Lea Alhilali, MD

@teachplaygrub

16 Tweets • 2023-02-22 •  See on Twitter

rattibha.com 

1/Having trouble remembering how to differentiate

dementias on imaging?

Here’s a #tweetorial to show you how to remember the

imaging findings in dementia & never forget!

#medtwitter #meded #neurorad #radres #dementia

#alzheimers #neurotwitter #neurology #FOAMed
#FOAMrad #PET
2/The most common functional imaging used in
dementia is FDG PET. And the most common
dementia is Alzheimer’s disease (AD).

On PET, AD demonstrates a typical Nike swoosh

pattern—with decreased metabolism in the parietal &
temporal regions
3/The swoosh rapidly tapers anteriorly—& so does
hypometabolism in AD in the temporal lobe. It usually
spares the anterior temporal poles.

So in AD look for a rapidly tapering Nike swoosh,

w/hypometabolism in the parietal/temporal regions—
sparing the anterior temporal pole
4/Medially, in AD, there’s involvement of the
precuneus & posterior cingulate. In fact, the earliest
AD findings may be in the precuneus

So medially, instead of a Nike swoosh, you see an

Adidas logo—w/a wedge in the region of the
precuneus widening anteriorly to the cingulate
5/So in AD, look for the sneaker signs:

—Adidas logo medially in the region of the precuneus

—Nike swoosh along the parietal & temporal regions,

sparing the anterior temporal pole.

So if you see sneaker logos—it’s AD. Just call it!

6/Dementia w/Lewy Bodies (DLB) also has
temporoparietal hypometabolism—but it also involves
the occipital cortex—a very specific finding for DLB.
DLB also extends to the ant. temporal cortex.

Together, these regions of hypometabolism look more

like an L. And Lewy starts w/an L
7/Next is frontotemporal dementia. As one might
expect, it has hypometabolism in…wait for it…the
frontal & temporal regions. This is one for Captain
Obvious. However, it is a little more complicated than
that.
8/Medially, frontotemporal dementia involves the
anterior cingulate gyrus. I remember this bc the
involvement of the anterior cingulate gyrus makes a
hook—so it looks like a lowercase letter f—and
frontotemporal starts with f
9/There are also variants of frontotemporal dementia
that will not show the classic frontal & temporal
involvement.

First, is the frontal variant. This only involves the

frontal lobe. It presents w/disinhibition as one would
expect to see with frontal lobe involvement
10/Temporal variant involves temporal lobe only.
Language processing is here (Wernicke’s anyone?).
So this presents w/language difficulties (semantic
dementia)

So you DON’T have to have BOTH frontal & temporal

involvement to have frontotemporal dementia bc there
are variants
11/Corticobasilar degeneration involves the
sensorimotor cortex & basal ganglia.

I remember this bc CORTICObasilar goes along the

CORTICOspinal tract—so it has hypometabolism at
the home of the corticospinal tract, the sensorimotor
cortex
12/You also see basal ganglia & thalamus
hypometabolism in corticobasilar degeneration. This
makes sense bc corticobasilar contains “BASilar”
referring to the BASal ganglia

So the 2 regions of hypometabolism in corticobasilar

degeneration are in the name—cortex & basal ganglia
13/A rare dementia is posterior cerebral atrophy
(PCA). As its name implies, hypometabolism is
POSTERIOR—occipital cortex & post temporal lobe

I like to call it posterior CAPE atrophy bc the

distribution looks a cape—w/arms (ant temporal lobes)
sticking out from under the cape
14/You might say PCA looks like Lewy Body dementia
—but PCA doesn’t usuallly involve the ant temporal
lobes

So the ant temp lobe involvement that gave Lewy

body its L shape is cut short—making the PCA
distribution look more like a c than an L

Remember C is PCA & L is Lewy body

15/Finally, vascular dementia has a variable
distribution, depending on the regions infarcted (V is
both for Vascular & Variable)

These patients may have wedged shaped regions of

hypometabolism corresponding to cortical infarcts—
remember this bc a wedge is just an inverted V.
16/So now you know the patterns of hypometabolism
on PET for the major dementias

This list isn’t all inclusive & there can be variations or

even mixed dementias

But hopefully this gives you a starting point you won’t

soon forget!
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