_{Published January 21, 2022}

Allison M. Grayev

Associate Professor of Radiology, Neuroradiology Section Director, Spine Imaging
Associate Residency Program Director
University of Wisconsin School of Medicine and Public Health

Chadwick L. Wright

Assistant Professor, Department of Radiology
Division of Molecular Imaging and Nuclear Medicine
Wright Center of Innovation in Biomedical Imaging
The Ohio State University Wexner Medical Center

Although these two populations—epilepsy patients and dementia patients—may seem very different at first glance, they share a number of important characteristics. Their clinical presentation is often myriad and varied, and early diagnosis leads to better long-term outcomes and more efficient health care utilization. Radiology is often critical for the proper diagnosis and management of these patients. To best utilize imaging resources and interpret studies, we will explore anatomic and functional considerations in these disease processes during our Sunday Featured Session, “Multimodality Approach to Epilepsy and Dementia,” at the 2022 ARRS Annual Meeting in New Orleans, LA.

In 2020, the estimated health care costs for Alzheimer treatment alone was estimated at $305 billion, not including other causes of dementia. It is even more difficult to quantify the monetary cost of epilepsy treatment, much less the cost of quality of life issues. Often times a combined approach with multiple imaging modalities is needed to accurately diagnosis these conditions—but where do we start, and how do we integrate the information?

Higher-resolution anatomic imaging, including diffusion tensor imaging, holds promise in both conditions, but it often serves as an entry point into the diagnostic algorithm. Artificial intelligence has gained traction in automatic segmentation of brain parenchyma, theoretically allowing a more precise localization of volume loss, which can be seen in selective areas in both conditions. This may allow stratification of patients in a community setting, before potential referral to a tertiary center for further evaluation.

Having a working understanding of available molecular imaging agents is also critical for optimizing patient evaluation. Although fluorine-18 fluorodeoxyglucose (¹⁸FDG) is in common use for oncologic PET, there is applicability in neurodegenerative imaging, potentially allowing the identification of relatively hypometabolic areas prior to the development of anatomic changes. Additional neurodegenerative PET imaging agents target amyloid and tau protein deposition. Brain perfusion nuclear medicine imaging, as well as ¹⁸FDG-PET, can also be helpful in the assessment and localization of epileptogenic foci.

The goal of our “Multimodality Approach to Epilepsy and Dementia” session is to explore a different utility of anatomic and molecular imaging in the evaluation of patients with these challenging neurological disorders, allowing radiologists to better understand potential imaging algorithms and advanced diagnostic tests.