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The pulvinar sign on magnetic resonance imaging in variant Creutzfeldt-Jakob disease
There is a need for an accurate non-invasive diagnostic test for variant Creutzfeldt-Jakob disease (vCJD). We investigated the sensitivity and specificity of bilateral pulvinar high signal on magnetic resonance imaging (MRI) for the diagnosis of vCJD. MRI from patients with vCJD and controls (patien...
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| Published in: | The Lancet (British edition) 2000-04, Vol.355 (9213), p.1412-1418 |
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| container_title | The Lancet (British edition) |
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| creator | Zeidler, Martin Sellar, Robin J Collie, Donald A Knight, Richard Stewart, Gillian Macleod, Margaret-Ann Ironside, James W Cousens, Simon Colchester, Alan FC Hadley, Donald M Will, Robert G |
| description | There is a need for an accurate non-invasive diagnostic test for variant Creutzfeldt-Jakob disease (vCJD). We investigated the sensitivity and specificity of bilateral pulvinar high signal on magnetic resonance imaging (MRI) for the diagnosis of vCJD.
MRI from patients with vCJD and controls (patients with suspected CJD) were analysed. Scans were reviewed on two separate occasions by two neuroradiologists and scored for the distribution of changes, and likely final diagnosis. Scans from vCJD cases were reassessed to reach a consensus on all abnormalities.
We analysed 36 patients and 57 controls. vCJD patients were correctly identified based on bilateral pulvinar high signal in 29 of 36 and 32 of 36 cases on the first assessment by the two radiologists, and 32 of 36 and 31 of 36 on their second assessment. Bilateral increased pulvinar signal was identified in one of 57 and one of 57 controls on the first assessment and two of 57 and three of 57 controls on the second assessment. These reported changes in controls were graded as minimal/equivocal in six of seven patients and moderate in one ( |
| doi_str_mv | 10.1016/S0140-6736(00)02140-1 |
| format | article |
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MRI from patients with vCJD and controls (patients with suspected CJD) were analysed. Scans were reviewed on two separate occasions by two neuroradiologists and scored for the distribution of changes, and likely final diagnosis. Scans from vCJD cases were reassessed to reach a consensus on all abnormalities.
We analysed 36 patients and 57 controls. vCJD patients were correctly identified based on bilateral pulvinar high signal in 29 of 36 and 32 of 36 cases on the first assessment by the two radiologists, and 32 of 36 and 31 of 36 on their second assessment. Bilateral increased pulvinar signal was identified in one of 57 and one of 57 controls on the first assessment and two of 57 and three of 57 controls on the second assessment. These reported changes in controls were graded as minimal/equivocal in six of seven patients and moderate in one (<0·5% of all control assessments). 80% of the assessments in vCJD cases were graded as moderate or substantial. On consensus review, 28 of 36 cases and none of 57 controls had prominent bilateral pulvinar signal—sensitivity 78% (95% CL 60–90%) and specificity 100% (95% CI 94–100%). Other common MRI features of vCJD were medial thalamic and periaqueductal grey matter high signal, and the notable absence of cerebral atrophy. Pulvinar high signal correlated with histological gliosis.
In the appropriate clinical context the MRI identification of bilaterally increased pulvinar signal is a useful non-invasive test for the diagnosis of vCJD.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(00)02140-1</identifier><identifier>PMID: 10791525</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Atrophy - etiology ; Biological and medical sciences ; Brain - pathology ; Case-Control Studies ; Caudate Nucleus - pathology ; Creutzfeldt-Jakob Syndrome - cerebrospinal fluid ; Creutzfeldt-Jakob Syndrome - classification ; Creutzfeldt-Jakob Syndrome - complications ; Creutzfeldt-Jakob Syndrome - pathology ; Disease Progression ; Electroencephalography ; False Positive Reactions ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Magnetic Resonance Imaging ; Medical sciences ; Middle Aged ; Nervous system ; Observer Variation ; Putamen - pathology ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Reproducibility of Results ; Sensitivity and Specificity ; Severity of Illness Index ; Single-Blind Method ; Thalamic Nuclei - pathology</subject><ispartof>The Lancet (British edition), 2000-04, Vol.355 (9213), p.1412-1418</ispartof><rights>2000 Elsevier Ltd</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-19e6b04dc247435822acba3f75af4c312b08926b05a1b0aab7f5604f942c15f53</citedby><cites>FETCH-LOGICAL-c425t-19e6b04dc247435822acba3f75af4c312b08926b05a1b0aab7f5604f942c15f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1331145$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10791525$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zeidler, Martin</creatorcontrib><creatorcontrib>Sellar, Robin J</creatorcontrib><creatorcontrib>Collie, Donald A</creatorcontrib><creatorcontrib>Knight, Richard</creatorcontrib><creatorcontrib>Stewart, Gillian</creatorcontrib><creatorcontrib>Macleod, Margaret-Ann</creatorcontrib><creatorcontrib>Ironside, James W</creatorcontrib><creatorcontrib>Cousens, Simon</creatorcontrib><creatorcontrib>Colchester, Alan FC</creatorcontrib><creatorcontrib>Hadley, Donald M</creatorcontrib><creatorcontrib>Will, Robert G</creatorcontrib><title>The pulvinar sign on magnetic resonance imaging in variant Creutzfeldt-Jakob disease</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>There is a need for an accurate non-invasive diagnostic test for variant Creutzfeldt-Jakob disease (vCJD). We investigated the sensitivity and specificity of bilateral pulvinar high signal on magnetic resonance imaging (MRI) for the diagnosis of vCJD.
