Imaging of Neurodegenerative and Cognitive Disorders Flashcards
When looking at an T1 sequence MRI scan, which of the following is NOT correct?
1 - CSF = white
2 - grey matter = grey
3 - white matter = white
4 - CSF = black/grey (low signal)
1 - CSF = white
- CSF is white on a T2 scan
WW2 = Water Whiter in T2
While Fat Whiter in T1
When looking at an T2 sequence MRI scan, which of the following is NOT correct?
1 - CSF = white (high signal)
2 - grey matter = white
3 - white matter = grey
4 - grey matter = grey
4 - grey matter = grey
In a T2 MRI scan, does pathology typically have a high or low signal?
- high signal
- typically occurs whiter
- pathology contains higher water so has a higher signal
- WW2 = Water Whiter on T2
In a T1 MRI scan, does pathology typically have a high or low signal?
- low signal
- typically grey or darker
In a Fluid Attenuated Inversion Recover (FLAIR), which of the following is NOT correct?
1 - CSF = high signal and appears whiter
2 - CSF = high signal but attenuated so appears black
3 - grey matter = high signal and appears whiter
4 - white matter = low signal and appears darker
1 - CSF = high signal and appears whiter
- white matter = myelinated axons (high fat)
- grey matter - neuronal cell bodies
In a Fluid Attenuated Inversion Recover (FLAIR) does pathology have a high or low signal?
- high signal
- FLAIR is good to separate CSF from pathology
- high sensitivity for pathology
- CSF has lots of water so is typically brighter, but this is attenuated here to highlight pathology
In a diffuse weighted image does the brain appear darker or lighter in a healthy patient?
- darker
In a diffuse weighted image does pathology appear lighter or darker?
- lighter
- often this is the best imaging to diagnose strokes
- abscess, infection and cholesteatoma can also be identified well using this approach
Which of the following techniques of MRI are most sensitive for detecting changes and pathophysiology associated with blood?
1 - FLAIR
2 - T2
3 - echo-T2
4 - diffuse weighted
3 - echo-T2
- blood appears black
The memory clinical report assessment parameters include the following:
- medial temporal atrophy score (MTA) scored 0-4
- Fazekas score to assess for vessel disease scored 0-3
- global corticoid atrophy score to assess atrophy of the whole brain scored 0-3
Which of these would be most appropriate when assessing patients with Alzheimer’s?
- medial temporal atrophy score (MTA) scored 0-4
- temporal atrophy is common in Alzheimers disease
The memory clinical report assessment parameters include the following:
- medial temporal atrophy score (MTA) scored 0-4
- Fazekas score to assess for vessel disease scored 0-3
- global corticoid atrophy score to assess atrophy of the whole brain scored 0-3
Which of these would be most appropriate when assessing patients with vascular dementia?
- Fazekas score to assess for vessel disease scored 0-3
What is the most common cause of dementia?
1 - vascular dementia
2 - Alzheimer’s
3 - frontal lobe dementia
4 - parkinsons disease
2 - Alzheimer’s
The medial temporal atrophy score (MTA) scored 0-4 is part of the memory clinical report assessment parameters include the following. Specifically which part of the brain does this focus on?
1 - amygdale
2 - hippocampus
3 - peririhinal cortex
4 - mammillary body
2 - hippocampus
The medial temporal atrophy score (MTA) scored 0-4 is part of the memory clinical report assessment parameters include the following. 3 is the worst score and 0 is the best score. What age does the patient have to be for an MTA score >3 to be classed as abnormal?
1 - >50
2 - >65
3 - >75
4 - >80
3 - >75
- an MTA >2 is abnormal in those <75
Although hippocampal atrophy is most common in Alzheimers, which of the following is NOT a differential for this?
1 - frontal lobe dementia
2 - parkinsons disease
3 - previous infection (herpes encephalitis)
4 - autoimmune condition
2 - parkinsons disease
- patient history of cognitive decline would confirm the Alzheimers diagnosis
- previous trauma and/or infection with no cognitive decline should make us think of other causes
Vascular dementia is the 2nd most common form of dementia. Vascular cognitive impairment is often used as vascular dementia is thought of as a spectrum. What is the cut off for mild dementia due to vascular changes?
1 - imaging confirms lacuna lesions
2 - 1-2 standard deviations below the normal
3 - >2 standard deviations above the norm
4 - all of the above
2 - 1-2 standard deviations below the normal
- major is >2 SD above the norm
In early onset of Alzheimers (<65 y/o), where in the brain is atrophy commonly observed?
1 - temporal lobe
2 - parietal lobe
3 - frontal lobe
4 - occipital lobe
2 - parietal lobe
- late onset (>65 y/o) is commonly temporal, specifically the hippocampus
Infarcts in all of the following are classed as large infarcts, EXCEPT which one?
1 - anterior cerebral artery
2 - vertebrae cerebral artery
3 - middle cerebral artery
4 - posterior cerebral artery
2 - vertebrae cerebral artery
Infarcts in all of the following are classed as large infarcts,
- anterior cerebral artery
- middle cerebral artery
- posterior cerebral artery
How many of these need to be affected to cause mild vascular cognitive disorder?
