer 1, 58.3%for Observer 2 and 70.8%for Observer 3; specificity was high (84.2, 89.5 and 81.6%, respectively). Diffusion-weighted sequences best showed the pathologic changes, followed by FLAIR. Periodic sharp and slow wave complexes were detected in the EEG in 32%(sensitivity), the 14-3-3 proteins in CSF were elevated in 91%. We conclude that the detection of hyperintense basal ganglia in MRI helps to improve the clinical diagnosis, and therefore, we propose to incorporate MRI in the diagnostic criteria for sCJD.展开更多
Aim: Magnetic resonance imaging (MRI) based colonography represents a new ima ging tool which has mainly been investigated for polyp screening. To evaluate th is approach for patients with inflammatory bowel disease (...Aim: Magnetic resonance imaging (MRI) based colonography represents a new ima ging tool which has mainly been investigated for polyp screening. To evaluate th is approach for patients with inflammatory bowel disease (IBD), we compared MRI based colonography with conventional colonoscopy for assessing the presence and extent of colonic inflammation. Patients and methods: In 22 consecutive patients with suspected or known IBD, MRI colonography was performed immediately before conventional colonoscopy. After bowel cleansing, a T1 positive contrast agent wa s applied rectally. In addition to T2 weighted sequences, T1 weighted two dimens ional and three dimensional Flash acquisitions as well as volume rendered virtua l endoscopy were performed. All images were evaluated with regard to typical MRI features of inflammation. The results were compared with colonoscopy findings. Results: Distension and image quality was assessed as good to fair in 97.4% of all colonic segments. Only four of 154 segments were considered non- diagnosti c. With colonoscopy serving as the gold standard, the sensitivity for correctly identifying inflammation on a per segment analysis of the colon was 31.6% for Crohn’ s disease (CD) and 58.8% for ulcerative colitis (UC). In CD, inmost cas es mild inflammation was not diagnosed by MRI while in UC even severe inflammati on was not always depicted by MRI. Virtual endoscopy did not add any relevant in formation. Conclusion: MRI based colonography is not suitable for adequately ass essing the extent of colonic inflammation in patients with IBD. Only severe colo nic inflammation in patients with CD can be sufficiently visualised.展开更多
文摘According to the current WHO criteria, technical investigations included in the clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) are electroencephalogram (EEG) and CSF-analysis for 14-3-3 proteins. MRI is not a criterion for the diagnosis of sCJD, although typical changes have been described. We investigated the reliability of MRI in the sCJD diagnosis, evaluated MRI sequences and compared MRI with EEG and 14-3-3. This study includes 193 consecutive suspected sCJD patients who had been referred to the German CJD Surveillance Unit from 2001 to 2003. Three observers independently analysed MRI scans, blinded to clinical data. MRI was rated as “typical for sCJD”if increased signal intensity was detected in the caudate nucleus and putamen. We analysed 442 MRI scans [184 T2-weighted sequences, 132 fluid attenuated inversion recovery (FLAIR) sequences, 75 diffusion-weighted sequences and 51 proton-density weighted sequences]. Inter-observer agreement was 123 of 193 patients or 63.7%(overall κ= 0.53). Sensitivity of MRI in clinically probable or autopsyproven sCJD was 59.7%for Observer 1, 58.3%for Observer 2 and 70.8%for Observer 3; specificity was high (84.2, 89.5 and 81.6%, respectively). Diffusion-weighted sequences best showed the pathologic changes, followed by FLAIR. Periodic sharp and slow wave complexes were detected in the EEG in 32%(sensitivity), the 14-3-3 proteins in CSF were elevated in 91%. We conclude that the detection of hyperintense basal ganglia in MRI helps to improve the clinical diagnosis, and therefore, we propose to incorporate MRI in the diagnostic criteria for sCJD.
文摘Aim: Magnetic resonance imaging (MRI) based colonography represents a new ima ging tool which has mainly been investigated for polyp screening. To evaluate th is approach for patients with inflammatory bowel disease (IBD), we compared MRI based colonography with conventional colonoscopy for assessing the presence and extent of colonic inflammation. Patients and methods: In 22 consecutive patients with suspected or known IBD, MRI colonography was performed immediately before conventional colonoscopy. After bowel cleansing, a T1 positive contrast agent wa s applied rectally. In addition to T2 weighted sequences, T1 weighted two dimens ional and three dimensional Flash acquisitions as well as volume rendered virtua l endoscopy were performed. All images were evaluated with regard to typical MRI features of inflammation. The results were compared with colonoscopy findings. Results: Distension and image quality was assessed as good to fair in 97.4% of all colonic segments. Only four of 154 segments were considered non- diagnosti c. With colonoscopy serving as the gold standard, the sensitivity for correctly identifying inflammation on a per segment analysis of the colon was 31.6% for Crohn’ s disease (CD) and 58.8% for ulcerative colitis (UC). In CD, inmost cas es mild inflammation was not diagnosed by MRI while in UC even severe inflammati on was not always depicted by MRI. Virtual endoscopy did not add any relevant in formation. Conclusion: MRI based colonography is not suitable for adequately ass essing the extent of colonic inflammation in patients with IBD. Only severe colo nic inflammation in patients with CD can be sufficiently visualised.