MRI from patients with vCJD and controls (patients with suspected CJD) were analysed. Scans were reviewed on two separate occasions by two neuroradiologists and scored for the distribution of changes, and likely final diagnosis. Scans from vCJD cases were reassessed to reach a consensus on all abnormalities.
We analysed 36 patients and 57 controls. vCJD patients were correctly identified based on bilateral pulvinar high signal in 29 of 36 and 32 of 36 cases on the first assessment by the two radiologists, and 32 of 36 and 31 of 36 on their second assessment. Bilateral increased pulvinar signal was identified in one of 57 and one of 57 controls on the first assessment and two of 57 and three of 57 controls on the second assessment. These reported changes in controls were graded as minimal/equivocal in six of seven patients and moderate in one (<0·5% of all control assessments). 80% of the assessments in vCJD cases were graded as moderate or substantial. On consensus review, 28 of 36 cases and none of 57 controls had prominent bilateral pulvinar signal—sensitivity 78% (95% CL 60–90%) and specificity 100% (95% CI 94–100%). Other common MRI features of vCJD were medial thalamic and periaqueductal grey matter high signal, and the notable absence of cerebral atrophy. Pulvinar high signal correlated with histological gliosis.
In the appropriate clinical context the MRI identification of bilaterally increased pulvinar signal is a useful non-invasive test for the diagnosis of vCJD.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Atrophy - etiology</subject><subject>Biological and medical sciences</subject><subject>Brain - pathology</subject><subject>Case-Control Studies</subject><subject>Caudate Nucleus - pathology</subject><subject>Creutzfeldt-Jakob Syndrome - cerebrospinal fluid</subject><subject>Creutzfeldt-Jakob Syndrome - classification</subject><subject>Creutzfeldt-Jakob Syndrome - complications</subject><subject>Creutzfeldt-Jakob Syndrome - pathology</subject><subject>Disease Progression</subject><subject>Electroencephalography</subject><subject>False Positive Reactions</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Observer Variation</subject><subject>Putamen - pathology</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Single-Blind Method</subject><subject>Thalamic Nuclei - pathology</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNqFkE1v1DAQQC0EokvLTwD5gCp6SDt27KQ5oWoFpVUlDiwSN2vijBdD1lnsZCX66-t0V5Qbp9GM3nw9xt4IOBcgqouvIBQUVV1W7wHOQM6ZeMYWQtWq0Kr-_pwt_iJH7FVKPwFAVaBfsiMBdSO01Au2Wv0gvp36nQ8YefLrwIfAN7gONHrLI6UhYLDEfa75sOY-8B1Gj2Hky0jTeO-o78biFn8NLe98Ikx0wl447BO9PsRj9u3Tx9Xyc3H35fpmeXVXWCX1WIiGqhZUZ2W-udSXUqJtsXS1RqdsKWQLl43MiEbRAmJbO12Bco2SVminy2N2up-7jcPvidJoNj5Z6nsMNEzJ1AIqrRuRQb0HbRxSiuTMNuaH4h8jwMw6zaNOM7syAOZRp5n73h4WTO2Gun-69v4y8O4AYLLYu5hd-fTElaUQasY-7DHKNnaeoknWU9ba-Uh2NN3g_3PJAyZYkPA</recordid><startdate>20000422</startdate><enddate>20000422</enddate><creator>Zeidler, Martin</creator><creator>Sellar, Robin J</creator><creator>Collie, Donald A</creator><creator>Knight, Richard</creator><creator>Stewart, Gillian</creator><creator>Macleod, Margaret-Ann</creator><creator>Ironside, James W</creator><creator>Cousens, Simon</creator><creator>Colchester, Alan FC</creator><creator>Hadley, Donald M</creator><creator>Will, Robert G</creator><general>Elsevier Ltd</general><general>Lancet</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20000422</creationdate><title>The pulvinar sign on magnetic resonance imaging in variant Creutzfeldt-Jakob disease</title><author>Zeidler, Martin ; Sellar, Robin J ; Collie, Donald A ; Knight, Richard ; Stewart, Gillian ; Macleod, Margaret-Ann ; Ironside, James W ; Cousens, Simon ; Colchester, Alan FC ; Hadley, Donald M ; Will, Robert G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c425t-19e6b04dc247435822acba3f75af4c312b08926b05a1b0aab7f5604f942c15f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Atrophy - etiology</topic><topic>Biological and medical sciences</topic><topic>Brain - pathology</topic><topic>Case-Control Studies</topic><topic>Caudate Nucleus - pathology</topic><topic>Creutzfeldt-Jakob Syndrome - cerebrospinal fluid</topic><topic>Creutzfeldt-Jakob Syndrome - classification</topic><topic>Creutzfeldt-Jakob Syndrome - complications</topic><topic>Creutzfeldt-Jakob Syndrome - pathology</topic><topic>Disease