Brain imaging

Structural and functional brain imaging has strongly improved the recognition of frontal and frontotemporal degeneration in FTD. Cortical atrophy with more or less frontal focal accentuation is shown with CT and magnetic resonance imaging (MRI).(9,33) MRI may show significantly more prevalent and severe periventricular hyperintense deep white-matter lesions in FTD patients than in matched normal controls. (34) The differential diagnosis from vascular dementia with frontal subcortical lesions, but lacking large cortical infarctions, may be difficult.

Brain imaging of metabolism and regional cerebral blood flow has radically improved recognition and differential diagnosis of dementing diseases. The frontotemporal regional cerebral blood flow abnormalities in FTD shown with xenon clearance technique, single-photon emission CT ( SPECT) (Plate 12), and positron emission tomography (PET) contrast with the temporoparietal pathology in Alzheimer's disease.(3 36. and 3Z» The findings are not disease specific, but are also found in vascular brain damage, in Alzheimer's disease with marked frontal-lobe involvement, k^» and in progressive supranuclear palsy. The regional cerebral blood flow pathology in progressive aphasia is most pronounced in the left hemisphere. (H)

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