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

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

doi:10.3389/fneur.2023.1242615

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

Front Neurol. 2023 Oct 10:14:1242615. doi: 10.3389/fneur.2023.1242615. eCollection 2023.

Authors

Yuki Kitazaki¹, Masamichi Ikawa^{1

2

3}, Tadanori Hamano^{1

4

5}, Hirohito Sasaki¹, Tomohisa Yamaguchi¹, Soichi Enomoto¹, Norimichi Shirafuji¹, Kouji Hayashi^{1

6}, Osamu Yamamura¹, Tetsuya Tsujikawa², Hidehiko Okazawa², Hirohiko Kimura⁷, Yasunari Nakamoto¹

Affiliations

¹ Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
² Biomedical Imaging Research Center, University of Fukui, Fukui, Japan.
³ Department of Advanced Medicine for Community Healthcare, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
⁴ Department of Aging and Dementia (DAD), University of Fukui, Fukui, Japan.
⁵ Life Science Innovation Center, University of Fukui, Fukui, Japan.
⁶ Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui, Japan.
⁷ Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.

Abstract

Background and objectives: 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).

Methods: This retrospective study enrolled 10 clinically diagnosed with probable sporadic CJD (sCJD) based on the National CJD Research & Surveillance Unit and EuroCJD criteria and 18 healthy controls (HCs). Diffusion-weighted images (DWIs), CBF images obtained from ASL, N-isopropyl-(¹²³I)-p-iodoamphetamine (¹²³IMP)-single-photon emission computed tomography (SPECT) images, and ¹⁸F-fluorodeoxyglucose (¹⁸FDG)-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 (< +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 (< -1 SD), SPECT hypoperfusion (< -1 SD), and PET low accumulation (< -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.

Results: The mean values of ASL-CBF (N = 10), ¹²³IMP-SPECT (N = 8), and ¹⁸FDG-PET (N = 3) in DWI-High regions were significantly lower than those in the DWI-Normal regions (p < 0.001 for all); however, HCs (N = 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 (r = 0.44, p < 0.001) and PET values (r = 0.46, p < 0.001) in CJD.

Discussion: Patients with CJD showed ASL hypoperfusion in lesions with DWI hyperintensity, suggesting that ASL-CBF could be beneficial for the diagnostic aid of CJD.

Keywords: Creutzfeldt–Jakob disease; arterial spin labeling; cerebral blood flow; epilepsy; magnetic resonance imaging.

Grants and funding

This study was supported in part by JSPS KAKENHI Grant Numbers JP 22 K07392 (awarded to TH) and 20 K07900 (awarded to MI), a research grant from the University of Fukui (Grant Number: LSI20306) (awarded to TH), and Novartis Pharma Grants for Basic Research 2022 (awarded to TH). The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.