Interactive Transcript
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Hi. My name is Suzie Bash.
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I'm a neuroradiologist at RadNet.
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And thank you so much for joining us today
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for this dementia mastery series.
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These are a few disclosures.
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So, there are a lot of different causes
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of significant memory loss
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that can result in a clinical picture of dementia.
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Now, some of these include Alzheimer's disease,
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vascular dementia, dementia with Lewy bodies,
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frontotemporal dementia,
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logopenic progressive aphasia,
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traumatic brain injury,
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cerebral amyloid angiopathy,
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CAA-related inflammation,
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and normal pressure hydrocephalus.
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And then we'll talk about these,
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and we'll also focus on the multimodal imaging appearance
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and approach to the workup of these different diagnoses.
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And then we'll spend some time discussing
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what causes dementia,
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as well as potential disease-modifying therapy
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and the imaging impact for patients that are on therapy.
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So, when a patient presents with memory loss,
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they'll often see a neurologist,
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and then they will do cognitive testing,
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such as a mini mental status exam, etc.
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And the neurologist will often order an MRI of the brain,
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and that's also typically to rule out any other
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pathology that may be causing memory loss.
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And it's at this point in time that we encourage the
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neurologist to order a quantitative
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volumetric imaging study.
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I've been using these in my clinical practice for the
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past 16 years.
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Our referring neurologists love it,
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and so we'll talk in more detail about that.
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And then if there remains clinical ambiguity,
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sometimes a PET is ordered.
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So there are three different PETs that we use for dementia.
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FDG PET, amyloid PET, and Tau PET.
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Right now, FDG is the only one that's covered by CMS,
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so we get that ordered much more frequently.
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Back during the ideas trial, I read over 200 amyloid PETs,
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but it's almost cost prohibitive for patients out of
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pocket these days.
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And then tau also is very useful,
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but again, not covered by insurance.
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So this is what a PET CT looks like.
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Here's a PET MR fusion.
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Here's the PET CT fusion.
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You see cortical hypometabolism
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in the bilateral temporal lobes.
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And so, this is a patient with Alzheimer's disease.
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Had we gone up higher,
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we'd also see hypometabolism in the parietal
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lobes and the posterior cingulate gyri.
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And this is what a positive amyloid PET looks like.
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You have diffuse binding of the tracer to the cortex.
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This is grayscale. This is color.
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And just for your reference,
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this is what an amyloid PET would look like where we have
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this sort of tree and branch pattern,
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where the white matter looks dark but the cortex looks light.
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