Progression</topic><topic>Electroencephalography</topic><topic>False Positive Reactions</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Observer Variation</topic><topic>Putamen - pathology</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Single-Blind Method</topic><topic>Thalamic Nuclei - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zeidler, Martin</creatorcontrib><creatorcontrib>Sellar, Robin J</creatorcontrib><creatorcontrib>Collie, Donald A</creatorcontrib><creatorcontrib>Knight, Richard</creatorcontrib><creatorcontrib>Stewart, Gillian</creatorcontrib><creatorcontrib>Macleod, Margaret-Ann</creatorcontrib><creatorcontrib>Ironside, James W</creatorcontrib><creatorcontrib>Cousens, Simon</creatorcontrib><creatorcontrib>Colchester, Alan FC</creatorcontrib><creatorcontrib>Hadley, Donald M</creatorcontrib><creatorcontrib>Will, Robert G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zeidler, Martin</au><au>Sellar, Robin J</au><au>Collie, Donald A</au><au>Knight, Richard</au><au>Stewart, Gillian</au><au>Macleod, Margaret-Ann</au><au>Ironside, James W</au><au>Cousens, Simon</au><au>Colchester, Alan FC</au><au>Hadley, Donald M</au><au>Will, Robert G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The pulvinar sign on magnetic resonance imaging in variant Creutzfeldt-Jakob disease</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2000-04-22</date><risdate>2000</risdate><volume>355</volume><issue>9213</issue><spage>1412</spage><epage>1418</epage><pages>1412-1418</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>There is a need for an accurate non-invasive diagnostic test for variant Creutzfeldt-Jakob disease (vCJD). We investigated the sensitivity and specificity of bilateral pulvinar high signal on magnetic resonance imaging (MRI) for the diagnosis of vCJD.
MRI from patients with vCJD and controls (patients with suspected CJD) were analysed. Scans were reviewed on two separate occasions by two neuroradiologists and scored for the distribution of changes, and likely final diagnosis. Scans from vCJD cases were reassessed to reach a consensus on all abnormalities.
We analysed 36 patients and 57 controls. vCJD patients were correctly identified based on bilateral pulvinar high signal in 29 of 36 and 32 of 36 cases on the first assessment by the two radiologists, and 32 of 36 and 31 of 36 on their second assessment. Bilateral increased pulvinar signal was identified in one of 57 and one of 57 controls on the first assessment and two of 57 and three of 57 controls on the second assessment. These reported changes in controls were graded as minimal/equivocal in six of seven patients and moderate in one (<0·5% of all control assessments). 80% of the assessments in vCJD cases were graded as moderate or substantial. On consensus review, 28 of 36 cases and none of 57 controls had prominent bilateral pulvinar signal—sensitivity 78% (95% CL 60–90%) and specificity 100% (95% CI 94–100%). Other common MRI features of vCJD were medial thalamic and periaqueductal grey matter high signal, and the notable absence of cerebral atrophy. Pulvinar high signal correlated with histological gliosis.
In the appropriate clinical context the MRI identification of bilaterally increased pulvinar signal is a useful non-invasive test for the diagnosis of vCJD.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>10791525</pmid><doi>10.1016/S0140-6736(00)02140-1</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Atrophy - etiology Biological and medical sciences Brain - pathology Case-Control Studies Caudate Nucleus - pathology Creutzfeldt-Jakob Syndrome - cerebrospinal fluid Creutzfeldt-Jakob Syndrome - classification Creutzfeldt-Jakob Syndrome - complications Creutzfeldt-Jakob Syndrome - pathology Disease Progression Electroencephalography False Positive Reactions Humans Investigative techniques, diagnostic techniques (general aspects) Magnetic Resonance Imaging Medical sciences Middle Aged Nervous system Observer Variation Putamen - pathology Radiodiagnosis. Nmr imagery. Nmr spectrometry Reproducibility of Results Sensitivity and Specificity Severity of Illness Index Single-Blind Method Thalamic Nuclei - pathology |
| title | The pulvinar sign on magnetic resonance imaging in variant Creutzfeldt-Jakob disease |
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