1 - all 3
2 - 2
3 - 1
3 - 1
- Vascular dementia requires >1 of the anterior, middle and posterior cerebral arteries
Lacunar infarcts are called this because following a lacunar stroke the damaged tissue becomes filled with fluid called cysts, resembling a lake. Typically which artery do these arteries affect?
1 - anterior cerebral artery
2 - vertebrae cerebral artery
3 - middle cerebral artery
4 - posterior cerebral artery
3 - middle cerebral artery
- specifically the deep branches that supply the basal ganglia
- often described as purely motor function
Do lacunar infarcts always lead to cognitive impairments?
- no
- older patients can have 1-2 and have no cognitive impairments
How many lacunar infarcts are diagnostic of a vascular cognitive disorder?
1 - >1
2 - >2
3 - >3
4 - >4
2 - >2
- BUT 1 lacunar infarct in a strategic position such as the striatum or thalamus may produce a vascular cognitive disorder, BUT there must be a temporal association
The memory clinical report assessment parameters include the Fazekas scoring to assess for vessel disease scored 0-3. What score in a <50 y/o would be classed as abnormal?
1 - >4
2 - >3
3 - >2
4 - >1
4 - >1
- however, other differentials should also be investigated such as multiple sclerosis
The memory clinical report assessment parameters include the Fazekas scoring to assess for vessel disease scored 0-3. What score in a 50-60 y/o would be classed as abnormal?
1 - >4
2 - >3
3 - >2
4 - >1
3 - >2
- a large proportion of elderly patients have a score of 2
- a score of 3 is linked with a higher progression to disability
The memory clinical report assessment parameters includes the global corticoid atrophy (GCA) score to assess atrophy of the whole brain scored 0-3. What score is abnormal at any age?
1 - 3
2 - 2
3 - 1
4 - 0
1 - 3
The memory clinical report assessment parameters includes the global corticoid atrophy (GCA) score to assess atrophy of the whole brain scored 0-3. What score is abnormal in those aged <75?
1 - 3
2 - 2
3 - 1
4 - 0
2 - 2
In Lewy body dementia, is an MRI useful for diagnosis?
- NOT for lewy body dementia
- used to rule out other pathologies
- DATscan is better for Lewy body dementia
Do dementias such as Alzheimers, lewy bodies dementia always occur in isolation?
- no
- called mixed dementia and is very common in dementia diagnoses
Mixed dementia is very common, but what is the most common dementia that is combined with other dementias?
1 - vascular dementia
2 - Alzheimer’s
3 - frontal lobe dementia
4 - parkinsons disease
2 - Alzheimer’s
- Alzheimer’s + Vascular dementia
- Alzheimer’s + Lewys body dementia
What is the imaging of choice to diagnose patients with neurocognitive disorders?
1 - ultrasound
2 - MRI
3 - CT
4 - PET-CT
2 - MRI
We can use nuclear medicine to identify which areas of the brain are well perfused (in yellow on image) and those that are hypoperfused (blue/purple on image). What is the most common hypoperfused site in Alzheimers disease?
1 - Bilateral temporoparietal hypoperfusion
2 - Bilateral temporoparietal hypoperfusion with other defects:
3 - Unilateral temporoparietal hypoperfusion
4 - Frontal hypoperfusion
1 - Bilateral temporoparietal hypoperfusion
- interestingly, around 19% of patients with Alzheimer’s can have a normal brain perfusion
Which scanning technique is most effective for diagnosing Parkinsons?
1 - Nuclear medicine scan
2 - MRI
3 - CT-PET
4 - DaTSCAN
4 - DaTSCAN
- a dopamine transporter radioligand
is used to assess the pre-synaptic striatal uptake in the basal ganglia of the brain
A DaTSCAN is a dopamine transporter radioligand used to assess the pre-synaptic striatal uptake in the basal ganglia of the brain. Is this technique able to distinguish between Lewy bodies dementia and Parkinson’s disease dementia?
- no
A DaTSCAN is a dopamine transporter radioligand used to assess the pre-synaptic striatal uptake in the basal ganglia of the brain. If a DaTSCAN is abnormal, is this more likely to be Lewy Bodies dementia or Alzheimers dementia?
- Lewy Bodies dementia
Which 2 of the following can be used as markers for Alzheimers?
1 - a-synuclein
2 - tau protein
3 - amyloid B
4 - sarcoid
2 - tau protein
3 - amyloid B
In the pathophysiology of Alzheimer’s disease, which 2 of the following markers are the first to become abnormal?
1 - amyloid
2 - CSF tau
3 - CSF AB42
4 - FDG-PET
1 - amyloid
3 - CSF AB42
MRI is the 1st line imaging for neurocognitive impairment disorders. If the MRI is inconclusive and Parkinsons has been ruled out, we can use the SPECT with HMPAO or ECD. However, if we want to look at patterns of brain metabolism we should use what?
1 - PET-CT
2 - FDG-PET/CT
3 - DeTSCAN
4 - Amyloid scans
2 - FDG-PET/CT
- amyloid scans are sensitive for Alzheimers disease
MRI is the 1st line imaging for neurocognitive impairment disorders. What is the next imaging modality that should be used?
1 - PET-CT
2 - FDG-PET/CT
3 - DeTSCAN
4 - SPECT with HMPAO or ECD
4 - SPECT with HMPAO or ECD
