A Clinical Approach to Structural Neuroimaging in Dementia-View Presentation Slides

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The presentation "A Clinical Approach to Structural Neuroimaging in Dementia" by Dr. Vimal M. Aga provides a comprehensive overview of the clinical utility of MRI and CT imaging in dementia diagnosis and management. MRI remains the preferred initial imaging modality to assess brain anatomy and atrophy patterns without radiation exposure, while CT is useful in certain clinical scenarios like emergency cases or for patients with contraindications to MRI.<br /><br />The lecture covers MRI physics fundamentals, including pulse sequences (Spin Echo, Gradient Echo) and weighting techniques (T1, T2, Proton density) that enhance contrast and lesion detection. Understanding imaging planes—axial, sagittal, and coronal—helps accurately evaluate relevant brain structures such as the hippocampus, posterior cingulate cortex, and frontal lobes.<br /><br />Visual rating scales like Scheltens’ Medial Temporal Atrophy (MTA) and ERICA score assist in quantifying medial temporal lobe atrophy indicative of Alzheimer’s disease (AD). Case studies illustrate typical MRI findings in amnestic AD, frontotemporal dementia (FTD), and early-onset AD variants, emphasizing patterns of asymmetric temporal atrophy, posterior atrophy, and signal changes. The use of volumetric software (e.g., NeuroQuant) complements visual analysis.<br /><br />White matter hyperintensities (WMH), cerebral microbleeds (CMB), and enlarged perivascular spaces are assessed using standardized rating scales (Fazekas, STRIVE) to evaluate vascular contributions to cognitive impairment (VCI). Differentiating vascular pathology from neurodegeneration is crucial since mixed pathologies frequently coexist in dementia patients.<br /><br />The presentation highlights imaging abnormalities related to anti-amyloid therapies, notably amyloid-related imaging abnormalities (ARIA), detectable via specialized MRI sequences. These can present as microhemorrhages or vasogenic edema and require careful monitoring.<br /><br />Final thoughts emphasize that structural neuroimaging reveals downstream effects of diverse pathologies; thus, multiplex patterns of atrophy and signal change are common. Clinical correlation is essential to interpret imaging findings accurately. The discussion recommends a personalized, consistent approach to MRI reading integrated with clinical and biomarker data to optimize dementia diagnosis and care.

Keywords

Structural neuroimaging

Dementia diagnosis

MRI imaging

CT imaging

Medial Temporal Atrophy (MTA)

Alzheimer's disease

White matter hyperintensities (WMH)

Amyloid-related imaging abnormalities (ARIA)

Vascular cognitive impairment (VCI)

Volumetric software NeuroQuant