PURPOSE: To describe the magnetic resonance (MR) imaging appearance of
Creutzfeldt-Jakob disease (CJD). MATERIALS AND METHODS: MR images obt
ained in 29 patients who died of CJD (aged 53-77 years at death) were
retrospectively reviewed by three neuroradiologists blinded to the dia
gnosis. RESULTS: Moderate to marked bilateral, symmetrically increased
signal intensity was demonstrated in the putamen and caudate nucleus
on T2- and proton-density-weighted MR images in 23 patients (79%). In
six patients (21%), images showed no major signal intensity abnormalit
ies. T1-weighted images revealed no signal intensity abnormalities and
no contrast material enhancement. The degree of atrophy in the cortex
and basal ganglia corresponded to the time between onset of symptoms
and MR imaging. All patients with a disease duration of longer than 4
months had substantial volume loss. CONCLUSION: Although approximately
20% of the patients did not have MR imaging abnormalities, MR imaging
did show signal intensity alterations due to gliosis and spongiform c
hanges early in the course of CJD in the remaining 80%. The demonstrat
ion of bilateral areas of increased signal intensity that predominantl
y affected the caudate nuclei and the putamina on long-repetition-time
MR images in an elderly patient with rapidly progressive dementia rep
resents a specific finding and clearly should suggest the diagnosis of
CJD.