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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.
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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.

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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.
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