We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Use of Diffusion-Weighted Magnetic Resonance Imaging in Sporadic Creutzfeldt-Jakob Disease

Paolo Vitali, MD, PhD1; Marina Pan, MD1; Eduardo Caverzasi, MD2,3
[+] Author Affiliations
1Neuroradiology and Brain MRI 3T Mondino Research Center, C. Mondino National Neurological Institute, Pavia, Italy
2Department of Neurology, University of California–San Francisco
3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
JAMA Neurol. 2016;73(9):1153-1154. doi:10.1001/jamaneurol.2016.2381.
Text Size: A A A
Published online


To the Editor The study by Eisenmenger et al1 published in JAMA Neurology explored the progression of diffusion-weighted imaging (DWI) hyperintensities in a large cohort (37 patients) of sporadic Creutzfeldt-Jakob disease (sCJD) over time by using a visual assessment approach previously applied by our group.2

The authors found inconsistent fluctuating signal intensities in the cortex, whereas within the striatum, they found only increasing DWI signal. Semiquantitative visual assessment on DWI in 26 cortical areas per hemisphere was performed, and only the left frontal cortex showed a positive correlation with the degree of spongiosis, supporting previous studies.3 For 7 patients, quantitative diffusion was also examined in the left striatum, finding reduced mean diffusivity (MD) longitudinally. Surprisingly, this was not performed at the cortical level. More importantly, the authors applied an inhomogeneous approach to their analysis; MD was measured in 3 patients studied at 3 T with 64 directions using diffusion-tensor imaging, but only apparent diffusion coefficient (ADC) was measured, and not MD, in 4 patients studied at 1.5 T with 3 directions using DWI. Combining these data, as shown in Figure 5 in their article,1 is inappropriate. Although MD and ADC should be equivalent, acquisition with different parameters from scanners with different magnetic fields makes the equivalence much less likely. Furthermore, ADC with 3 directions is sensitive to the head position, which is crucial in serial studies of patients with advanced CJD.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





September 1, 2016
Laura Eisenmenger, MD; Simon Mead, PhD; Harpreet Hyare, PhD
1Department of Radiology, University of Utah, Salt Lake City
2MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, London, England
JAMA Neurol. 2016;73(9):1154. doi:10.1001/jamaneurol.2016.2384.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...