Characteristics of 18F⁃FDG PET in Creutzfeldt⁃Jakob disease

Abstract

Objective To explore the characteristics of 18F⁃fluoro⁃2⁃deoxy⁃D⁃glucose (18F⁃FDG) PET in Creutzfeldt⁃Jakob disease (CJD). Methods and Results The manifestations of 18F⁃FDG PET of 8 cases confirmed as CJD were analyzed retrospectively from August 2018 to January 2020. Five patients were male and 3 were female, with a mean age of (49.63±13.19) years. There were 7 sporadic CJD (sCJD) patients and one genetic CJD (gCJD) patient. All 8 patients were characterized by rapid progressive dementia. DWI hyperintensity in brain MRI were observed in all 8 patients. 18F⁃FDG PET analysis revealed frontal, parietal and temporal regions hypometabolism in all 8 cases. Occipital region hypometabolism was observed in 7 cases (7/8). For subcortical regions, hypometabolism were identified in thalamus (5/8), basal ganglia (3/8), brainstem (3/8) and cerebellum (3/8). Compared with the DWI hyperintensities, there were 40 hyperintense on DWI in the 50 cortical regions that were hypometabolic on 18F⁃FDG PET, especially in the frontal lobe. For subcortical regions, there were only 9 hyperintense on DWI in the 25 regions that were hypometabolic on 18F⁃FDG PET, especially the basal ganglia region. The brain stem and cerebellum hypometabolic regions showed no hyperintense on DWI. Conclusions The higher sensitivity of 18F⁃FDG PET is conducive to the differential diagnosis of CJD, especially in patients with rapid progression. 18F⁃FDG PET hypometabolism may indicate severe focal neurological impairment. The diagnosis of CJD should be considered for patients with rapidly progressive dementia accompanied with obvious symptoms of extra pyramidal system or cerebellum, cortical hypometabolism in 18F⁃FDG PET, and without obvious DWI hyperintensity.

Keywords

• creutzfeldt ⁃ jakob syndrome
• magnetic resonance imaging
• positron ⁃ emission tomography
• fluorodeoxyglucose f18