A discriminative event-based model for subtype diagnosis of sporadic Creutzfeldt-Jakob disease using brain MRI

Vikram Venkatraghavan, Riccardo Pascuzzo, Esther E. Bron, Marco Moscatelli, Marina Grisoli, Amy Pickens, Mark L. Cohen, Lawrence B. Schonberger, Pierluigi Gambetti, Brian S. Appleby, Stefan Klein, Alberto Bizzi

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)


Introduction: Sporadic Creutzfeldt-Jakob disease (sCJD) comprises multiple subtypes (MM1, MM2, MV1, MV2C, MV2K, VV1, and VV2) with distinct disease durations and spatiotemporal cascades of brain lesions. Our goal was to establish the ante mortem diagnosis of sCJD subtype, based on patient-specific estimates of the spatiotemporal cascade of lesions detected by diffusion-weighted magnetic resonance imaging (DWI). Methods: We included 488 patients with autopsy-confirmed diagnosis of sCJD subtype and 50 patients with exclusion of prion disease. We applied a discriminative event-based model (DEBM) to infer the spatiotemporal cascades of lesions, derived from the DWI scores of 12 brain regions assigned by three neuroradiologists. Based on the DEBM cascades and the prion protein genotype at codon 129, we developed and validated a novel algorithm for the diagnosis of the sCJD subtype. Results: Cascades of MM1, MM2, MV1, MV2C, and VV1 originated in the parietal cortex and, following subtype-specific orderings of propagation, went toward the striatum, thalamus, and cerebellum; conversely, VV2 and MV2K cascades showed a striatum-to-cortex propagation. The proposed algorithm achieved 76.5% balanced accuracy for the sCJD subtype diagnosis, with low rater dependency (differences in accuracy of ± 1% among neuroradiologists). Discussion: Ante mortem diagnosis of sCJD subtype is feasible with this novel data-driven approach, and it may be valuable for patient prognostication, stratification in targeted clinical trials, and future therapeutics. Highlights: Subtype diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) is achievable with diffusion MRI. Cascades of diffusion MRI abnormalities in the brain are subtype-specific in sCJD. We proposed a diagnostic algorithm based on cascades of diffusion MRI abnormalities and demonstrated that it is accurate. Our method may aid early diagnosis, prognosis, stratification in clinical trials, and future therapeutics. The present approach is applicable to other neurodegenerative diseases, enhancing the differential diagnoses.
Original languageEnglish
Pages (from-to)3261-3271
Number of pages11
JournalAlzheimer's and Dementia
Issue number8
Early online date2023
Publication statusPublished - Aug 2023


  • Creutzfeldt-Jakob disease
  • diffusion-weighted MRI
  • discriminative event-based modeling
  • disease progression
  • prion disease
  • subtype diagnosis

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