Multimodality Imaging of

Neurodegenerative
Processes: Part 1, The Basics
and Common Dementias

Objective
Multimodality imaging --> important role in the
structural and functional characterization of
neurodegenerative conditions
Basic concepts of anatomic, metabolic and amyloid
imaging
Applications of multimodality approach in the evaluation
of the patient with neurodegenerative dementia
processes

Dementia
Loss of cognitive function that disrupts the activities of
daily living

Dementi
a

7-8%
> 65 yo

30%
> 80 yo

Alzheimer disease --> 50-80%

cases
Lewy bodies & frontotemporal
dementia

Dementia
Diagnosis of dementia must exclude
Short term cognitive dysfunction (delirium)
Psychiatric conditions
Treatable non-neurodegenerative intracranial conditions
Mass lesions, infarcts, subdural hematomas, normal-pressure
hydrocephalus

The diagnosis is very important --> different treatment

and prognosis

Imaging in Dementia
Imaging focused to rule out treatable nonneurodegenerative causes
Rule in early neurodegenerative processes
Anatomic neuroimaging
F-FDG PET/CT (Fludeoxyglucose PET/CT)

Modern MRI can reveal structural abnormalities and

signal intensity alterations
In conventional MRI, structural findings lag behind clinical
symptoms

Imaging in Dementia
Metabolic imaging with FDG PET/CT
Identification of cellular dysfunction and atrophy
Quantitative analyses --> identify pattern of change in
neurodegenerative processes

Metabolic imaging with Amyloid-binding PET

Identify patients at risk for developing dementia
Mark early stages of the disease process
Help differentiate dementia due to amyloid-related processes
from other non-amyloid neurodegenerative processes

The Purpose
Build on readers' knowledge of the classic appearances
of common neurodegenerative processes by highlighting
complementary metabolic and amyloid imaging
techniques and discussing basic clinical correlation
Multimodal approach promises earlier characterization
and a better ability to prognosticate, tailor treatment,
choosing clinical trials, counseling or disease-modifying
therapy for the patients

Anatom
ic
Imaging

Metabol
ic
Imaging

Amyloid
Imaging

Anatomic Imaging
MRI and CT can be useful for excluding nonneurodegenerative causes of dementia
Often ordered before molecular imaging
Evaluation of dementia and can show characteristic
pattern of volume loss in late-stage neurodegenerative
processes

Classic MRI sequences for dementia

evaluation
Sagittal and axial T1-weighted
Axial T2-weighted
Axial T2-weighted FLAIR
Axial DWI
T2-weighted gradient-echo sequences
3D volume acquisitions
Coronal sequences
Gadolinium-enhanced sequences

MRI
Targets evaluation for surgically treatable lesions
The extent of vascular disease
Patterns of cortical atrophy with emphasis on the
hippocampi, precuneus, temporal and frontal lobes,
midbrain and pons
Advanced techniques--> diffusion-tensor imaging,
functional imaging, spectroscopy, arterial spin labeling
Should be used alongside additional neurodegenerative
process biomarkers