AUTHOR=Kitazaki Yuki , Ikawa Masamichi , Hamano Tadanori , Sasaki Hirohito , Yamaguchi Tomohisa , Enomoto Soichi , Shirafuji Norimichi , Hayashi Kouji , Yamamura Osamu , Tsujikawa Tetsuya , Okazawa Hidehiko , Kimura Hirohiko , Nakamoto Yasunari 

TITLE=Magnetic resonance imaging arterial spin labeling hypoperfusion with diffusion-weighted image hyperintensity is useful for diagnostic imaging of Creutzfeldt–Jakob disease

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1242615

DOI=10.3389/fneur.2023.1242615

ISSN=1664-2295

ABSTRACT=<sec id="sec1"><title>Background and objectives</title><p>Magnetic resonance imaging with arterial spin labeling (ASL) perfusion imaging is a noninvasive method for quantifying cerebral blood flow (CBF). We aimed to evaluate the clinical utility of ASL perfusion imaging to aid in the diagnosis of Creutzfeldt–Jakob disease (CJD).</p></sec><sec id="sec2"><title>Methods</title><p>This retrospective study enrolled 10 clinically diagnosed with probable sporadic CJD (sCJD) based on the National CJD Research &amp; Surveillance Unit and EuroCJD criteria and 18 healthy controls (HCs). Diffusion-weighted images (DWIs), CBF images obtained from ASL, <italic>N</italic>-isopropyl-(<sup>123</sup>I)-<italic>p</italic>-iodoamphetamine (<sup>123</sup>IMP)-single-photon emission computed tomography (SPECT) images, and <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>FDG)-positron emission tomography (PET) images were analyzed. First, the cortical values obtained using volume-of-interest (VOI) analysis were normalized using the global mean in each modality. The cortical regions were classified into DWI-High (≥ +1 SD) and DWI-Normal (&lt; +1 SD) regions according to the DWI-intensity values. The normalized cortical values were compared between the two regions for each modality. Second, each modality value was defined as ASL hypoperfusion (&lt; −1 SD), SPECT hypoperfusion (&lt; −1 SD), and PET low accumulation (&lt; −1 SD). The overall agreement rate of DWIs with ASL-CBF, SPECT, and PET was calculated. Third, regression analyses between the normalized ASL-CBF values and normalized SPECT or PET values derived from the VOIs were performed using a scatter plot.</p></sec><sec id="sec3"><title>Results</title><p>The mean values of ASL-CBF (<italic>N</italic> = 10), <sup>123</sup>IMP-SPECT (<italic>N</italic> = 8), and <sup>18</sup>FDG-PET (<italic>N</italic> = 3) in DWI-High regions were significantly lower than those in the DWI-Normal regions (<italic>p</italic> &lt; 0.001 for all); however, HCs (<italic>N</italic> = 18) showed no significant differences in ASL-CBF between the two regions. The overall agreement rate of DWI (high or normal) with ASL-CBF (hypoperfusion or normal) (81.8%) was similar to that of SPECT (85.2%) and PET (78.5%) in CJD. The regression analysis showed that the normalized ASL-CBF values significantly correlated with the normalized SPECT (<italic>r</italic> = 0.44, <italic>p</italic> &lt; 0.001) and PET values (<italic>r</italic> = 0.46, <italic>p</italic> &lt; 0.001) in CJD.</p></sec><sec id="sec4"><title>Discussion</title><p>Patients with CJD showed ASL hypoperfusion in lesions with DWI hyperintensity, suggesting that ASL-CBF could be beneficial for the diagnostic aid of CJD.</p></sec>