Magnetic resonance imaging of corticobasal degeneration

The purpose of this paper is to clarify the frequency of each magnetic resonance (MR) finding in corticobasal degeneration (CBD) patients, and to evaluate correlations between the predominant side of MR findings and the most affected side of cortical dysfunction and extrapyramidal symptoms. In 30 patients with clinically diagnosed CBD, MR images were reviewed retrospectively. Two experienced neuroradiologists evaluated previously reported MR findings of CBD (cortical atrophy, subcortical high intensity on T2WI, ventricular dilatation, atrophy of basal ganglia, high or low intensity of basal ganglia on T2WI, and atrophy of corpus callosum) using a 4 step-scale (absent, mild, moderate, and severe). Asymmetrical changes in the cortex and basal ganglia were also evaluated. A neurologist reviewed clinical records of all 30 patients and determined the most affected side of cortical dysfunction and extrapyramidal symptoms. Cortical atrophy was observed in all 30 CBD patients (mild=10, moderate=14, severe=6), particularly at paracentral region (17/30), frontotemporal lobe (6/30), and whole cerebrum (7/30). Other findings such as subcortical high intensity on T2WI (n=11), ventricular dilatation (n=26), atrophy of basal ganglia (n=16), high or low intensity of putamen on T2WI (n=15) were also observed. Asymmetrical atrophic and/or intensity changes were seen in cortex (n=26) and basal ganglia (n=13). Atrophy of corpus callosum was observed in 10 out of the 19 patients who underwent sagittal imaging, and was limited to the middle of corpus callosum. In 16 patients with predominantly left-sided body symptoms due to cortical dysfunction, MR images showed right dominant (n=12) or symmetrical (n=4) cortical atrophy. All 13 patients with predominantly right body symptoms due to cortical dysfunction showed left dominant cortical atrophy on MR images. In 13 patients with predominantly left body extrapyramidal symptoms, MR images showed right dominant (n=3), symmetrical (n=4), or no (n=6) atrophic and/or intensity changes of basal ganglia. In 16 patients with predominantly right body extrapyramidal symptoms, MR images showed left dominant (n=10), symmetrical (n=1), or no (n=5) atrophic and/or intensity changes of basal ganglia. MR findings of CBD were variable, but most of the patients showed asymmetrical cortical atrophy in the paracentral region. Some patients showed subcortical high intensity on T2WI, asymmetrical changes of basal ganglia, or atrophy in the middle of corpus callosum. Identifying this combination of these findings is useful in diagnosing CBD comprehensively. The side of prominent MR findings and most affected side of neurological dysfunction correlated closely. (author)