title: Usefulness of high b-value diffusion-weighted MRI in the diagnosis of Creutzfeldt-Jakob disease.
abstract: BACKGROUND
  current diagnostic criteria of probable Creutzfeldt-Jakob disease (CJD) include a combination of clinical, EEG and analytic data. Recent data indicate that brain MRI including fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) sequences can be a valid and reliable tool for the diagnosis of CJD. We describe our experience with high b-value (3000s/mm(2)) diffusion-weighted imaging (DWI) in patients with probable or definite CJD and compare it with standard b-value (1000s/mm(2)) DWI.
  
  
  METHODS
  we performed a retrospective analysis of patients admitted to our Hospital Service between 2002 and 2008 with a final diagnosis of probable or definite CJD. Patients were examined using either a 1.5 Tesla or a 3 Tesla MRI. The MRI protocol included T1-weigthed spin-echo sequences, T2-weighted fast spin-echo, FLAIR and DWI sequences with high b-value and standard b-value.
  
  
  RESULTS
  during the study period there were 7 patients with probable or definite CJD. Only 3 patients (43%) showed changes on FLAIR sequence consistent with CJD. All the cases were detected with high b-value DWI, including 2 cases (28%) that would have been missed using standard b-value (1000s/mm(2)) DWI. In all the patients the changes were more conspicuous and extensive at high b-value DWI (b=3000s/mm(2)).
  
  
  CONCLUSIONS
  our data indicate that high b-value DWI may improve the sensitivity of brain MRI for the diagnosis of CJD, allowing the detection of some cases that would have been overlooked by conventional sequences.
authors.affiliation: Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain. eriva@ruberinternacional.es
authors.forename: E
authors.initials: E
authors.lastname: Riva-Amarante
authors.forename: A
authors.initials: A
authors.lastname: Jiménez-Huete
authors.forename: R
authors.initials: R
authors.lastname: Toledano
authors.forename: M
authors.initials: M
authors.lastname: Calero
authors.forename: J
authors.initials: J
authors.lastname: Alvarez-Linera
authors.forename: J
authors.initials: J
authors.lastname: Escribano
authors.forename: M J
authors.initials: MJ
authors.lastname: Sánchez Migallón
authors.forename: O
authors.initials: O
authors.lastname: Franch
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001921:Brain / Q000473:pathology; D007562:Creutzfeldt-Jakob Syndrome / Q000175:diagnosis* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies