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Diffusion-weighted MRI in vascular dementia

From the Departments of Neurology (Drs. D.L. Na, Chung, and Lee) and Diagnostic Radiology (Dr. D.G. Na), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology (Dr. Choi), College of Medicine, Inha University, Incheon, Korea; and Department of Neurology (Dr. Adair), University of New Mexico, Albuquerque, NM.

Address correspondence and reprint requests to Dr. Duk L. Na, Department of Neurology, Sungkyunkwan University, Samsung Medical Center, 50 ILwon-dong Kangnam-ku Seoul, 135-710 Korea; e-mail: dukna{at}smc.samsung.co.kr

OBJECTIVE: To examine the ability of diffusion-weighted MRI (DWI) to detect ongoing cerebral ischemia in patients with vascular dementia (VaD).

BACKGROUND: VaD due to small-vessel disease results from the cumulative impact of recurrent cerebral ischemia. Cerebral ischemia may produce clinical manifestations, producing the "stepwise" decline characteristic of VaD. Conventional MRI can detect small regions of ischemic damage but cannot determine when injury developed. In contrast, DWI shows sensitivity in detecting ischemia of recent onset.

DESIGN/METHODS: Patients with VaD (n = 30) underwent DWI in addition to standard MRI sequences. Patients were divided into two groups according to the presence of new focal deficits or mental change within 10 days before MRI. In 10 patients of positive group, symptomatic neurologic decline occurred an average of 4.2 days before the imaging procedure.

RESULTS: Seven (70%) of 10 patients with a recent neurologic event showed 15 new regions of signal abnormality on DWI. The anatomic distribution of signal change could account for the patients’ new symptoms or signs in all but one patient. Similar signal abnormality was detected in 4 (20%) of 20 patients without a recent neurologic event. New foci of altered signal intensity were distinguishable from prior injuries only with DWI. No significant difference was found between patients with and without DWI abnormalities in gender, age, Mini-Mental State Examination score, Hachinski Ischemic Score, vascular risk factors, or severity of increased signal on T₂-weighted MRI scans.

CONCLUSION: Small foci of abnormal signal on diffusion-weighted MRI (DWI), presumably representing recent small infarcts, occur often in vascular dementia (VaD) from small-vessel disease, even in patients without a recent "stepwise decline." The results suggest that DWI might be used to monitor VaD progression in future observational and interventional studies of this disorder.

Key words: Vascular dementia—Diffusion-weighted MRI—Small-vessel disease

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