Diffusion‐Weighted MRI in Creutzfeldt‐Jakob Disease: A Better Diagnostic Marker Than CSF Protein 14‐3‐3?

• Published in: Journal of neuroimaging 2003-04, Vol.13 (2), p.147-151
• Main Authors: Mendez, Oscar E., Shang, Jingzi, Jungreis, Charles A., Kaufer, Daniel I.
• Format: Article
• Language: English
• Subjects: 14-3-3 Proteins; Aged; Creutzfeldt-Jakob Syndrome - cerebrospinal fluid; Creutzfeldt-Jakob Syndrome - diagnosis; Creutzfeldt‐Jakob disease; CSF; diffusion MRI; Fatal Outcome; Female; Humans; Magnetic Resonance Imaging - methods; Male; protein 14‐3‐3; Tyrosine 3-Monooxygenase - cerebrospinal fluid
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/j.1552-6569.2003.tb00171.x

ABSTRACT Two middle‐aged patients presented with rapidly progressive dementia and ataxia, nonspecific electroencephalography findings, and negative cerebrospinal fluid (CSF) protein 14‐3‐3. Both patients underwent brain magnetic resonance imaging (MRI) scans that demonstrated abnormalities on diffusion‐weighted imaging (DWI) sequences, and both were later confirmed to have Creutzfeldt‐Jakob disease (CJD) by tissue examination. Because a recent position paper from the American Academy of Neurology characterized CSF protein 14‐3‐3 as a gold standard for clinically diagnosing CJD, the authors reviewed studies of CJD in which DWI‐MRI imaging and CSF protein 14‐3‐3 studies were both performed. Among 19 reported cases of CJD with DWI‐MRI lesions, CSF protein 14‐3‐3 was negative in 6 cases and positive in 2 others. The authors' findings suggest that multifocal cortical and subcortical hyperintensities confined to gray matter regions in DWI‐MRI may be a more useful noninvasive diagnostic marker for CJD than CSF protein 14‐3‐3. These observations provide a compelling rationale for a prospective comparative study.