Job Aid MRI in Dementia Part 2

SIEMENS Healthineers MRI in Dementia ARISE 2022 Wahyu Widhianto Restricted © Siemens Healthineers, 2022 SIEMENS Healthineers ... MRI Assesment MAGNETOM Sola Click to add footnote 14 second line Restricted © Siemens Healthineers, 2022 MRI Assessment in Dementia SIEMENS Healthineers ... Global Atrophy GCA scale Vascular Dementia The standardized assessment of the MR findings in a Normal aging patient suspected of having a cognitive disorder includes : • Medial Temporal Atrophy Alzheimer (FTLD) GCA-scale for Global Cortical Atrophy MTA scale • asymmetric) MTA-scale for Medial Temporal lobe Atrophy • Koedem score for parietal atrophy Frontal Atrophy FTLD • Fazekas scale for WM Hiperintensity Parietal Atrophy Koedam score + • Looking for strategic infarcts WMH Fazekas scale Vascular Dementia Normal aging Strategic infarcts Vascular Dementia Kaushik, et al., 2020, Evaluation of MT Visual Rating Scales in Major Forms of Dementia 15 Restricted © Siemens Healthineers, 2022 MRI Assessment in Dementia SIEMENS Healthineers GCA scale is the mean score for cortical atrophy throughout the complete cerebrum : • 0 : no cortical atrophy • 1 : mild atrophy : opening of sulci • 2 : moderate atrophy : volume loss of gyri • 3 : severe end-stage atrophy GCA 0 GCA 1 GCA 2 GCA 3 Lars-Olof Wahlund et al., 2017, Imaging biomarkers of dementia : recommended visual rating scales with teaching cases 16 Restricted © Siemens Healthineers, 2022 MRI Assessment in Dementia SIEMENS Healthineers MTA score is based on a visual rating of the width of the choroid fissure, the width of the temporal horn, and the height of the hippocampal formation: • 0 : no atrophy MTA=0 MTA=1 • 1 : only widening of choroid fissure • 2 : also widening of temporal horn of lateral ventricle • 3 : moderate loss of hippocampal volume • 4 : severe volume loss of MTA=2 MTA=3 hippocampus < 75 years : score 2 or more is abnormal > 75 years : score 3 or more is abnormal MTA=4 MTA=4 Lars-Olof Wahlund et al., 2017, Imaging biomarkers of dementia : recommended visual rating scales with teaching cases 17 Restricted © Siemens Healthineers, 2022 MRI Assessment in Dementia SIEMENS Healthineers Koedam scale rates parietal atrophy, assessed in sagittal, coronal and axial planes • 0 : No cortical atrophy, closed sulci of parietal lobes O and cuneus • 1 : Mild parietal cortical atrophy, mild widening of posterior cingulate and parieto-occipital sulci Kaushik, et al., 2020, Evaluation of MT Visual Rating Scales in Major Forms of Dementia 18 Restricted © Siemens Healthineers, 2022 MRI Assessment in Dementia SIEMENS Healthineers Koedam scale rates parietal atrophy, assessed in sagittal, coronal and axial planes 2 • 2 : Substantial parietal cortical atrophy, substantial widening of sulci • 3 : End-stage atrophy, extreme widening of posterior cingulate and parieto-occipital sulci 3 Kaushik, et al., 2020, Evaluation of MT Visual Rating Scales in Major Forms of Dementia 19 Restricted © Siemens Healthineers, 2022 MRI Assessment in Dementia SIEMENS Healthineers White Matter Lesion (WML) and lacunes are generally viewed as Fazekas 1 evidence of small vessels disease. The Fazekas-scale provide an overall impression of the presence of WML in the entire brain. Best scored in FLAIR images. • 0 : None or a single punctate WM lesion • 1 : Multiple punctate lesions • 2 : Beginning confluency of lesions (bridging) Fazekas 2 • 3 : Large confluent lesions Fazekas 3 Lars-Olof Wahlund et al., 2017, Imaging biomarkers of dementia : recommended visual rating scales with teaching cases 20 Restricted © Siemens Healthineers, 2022 MRI Assessment in Dementia SIEMENS Healthineers Parieto-temporal or Strategic infarctions are infarcts in areas that are crucial for Medial Cerebral Artery temporo-occipital normal cognitive functioning of the brain. Best observed in FLAIR association areas Angular gyrus Paramedian thalamic, Posterior Cerebral Artery inferior medial temporal lobe Watershed infarctions Superior frontal or parietal Lacunar infarctions Bilateral thalamic 21 Restricted © Siemens Healthineers, 2022