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Imaging Degenerative Diseases of the Brain

Imaging Degenerative Diseases of the Brain . Cathleen Kouvolo. Alzheimer’s Disease Parkinson’s Disease Huntington’s Disease Pick’s Disease. Alzheimer’s Disease. Most common cause of dementia Defective processing of amyloid precursor protein

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Imaging Degenerative Diseases of the Brain

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  1. Imaging Degenerative Diseases of the Brain Cathleen Kouvolo

  2. Alzheimer’s Disease Parkinson’s Disease Huntington’s Disease Pick’s Disease

  3. Alzheimer’s Disease Most common cause of dementia Defective processing of amyloid precursor protein Affects hippocampus/parahippocampal cortex, cerebral cortex Dementia, anxiety, hallucinations, delusions, tremor Dx is clinical; MR used to rule out other causes of dementia Tx: cholinesterase inhibitors; antidepressants/antipsychotics

  4. Alzheimer’s – MR/CT CT- Diffuse cerebral atrophy, enlarged ventricles and widened sulci T1 MR- Medial temporal lobe atrophy (amygdala, hippocampus, parahippocampal gyrus)

  5. T1 weighted MR Control Alzheimer’s

  6. Alzheimer’s – SPECT/PET SPECT- Temporoparietal hypoperfusion (especially in medial temporal lobes) PET- decreased glucose metabolism in frontal, parietal, temporal regions

  7. SPECT Alzheimer’s

  8. Parkinson’s Disease Hypokinetic disorder Loss of dopaminergic neurons in substantia nigra (pars compacta) Pill-rolling tremor, cog-wheel rigidity, bradykinesia, shuffling gait, mask-like facies Dx: clinical after other etiologies ruled out Tx: levodopa/carbidopa, anticholinergics, amantadine; surgery for refractory cases

  9. Parkinson’s – MR/CT Diffuse atrophy and enlarged ventricles seen on CT Decreased pars compacta width (substantia nigra) may be evident on MR

  10. T2 weighted MR Control Parkinson’s

  11. Parkinsons - PET FDG- Similar distribution of hypoperfusion to that of Alzheimer’s (temporoparietal region) Fluorodopa- Less uptake in pars compacta in severe clinical disease as compared to mild disease

  12. Huntington’s Disease CAG triplet repeat expansion in huntingtin (HD) gene Loss of spiny neurons, atrophy of striatum (especially caudate nucleus) Choreiform movements, ataxic gait, facial grimacing/lip smacking, dementia Dx: MR and positive family history Tx: supportive

  13. Huntingtons – MR/CT CT and T1 MR- caudate atrophy T2- increased intensity in caudate and putamen (due to gliosis); decreased intensity in globus pallidus (due to iron deposition)

  14. CT Control Huntington’s

  15. Huntington’s - PET PET FDG- hypoperfusion of caudate nucleus May be evident before MR or CT changes

  16. Pick’s Disease Defect in tau protein Frontal and temporal lobes involved Symptoms similar to Alzheimer’s disease, greater personality change as compared to memory loss Younger age of onset (compared to Alzheimer’s disease) Dx: MR Tx: Cholinesterase inhibitors not helpful, serotonergic agents may help with behavior

  17. Pick’s – MR/CT CT- Frontotemporal atrophy MR- Sulcal widening, ventricular enlargement, widening on lateral sulcus (sylvian fissure), atrophy of insula, inferior frontal/superior.

  18. CT Control Pick’s

  19. Pick’s - SPECT (Frontal variant) Hypoperfusion in ventromedial frontal region (Lateral variant) Hypoperfusion in one/both temporal lobes and anterolateral temporal lobe atrophy (sparing of hipppocampal formation)- left more affected than right

  20. SPECT Pick’s

  21. Summary of Buzzwords Alzheimer’s- medial temporal lobe Parkinson’s- substantia nigra Huntington’s- caudate nucleus Pick’s- frontotemporal lobes

  22. Resources University of Virginia: Introduction to Head CT; http://www.med-ed.virginia.edu/courses/rad/headct/index.html Goetz: Textbook of Clinical Neurology, 2nd ed Basic Clinical Neuroanatomy, Williams and Wilkins Boards and Wards, 2nd ed, Lippincott Williams and Wilkins

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