Expert consensus on neuroimaging diagnosis of dementia and cognitive impairment (2023)

Abstract

Abstract:

For patients with cognitive impairment as the main clinical manifestation, structural MRI (or CT instead) should be performed first to clarify intracranial lesions and brain atrophy. For patients with specific clinical manifestations, specific MRI sequences is recommended to further assist diagnosis. If the patient is suspected of AD, it is recommended to perform oblique coronal T1WI for MTA grading to score medial temporal lobe atrophy. If the patient is suspected to be caused by vascular factors or special infections (prion proteins), it is recommended to perform diffusion-weighted imaging. If the patient has extrapyramidal symptoms or small vessel disease, especially cerebral amyloid angiopathy or cognitive impairment complicated by diabetes, it is recommended to perform susceptibility-weighted imaging. If a mass is suspicious on MRI, contrast-enhanced MR imaging and MR spectroscopy should be performed. If the patient has amyotrophic lateral sclerosis, it is recommended to perform diffusion tensor imaging. If the patient is suspected to be caused by neurodegenerative diseases, it is recommended to perform¹⁸F-FDG PET and Aβ-PET or tau-PET. Aβ-PET imaging and tau-PET imaging can visualize the degree and scope of pathological protein deposition in the brain, which has important predictive and diagnostic value for dementia and can be used for the differential diagnosis of dementia and staging the disease progression. In addition, resting-state functional magnetic resonance imaging, near-infrared spectroscopy, and some emerging imaging techniques such as cine phase-contrast magnetic resonance imaging, and diffusion tensor image analysis along the perivascular space have been studied in patients with cognitive impairment. It is expected that these technologies can be used in the future to better assist the diagnosis and differential diagnosis of cognitive impairment. It should be noted that neuroimaging does not represent the complete diagnosis and clinical symptoms of the disease and must be interpreted with caution.

Key words:Dementia,Cognitive impairment,Alzheimer’s disease,Neuroimaging,Expert Consensus

CLC Number:

Aging and Cognitive Impairment Branch of Shanghai Society of Aging and Degenerative Diseases. Expert consensus on neuroimaging diagnosis of dementia and cognitive impairment (2023)[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(01): 30-39.

Figures/Tables6

Table 1

Recommendations when choosing a sequence for structural MRI

	推荐加做序列	推荐人群	推荐依据
所有可疑认知障碍患者需完善T₁WI、T₂WI、FLAIR像（水平位+海马冠状位）	斜冠状位T1W1	疑似AD患者	从认知正常人群中鉴别出AD源性痴呆的MTA界值分别是，50-64岁≥1.0（灵敏度和特异度分别为 92.3% 和 68.4%），65~74岁≥1.5（灵敏度和特异度分别为 90.4% 和 85.2%），75~84岁≥2.0（灵敏度和特异度分别为70.8%和82.3%）^{[ 6 ]}。
	弥散加权成像	疑似血管性因素或特殊感染（朊蛋白）导致的认知障碍患者	对于朊蛋白病的诊断能力，灵敏度为90%~95%，特异度为90% 到 100%^{[ 8 ]}。
	磁敏感加权成像	疑似合并锥体外系症状和（或）小血管病变，尤其是CAA及并发糖尿病的认知障碍患者	在CAA病例中，评估者在SWI序列上评估微出血的评估者之间的可靠性良好（组内r=0.87）^{[ 9 ]}。
	增强MRI和MRS	常规MRI发现关键脑结构可疑占位的患者	利用Cho峰和NAA峰可将肿瘤和非肿瘤鉴别，其AUC为0.94，特异度86%，灵敏度90%^{[ 10 ]}。
	DTI	疑似合并ALS的认知障碍患者，如bvFTD	一项荟萃分析纳入8项研究143例ALS患者和145名健康对照，发现ALS额叶白质，扣带回以及内囊后肢的FA减少^{[ 11 ]}。

Table 1

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