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

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. Guidelines : 2007  2010  2012. Keypoints.

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

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  1. A practical MRI-dementia protocol and structured reporting of MRI scans in dementia GiorgosKaras, MD, PhD Radiologist Dept. Radiology Sint Lucas-Andreas Hospital, Amsterdam XIX Symposium Neuroradiologicum, Bologna, 2010

  2. Guidelines: 2007  2010  2012

  3. Keypoints • Imaging at leastoncewithdualpurpose: • Excludesurgicalcauses (e.g. tumor, subduralhematoma) • Evaluatedementia-specificfindings • Integration with: clinic, neuropsychology, EEG, CSF findings • Next step: functional imaging (SPECT-PET)

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

  5. T1 coronal: correct axis!

  6. Visual rating score formedial temporal lobeatrophy (MTA) 0 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: hummingbirdsign

  11. FLAIR, T2 and T2*: vascularchanges – Vascular dementia (VaD) • Largevessel dementia (multiple infarcts) • Smallvessel dementia (smallvesseldisease and microinfarction) • Strategic infarct dementia • Hypoperfusive dementia • Dementia related to angiopathies • Haemorrhagic dementia • Othercauses (vasculitis) • HereditaryVaD (CADASIL)

  12. Normal: caps and... bands

  13. White matter rating scales: high correlation, simple scale: FazekasSubcorticalarterioscleroticencephalopathy (SAE) • 0: nolesions • 1: somelesions, noconfluence • 2: more lesions, someconfluence • 3: a lot of lesions, more confluence

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

  15. VR-spacesalone and VR in combinationwith SAE

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

  17. Medial temporal lobe infarct: DWI

  18. CADASIL: temporallobe!

  19. Cerebralamyloid angiopathy(CAA)

  20. Differential of roundsusceptibilityartefactson T2* Trauma Hypertensive

  21. StructuredReporting • Agreewithclinicianonscalesused! – Multidisciplinary meetings! • T1: hippocampal atrophy, otherfocalatrophypatterns • T2: thalamicinfarcts • FLAIR: infarcts (SVD – LVD) • T2*: microbleeds • DWI: CJD • Conclusion: Summarize the findings, suggest a possiblepattern but no hard diagnosis– dementia is a clinical diagnosis – imaging is onlyone of the markers!

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

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