Anatomic and Molecular Imaging of Dementia

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Neurological: 1.00

Nuclear Medicine Technology: 2.00
Procedures: 2.00
Other Imaging Procedures: 2.00

Registered Radiologist Assistant: 0.75
Procedures: 0.75
Neurological, Vascular, and Lymphatic Sections: 0.75

Outline

1. Introduction
2. Structural Imaging
3. Molecular Imaging
   1. FDG PET
   2. Amyloid-β PET
   3. ¹²³I-Ioflupane SPECT
   4. τ-based PET
4. Computer-Assisted Quantitative Evaluation
5. Pathophysiology of Neurodegenerative Diseases
6. Alzheimer Disease
7. Dementia with Lewy Bodies
8. Frontotemporal Lobar Degeneration
9. Vascular Dementia
10. Other Dementing Disorders
11. Patient Workup, Algorithm, and Recommendations
12. Conclusion

Objectives

Upon completion of this course, students will:

1. know how definitive objective diagnosis of neurodegenerative disease can currently be made
2. identify the traditional role of neuroimaging in dementia
3. be familiar with the various areas of the brain that are important to evaluate during structural imaging assessment
4. be familiar with the reasons for using the various MRI sequences for evaluating patients with suspected dementia
5. know the usefulness of FDG PET for brain imaging
6. know SNMMI recommendations for ¹⁸F-FDG use for neurologic PET imaging
7. be familiar with the location and orientation of the recommended T2-weighted MR images for the assessment of the visual rating system for mesial temporal atrophy scoring
8. know the area of the brain that, when spared, is a classic finding of Alzheimer disease
9. know the various radiopharmaceuticals used in beta-amyloid PET imaging and their trade names
10. know the area of the brain that is typically used as an internal control for uptake comparison when evaluating cortical uptake of beta-amyloid PET agents
11. be familiar with the SNMMI recommendations for ¹⁸F-amyloid PET imaging and its multiple radiopharmaceutical options
12. know the target radiopharmaceutical of dopamine transporter which allows visualization of the active synapses in the corpus striatum
13. understand the cause and appearance of DaTScan in SPECT imaging of patients with parkinsonian diseases
14. understand the potential effect of ¹²³I-ioflupane on the thyroid gland and what can be done to alleviate these concerns
15. be familiar with some aspects of t-based PET radiopharmaceuticals
16. know the type(s) of abnormal t protein accumulated by diseases that demonstrate the most radiotracer accumulation
17. know how quantitative measurements can currently be performed for neurologic PET studies, even though extensive data required to standardize uptake values in neurologic PET imaging does not yet exist
18. know the relative quantitative value that reflects the number of standard deviations of abnormal uptake from that of a normal distribution of uptake
19. be familiar with the neurodegenerative diseases of the tauopathies category
20. understand the pros and cons of utilizing beta-amyloid PET imaging in the evaluation of a patient for Alzheimer disease
21. know the entities that make up the alpha-synucleinophathy subgroup of neurodegenerative diseases
22. be familiar with how imaging of alpha-synucleinopathies can currently be performed clinically
23. know how Alzheimer disease is characterized histopathologically
24. be familiar with the t protein deposition in the various stages of the Braak staging system
25. be familiar with the diagnostic criteria for Alzheimer disease diagnosis
26. be familiar with the pattern of atrophic changes in Alzheimer disease on structural MRI
27. know the typical areas of hypometabolic activity in Alzheimer disease at ¹⁸F-FDG PET imaging
28. understand the value of negative amyloid imaging agent uptake on the assessment for Alzheimer disease
29. understand the progression of Lewy bodies according to the Braak staging system for Lewy body aggregation
30. understand the differences between the progression of clinical symptoms among the various neurodegenerative diseases
31. know how to differentiate DLB from Alzheimer disease at ¹⁸F-FDG PET imaging
32. be familiar with the grouping of similar tauopathies described by the term “frontotemporal lobar degeneration”
33. know how to differentiate FTLDs from DLB and Alzheimer disease at ¹⁸F-FDG PET imaging
34. be familiar with the typical vascular insults found in vascular dementia patients at MRI
35. be familiar with the imaging appearance of various neurologic processes for neurodegenerative diseases