MR spectroscopy is a research tool and, to date, does not appear to clinically help establish a diagnosis of VaD or mixed VaD and AD. MRA Head Although vascular imaging is not needed for diagnosis of suspected VaD, MRA is a sensitive modality to detect vascular occlusion or stenosis intracranially. MRA Neck Vascular imaging is not needed for workup of suspected VaD. MRI functional (fMRI) Head The use of fMRI is investigational and, to date, does not appear to clinically help establish a diagnosis of VaD or mixed VaD and AD. MRI Head One of the roles of neuroimaging is to document the presence or absence of strokes. Although CT can detect the presence or absence of infarctions in patients with dementia, histopathologically verified cases of VaD with normal CT studies have been reported [28]. Thus, MRI is preferable to CT for detecting vascular lesions in patients with dementia. On MRI, evidence for vascular abnormalities includes cortical or subcortical infarcts, leukoariosis or white matter T2 hyperintensity, microhemorrhages, and lacunar infarct. Hippocampal atrophy has been seen in patients with vascular cognitive impairment [64], and some studies have argued that it is the best predictor of post stroke dementia [65]. The above-mentioned imaging findings on routine MRI lack specificity and correlation with degree of cognitive impairment. Diffusion tensor imaging has been shown to correlate better with cognitive deficits, but its use has been confined to research settings [66]. Differentiation of VaD from either AD with superimposed cerebrovascular disease or mixed AD and VaD is especially difficult and is best performed by amyloid PET/CT brain. On MRI, extensive infarctions (cortical or Dementia lacunar or both) and white-matter changes (hyperintense on T2-weighted MRI) in a patient with dementia favor a contribution from VaD or mixed VaD and AD over AD. The absence or mild extent of these changes in a patient with dementia argues against a diagnosis of VaD.
Dementia. MR spectroscopy is a research tool and, to date, does not appear to clinically help establish a diagnosis of VaD or mixed VaD and AD. MRA Head Although vascular imaging is not needed for diagnosis of suspected VaD, MRA is a sensitive modality to detect vascular occlusion or stenosis intracranially. MRA Neck Vascular imaging is not needed for workup of suspected VaD. MRI functional (fMRI) Head The use of fMRI is investigational and, to date, does not appear to clinically help establish a diagnosis of VaD or mixed VaD and AD. MRI Head One of the roles of neuroimaging is to document the presence or absence of strokes. Although CT can detect the presence or absence of infarctions in patients with dementia, histopathologically verified cases of VaD with normal CT studies have been reported [28]. Thus, MRI is preferable to CT for detecting vascular lesions in patients with dementia. On MRI, evidence for vascular abnormalities includes cortical or subcortical infarcts, leukoariosis or white matter T2 hyperintensity, microhemorrhages, and lacunar infarct. Hippocampal atrophy has been seen in patients with vascular cognitive impairment [64], and some studies have argued that it is the best predictor of post stroke dementia [65]. The above-mentioned imaging findings on routine MRI lack specificity and correlation with degree of cognitive impairment. Diffusion tensor imaging has been shown to correlate better with cognitive deficits, but its use has been confined to research settings [66]. Differentiation of VaD from either AD with superimposed cerebrovascular disease or mixed AD and VaD is especially difficult and is best performed by amyloid PET/CT brain. On MRI, extensive infarctions (cortical or Dementia lacunar or both) and white-matter changes (hyperintense on T2-weighted MRI) in a patient with dementia favor a contribution from VaD or mixed VaD and AD over AD. The absence or mild extent of these changes in a patient with dementia argues against a diagnosis of VaD.