Multimodality Imaging of Amyloid-Related Diseases of the CNS

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 14, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.75
Procedures: 0.75
Head, Spine, and Musculoskeletal: 0.75

Magnetic Resonance Imaging: 0.75
Procedures: 0.75
Neurological: 0.75

Nuclear Medicine Technology: 0.75
Procedures: 0.75
Other Imaging Procedures: 0.75

Registered Radiologist Assistant: 2.25
Procedures: 2.25
Neurological, Vascular, and Lymphatic Sections: 2.25

Outline

1. Introduction
2. Characteristics of A≤
3. Characteristics of AD
   1. Clinical Features
   2. Pathophysiology
   3. Imaging Features
      1. Findings at Structural Imaging
      2. Findings at FDG PET
      3. Findings at Amyloid PET
      4. Findings at Tau PET
4. Characteristics of CAA
   1. Clinical Features
   2. Pathophysiology
   3. Imaging Features
5. Characteristics of Inflammatory CAA
   1. Clinical Features
   2. Pathophysiology
   3. Imaging Features
6. Characteristics of Cerebral Amyloidoma
   1. Clinical Features
   2. Pathophysiology
   3. Imaging Features
7. Conclusion

Objectives

Upon completion of this course, students will:

1. list the common isoforms of Ab peptide
2. describe the percentage of patients with dementia that have AD or AD mixed with another type of dementia
3. identify the major cause of dementia that includes a clinical symptom of visual impairment
4. list the criteria associated with a diagnosis of probable AD
5. list the classes of medications that have been approved by the U.S. Food and Drug Administration to improve the cognitive symptoms of AD temporarily
6. identify the Ab-related disease that demonstrates a solidly enhancing mass at CT or MR imaging
7. describe the genetic mutation that increases an individual’s risk for AD up to 15-fold
8. identify the brain location where neurofibrillary tangles typically form first
9. list the CSF biomarkers that have been incorporated into the diagnostic guidelines for AD
10. identify the brain region that typically demonstrates gross neuropathologic changes in the setting of AD
11. describe the imaging modalities that may be particularly helpful when evaluating patients in whom the cause of dementia is uncertain
12. identify the lobes of the brain where cortical volume loss at structural imaging is more prominent in patients with AD
13. list the brain regions that demonstrate hypometabolism at FDG PET in the early stages of AD
14. identify the brain region in which FDG PET is not well suited to showing physiologic changes in patients with AD
15. describe the usefulness of FDG PET in distinguishing AD from other causes of dementia
16. list the AD indications for which FDG PET is reimbursed by Medicare and Medicaid
17. describe the chemical structure of the PET imaging agent Pittsburgh compound B (PiB)
18. identify the amyloid PET imaging agents that are approved by the U.S. FDA for clinical use in imaging patients with AD
19. list the patient conditions that can demonstrate Ab deposits in the brain
20. describe the appropriate use criteria for amyloid PET imaging
21. identify the brain regions that demonstrate increased uptake at tau PET imaging in a patient with AD
22. list the conditions that can demonstrate brain uptake of tau PET imaging agents
23. describe the comorbidities that are linked to increased prevalence of CAA
24. list the histologic features associated with a severe grade of CAA
25. identify the brain regions that demonstrate hemorrhage in patients with CAA
26. identify the lobes of the brain most frequently affected by cortical hemorrhages in patients with CAA
27. describe the imaging modality that is indicated in CAA patients with acute neurologic symptoms for exclusion of acute ischemic stroke
28. compare susceptibility-weighted MR imaging and gradient-echo MR sequences in the detection of cortical and subcortical microhemorrhages in CAA patients
29. identify the brain region that demonstrates a typical pattern of leukoencephalopathy at CT or MR imaging in patients with sporadic CAA
30. describe the Ab-related disease that demonstrates perivascular lymphocytic infiltrate with edematous gyri at autopsy
31. describe the Ab-related disease that demonstrates leptomeningeal enhancement in edematous areas at imaging
32. identify the Ab-related disease with an imaging appearance that closely resembles that of CAA-related inflammation
33. describe the rarest form of intracerebral Ab deposition
34. list the CNS conditions that may mimic amyloidoma at imaging
35. describe the MR imaging sequence that best demonstrates the perilesional edema associated with cerebral amyloidoma