Introduction
Patient History
A 65-year-old female with a two-year history of acute onset difficulty with expressive speech.
No other associated neurological problems.
Materials and Methods
MRI was performed on the MAGNETOM Vida (3.0T, Siemens Healthineers Medical Systems, Erlangen, Germany)
using a 64-Channel Head & Neck coil. Three-dimensional (3-D) T1-weighted images were obtained to perform morphometry analysis. Morphometry was performed using MR Neurology Workflow.
Case Presentation
Fig.B - Coronal T1 shows the atrophic changes in the left temporal and insular regions.
Examination
MRI brain examination was performed with contrast. The findings included uneven involutional changes, notably towards the left frontal, left temporal, and left insular/sub-insular regions. The study also showed small vessel disease (Fazekas II).In a previous MRI study with the same findings, the preferential left-side involutional changes couldn’t be identified by the radiologist.
In the current study, MRI morphometry confirmed and eased the diagnosis with confidence, as shown in the morphometry report.
The suggested diagnosis based on the imaging findings is progressive non-fluent aphasia (PNFA).
Conclusion
PNFA is a rare neurodegenerative disorder mainly characterized by increasing language impairment. The imaging-supported diagnosis of PNFA would include both of the following:
1. Clinical diagnosis of non-fluent/agrammatic variant primary progressive aphasia.
2. Imaging showing predominant left posterior fronto-insular atrophy on MRI and/or predominant left posterior fronto-insular hypoperfusion on SPECT or PET.
Radiographic features
In the context of PNFA, radiographic features generally exhibit variable atrophy, with more pronounced effects in the posterior frontal, insular cortex, and temporal lobe, including the hippocampus. This left hemisphere predominance is a hallmark feature, aiding in the understanding of the specific anatomical characteristics and progression of the disease.
The utilization of advanced imaging techniques, particularly MRI morphometry, not only enhances the accuracy of diagnosis but also contributes to a more comprehensive understanding of the disease’s impact on neural structures. These advancements in diagnostic imaging are crucial for refining treatment strategies and improving patient outcomes.
Contact
Aviv Clinic, Dubai, UAE