Journal
JAMA NEUROLOGY
Volume 77, Issue 9, Pages 1141-1149Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jamaneurol.2020.1319
Keywords
-
Categories
Funding
- European Union [666992]
- National Institutes of Health [P01AI106705, R01NS083687, P01A107774]
- Charles S. Britton Fund
- Centers for Disease Control and Prevention [NU2GCK000434]
Ask authors/readers for more resources
Importance Early diagnosis is a requirement for future treatment of prion diseases. Magnetic resonance imaging (MRI) with diffusion-weighted images and improved real-time quaking-induced conversion (RT-QuIC) in cerebrospinal fluid (CSF) have emerged as reliable tests. Objectives To assess the sensitivity and specificity of diffusion MRI for the diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) with a new criterion (index test) of at least 1 positive brain region among the cortex of the frontal, parietal, temporal, and occipital lobes; the caudate; the putamen; and the thalamus. Design, Setting, and Participants This diagnostic study with a prospective and a retrospective arm was performed from January 1, 2003, to October 31, 2018. MRIs were collected from 1387 patients with suspected sCJD consecutively referred to the National Prion Disease Pathology Surveillance Center as part of a consultation service. Intervention Magnetic resonance imaging. Four neuroradiologists blinded to the diagnosis scored the MRIs of 200 randomly selected patients. One neuroradiologist scored the MRIs of all patients. Main Outcomes and Measures Sensitivity and specificity of the index test compared with currently used criteria and CSF diagnostic (improved RT-QuIC, 14-3-3, and tau CSF tests). Results A total of 872 patients matched the inclusion criteria (diffusion MRI and autopsy-confirmed diagnosis), with 619 having sCJD, 102 having other prion diseases, and 151 having nonprion disease. The primary analysis included 200 patients (mean [SD] age, 63.6 [12.9] years; 100 [50.0%] male). Sensitivity of the index test of 4 neuroradiologists was 90% to 95% and superior to sensitivity of current MRI criteria (69%-76%), whereas specificity was 90% to 100% and unchanged. Interrater reliability of the 4 neuroradiologists was high (kappa = 0.81), and individual intrarater reliability was excellent (kappa >= 0.87). The sensitivity of the index test of 1 neuroradiologist for 770 patients was 92.1% (95% CI, 89.7%-94.1%) and the specificity was 97.4% (95% CI, 93.4%-99.3%) compared with a sensitivity of 69.8% (95% CI, 66.0%-73.4%; P < .001) and a specificity of 98.0% (95% CI, 94.3%-99.6%; P > .99) according to the current criteria. For 88 patients, index test sensitivity (94.9%; 95% CI, 87.5%-98.6%) and specificity (100%; 95% CI, 66.4%-100%) were similar to those of improved RT-QuIC (86.1% [95% CI, 76.5%-92.8%] and 100% [95% CI, 66.4%-100%], respectively). Lower specificities were found for 14-3-3 and tau CSF tests in 452 patients. Conclusions and Relevance In this study, the diagnostic performance of diffusion MRI with the new criterion was superior to that of current standard criteria and similar to that of improved RT-QuIC. These results may have important clinical implications because MRI is noninvasive and typically prescribed at disease presentation. This diagnostic study assesses the sensitivity and specificity of diffusion magnetic resonance imaging with a new criterion of at least 1 positive brain region for the diagnosis of sporadic Creutzfeldt-Jakob disease. Question Is diffusion magnetic resonance imaging (MRI) using a new criterion of at least 1 positive brain region for diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) more accurate than currently used criteria and 3 commonly used cerebrospinal fluid tests? Findings In this diagnostic study of 1387 patients with suspected sCJD, the new criterion increased the sensitivity of MRI for autopsy-confirmed sCJD compared with current applied criteria. The diagnostic performance of diffusion MRI was comparable with the improved version of the real-time quaking-induced conversion test in cerebrospinal fluid. Meaning The findings suggest that diffusion MRI is an accurate test for establishing a diagnosis of prion diseases in the appropriate clinical context.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available