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1、MolecularImagingofDementiaMatthewLHemming,PhDHarvardMedicalSchoolYearIIIGillianLeiberman,MDJuly2010Agenda1.Introductiontodementia2.Examplesofimagingdementia3.Alzheimer’sdiseaseoverview4.PiB-PETimaginginAlzheimer’sdiseaseDementiaOverviewAbbreviateddefiniti
2、on:thedevelopmentofcognitivedefectsmanifestedbyimpairmentofmemory,socialoroccupationalfunctionandasignificantdeclinefrompreviouslevelsoffunctioning.CausePercentofTotalAlzheimer’sdisease60-70Vasculardementia20-30OtherNeurodegenerative~5Non-Neurodegenerativ
3、e&~5Non-VascularEarlyonsetandlateonsetformsofdementiaexist.DiagnosisofDementiaTheMiniMentalStatusExam(MMSE)isthemostwidelyuseddementiascreeningtool.Moreextensiveneuropsychiatrictestingenhancesthedementiadiagnosisbutisnotalwaysavailable.Physicalexamandlabt
4、estingareusedtoexcludeothercausesofdementia,butthisisoftentheextentofclinicalinvestigation.Neuroimagingindementiaiscurrentlycontroversial,withMRIbeingabletoidentifyatrophyandhelpdifferentiatestructural,cerebrovascularandmetastaticcausesofdementia.Let’sloo
5、katafewpatientpresentationstoillustratetheutilityofimagingindementiaandconditionsofalteredmentalstatus.Patient1This76yearoldmalepresentswithagitation,confusion,paranoiaandaninabilitytorecognizefamilymembers.Hehasa100pack-yearsmokinghistory.MRI,T1,nocontra
6、st,axialplaneMRI,T1,contrast,axialplaneNotethecontrastenhancingmetastaticlesionsDiagnosis:SmallCellLungCancerwithbrainmetastasisPACS,BIDMCPatient2This64yearoldmalehadFollicularNon-HodgkinLymphomaandreceivedabonemarrowtransplant.Hedevelopedmentalstatuschan
7、gesaftertreatmentwithcyclophosphamide.InitialPresentation7DaysafterdrugcessationMRI,FLAIR,axialplaneMRI,FLAIR,axialplaneNotetheposteriorandperiventricularlesionsthatimproveafterdrugcessationDiagnosis:PosteriorReversibleEncephalopathySyndrome(PRES)PACS,BID
8、MCPACS,BIDMCPatient3,CTScanThis80yearoldmalepresentedwithanacuteonsetofdizziness,nauseaandvomiting.Historyissignificantonlyforhypertension.InitialCTscanrevealscerebellarhemorrhage(arrow).AnMRIwasperformedtoprobeforp
