Dementia imaging in clinical practice: a European-wide survey of 193 centres and conclusions by the ESNR working group

M W Vernooij,R Schmidt,M Smits,T A Yousry,G B Frisoni,S Haller,S Haller,S Haller,F Barkhof,F Barkhof,F B Pizzini,N Bargallo

doi:10.1007/s00234-019-02188-y

Abstract

PurposeThrough a European-wide survey, we assessed the current clinical practice of imaging in the primary evaluation of dementia, with respect to standardised imaging, evaluation and reporting.MethodsAn online questionnaire was emailed to all European Society of Neuroradiology (ESNR) members (n = 1662) and non-members who had expressed their interest in ESNR activities in the past (n = 6400). The questionnaire featured 42 individual items, divided into multiple choice, single best choice and free text answers. Information was gathered on the context of the practices, available and preferred imaging modalities, applied imaging protocols and standards for interpretation, reporting and communication.ResultsA total of 193 unique (non-duplicate) entries from the European academic and non-academic institutions were received from a total of 28 countries. Of these, 75% were neuroradiologists, 12% general radiologists and 11% (neuro) radiologists in training. Of responding centres, 38% performed more than five scans/week for suspected dementia. MRI was primarily used in 72% of centres. Over 90% of centres acquired a combination of T2w, FLAIR, T1w, DWI and T2*w sequences. Visual rating scales were used in 75% of centres, most often the Fazekas and medial temporal atrophy scale; 32% of respondents lacked full confidence in their use. Only 23% of centres performed volumetric analysis. A minority of centres (28%) used structured reports.ConclusionsCurrent practice in dementia imaging is fairly homogeneous across Europe, in terms of image acquisition and image interpretation. Hurdles identified include training on the use of visual rating scales, implementation of volumetric assessment and structured reporting.

Highlights

Worldwide populations are ageing, with an accompanying increase in prevalence of cognitive problems and dementia
50 million people worldwide are living with dementia, of whom the majority with Alzheimer’s disease as its most common subtype, and this number is predicted to double every 20 years to reach over 130 million by 2050 [1]
Brain imaging plays a key role in the diagnosis and evaluation of patients suspected of dementia

Summary

Introduction

With an accompanying increase in prevalence of cognitive problems and dementia. Structural imaging, either with computed tomography (CT) or magnetic resonance imaging (MRI), is recommended at least once in the diagnostic workup of patients with cognitive impairment [2] Whereas these exams initially served the goal to exclude alternative causes of dementia than neurodegeneration, which are potentially treatable (e.g. subdural hematomas or brain tumours), progressive insight has led to a role of imaging markers to help establish a positive diagnosis of dementia subtype. The latter is of increasing importance in light of prognosis, disease-modifying therapies and emerging treatment options. This is reflected by the inclusion of neuroimaging markers into the diagnostic and research criteria for Alzheimer’s disease [5,6,7] and for vascular dementia [8, 9]

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Conclusion