Evaluation of Apparent Diffusion Coefficient ADC in Prion

Evaluation of Apparent Diffusion Coefficient (ADC) in Prion Encephalopathies REYES GARCÍA DE EULATE RADIOLOGY DEPARTMENT

Introduction Materials & methods Results Pr. Pc Neuronal death Spongiosis Gliosis Limitations Conclusions

Introduction Materials & methods Results Limitations Hyperintensity in the fronto-parietal cortical areas and basal ganglia. Rolandic Cortices are preserved Conclusions

Introduction Materials & methods Results Limitations DWI in Prion Encephalopaties: High sensitivity and specificity Conclusions

Introduction Materials & methods 8 17 17 Results Limitations Conclusions 4 Study 7 Hypotheses: 1. Quantitative ADC assessment is a valuable diagnosis technique for PD 2. It is a reliable technique: findings of different radiologists are consistent Diagnostic criteria: 1. Clinical findings 2. EEG 3. Protein 14 -3 -3 in CSF 4. Brain biopsy-autopsy Exclusion criteria: 1. Intracranial masses 2. Intracranial collections 3. Ischemic pathology 4. Surgical findings

Introduction Materials & methods Study protocol: T 2 WI: TSE; TR 4100; TE 140. FLAIR: GRE; TR 8150; TE 125; TI 2580 Results Limitations Conclusions DWI: EPI (b 0; b 500; b 1000) TR 3780; TE 105 Automatic ADC maps

Introduction Materials & methods Results Limitations Conclusions

Introduction Materials & methods Figure 1: ADC values of basal ganglia in patients with CJD (green) and controls (blue). Results Limitations Conclusions Significant differences: Caudate, putamen, thalamus, left globus pallidus No significant differences: Right globus pallidus

Introduction Materials & methods Results Limitations Conclusions Significant differences: Figure 2: ADC values in cortical areas in patients with CJD (green) and controls (blue). Bilateral PMC, bilateral PSC, bilateral SFG, right SMG No significant differences: Left SMG

Introduction Materials & methods Results Limitations Conclusions Ratio U Mann-Withney Asintotic sig. Exact sig. PSC/SMGr_left 67, 00 0, 730 0, 756 PSC/SMGr_right 45, 00 0, 131 0, 140 PMC/SFGr_left 68, 00 0, 770 0, 796 PMC/SFGr_right 52, 00 0, 254 0, 272 Table 1: ADC cortical ratios: diffuse cortical involvement, INCLUDING Rolandic cortices. Excellent interobserver correlation (ICC> 0. 80)

Introduction Materials & methods Results Limitations Conclusions Low number of patients (non parametric tests) Absence of histological confirmation in some patients

Introduction Materials & methods Results Limitations Conclusions Quantitative ADC measurement demostrates diffuse affection This is a reproducible technique for any radiologist, regarless of his or her experience Quantitative ADC measurement provides a proper diagnosis as well as sensitive, reliable and applicable in daily clinical practice

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Radiology Department Gracias/Thank you mgeulate@unav. es