title: Serial diffusion-weighted MRI of Creutzfeldt-Jakob disease.
abstract: OBJECTIVE
  The objective of our study was to evaluate the clinical usefulness of MRI findings, including diffusion-weighted imaging, in relation to the clinical signs and symptoms of Creutzfeldt-Jakob disease (CJD).
  
  
  METHODS
  We reviewed nine cases of CJD in which MRI was performed from the early to terminal phase of the disease. MRI findings were correlated before (early phase) and after (intermediate phase) the onset of the characteristic clinical findings of myoclonus and periodic synchronous discharges on electroencephalograms. The chronologic changes in imaging findings were followed from the akinetic mutism to the terminal phase of the disease (terminal phase). T2-weighted images had been obtained in all the patients, and diffusion-weighted images and FLAIR images had been obtained in six patients. We evaluated the images for the presence and location of abnormal signal intensities.
  
  
  RESULTS
  During the early phase, the T2-weighted images showed no abnormal findings. The diffusion-weighted images, however, revealed abnormal high signal intensities in the cortex in all patients and in the basal ganglia in five patients. In two cases, there were abnormal signals on FLAIR images that corresponded to diffusion-weighted imaging abnormalities. During the intermediate phase, the area of the high signal intensities on the diffusion-weighted images had expanded and progressive cerebral atrophy had become apparent. During the terminal phase, abnormal high signal intensities in the cerebral cortex and basal ganglia on the diffusion-weighted images in one patient disappeared.
  
  
  CONCLUSIONS
  Diffusion-weighted imaging is extremely useful in detecting CJD during the very early phase-even before the onset of characteristic clinical findings.
authors.affiliation: Department of Radiology, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuzuki-ku, Yokohama 224-8503, Japan.
authors.forename: Ryutarou
authors.initials: R
authors.lastname: Ukisu
authors.forename: Tamio
authors.initials: T
authors.lastname: Kushihashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitanosono
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Fujisawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takenaka
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Ohgiya
authors.forename: Takehiko
authors.initials: T
authors.lastname: Gokan
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Munechika
mesh_terms: D000368:Aged; D007562:Creutzfeldt-Jakob Syndrome / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged