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title: "Frontotemporal Lobar Degeneration"
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docid: "49510d0e-acf7-45cb-9eb1-53f8193b0b6d"
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authors:
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- key: "1fa14dfd-71ea-4960-908e-e720313bc63a"
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value: "Santhosh Gaddikeri, MD"
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- key: "a25c450b-3d34-4f64-bba3-cc0834813df6"
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value: "Miral D. Jhaveri, MD, MBA"
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breadcrumbs:
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name: "Brain"
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slug: "brain"
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treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
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name: "Diagnosis"
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slug: "diagnosis"
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treeNodeId: "51c00394-446e-4a38-94af-d3b1d14d34e8"
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name: "Pathology-Based Diagnoses"
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slug: "pathology-based-diagnoses"
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treeNodeId: "d9d3a8ed-f21b-4831-8c77-591a3500ef77"
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name: "Acquired Toxic/Metabolic/Degenerative Disorders"
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slug: "acquired-toxicmetabolicdegenerativ-"
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treeNodeId: "ba3cfeaf-64d9-4117-91e8-d2ce58783fc5"
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name: "Dementias and Degenerative Disorders"
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slug: "dementias-and-degenerative-disorde-"
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treeNodeId: "6381104d-7a4c-4be5-bb19-3cd90837d547"
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-
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name: "Frontotemporal Lobar Degeneration"
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slug: "frontotemporal-lobar-degeneration"
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treeNodeId: null
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category: "Brain"
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cmeTopicId: "144a695e-95a4-4ec7-8df6-1c4db98375f6"
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documentVersionId: "857bab94-d633-4e44-a081-50f182d9ed83"
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imageCount: 30
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lastUpdated: "09/30/20"
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pageDescription: "Frontotemporal Lobar Degeneration"
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pageKeywords: "Brain, Diagnosis, Pathology-Based Diagnoses, Acquired Toxic/Metabolic/Degenerative Disorders, Dementias and Degenerative Disorders, Frontotemporal Lobar Degeneration"
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pageTitle: "Frontotemporal Lobar Degeneration | STATdx"
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enhancedTitle: "Frontotemporal Lobar Degeneration"
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type: "DX"
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references: true
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tables: 1
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breadcrumbs:
|
||||
- "Brain"
|
||||
- "Diagnosis"
|
||||
- "Pathology-Based Diagnoses"
|
||||
- "Acquired Toxic/Metabolic/Degenerative Disorders"
|
||||
- "Dementias and Degenerative Disorders"
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- "Frontotemporal Lobar Degeneration"
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---
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# KEY FACTS
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- ## Terminology
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- Clinical subtypes
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- Behavioral variant frontotemporal dementia **(bvFTD)**
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- Primary progressive aphasia syndromes **(PPA)**
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- Semantic variant **(sv-PPA)**: Previously known as semantic dementia
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- Nonfluent/agrammatic variant **(nfv-PPA)**: Previously known as progressive nonfluent aphasia
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- Logopenic variant **(lv-PPA)**
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- Frontotemporal dementia with motor symptoms
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- ## Imaging
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- Early
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- PET shows frontotemporal ↓ glucose metabolism
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- Late: Frontotemporal atrophy with knife-like gyri on MR
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- Subtypes have characteristic cortical atrophy patterns
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- ## Top Differential Diagnoses
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- Alzheimer dementia (AD)
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- Vascular dementia
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- Corticobasal ganglionic degeneration (CBD)
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- Dementia with Lewy bodies (DLB)
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- ## Clinical Issues
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- Clinical syndromes (some overlap)
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- **bvFTD**: Disinhibition, apathy & loss of empathy, hyperorality, & compulsive behavior
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- **sv-PPA**: Impaired single-word comprehension & object naming with preserved fluency, repetition, & grammar
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- **nfv-PPA**: Effortful speech production of phonemes (linguistic units of sound) & orofacial apraxia
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- **lv-PPA**: Impaired word finding & repetition with errors in speech & naming
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- Younger age group than AD
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- FTLD most common cause of early-onset (< 65 years) dementia
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- Median survival: 6-11 years from symptom onset & 3-4 years from diagnosis
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# TERMINOLOGY
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- ## Abbreviations
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- Frontotemporal lobar degeneration (FTLD)
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- Clinical subtypes
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- Behavioral variant frontotemporal dementia **(bvFTD)**
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- Primary progressive aphasia syndromes **(PPA)**
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- Semantic variant **(sv-PPA)**: Previously known as semantic dementia
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- Nonfluent/agrammatic variant **(nfv-PPA)**: Previously known as progressive nonfluent aphasia
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- Logopenic variant**(lv-PPA)**: Has Alzheimer pathology & is not included as 1 of 3 clinical FTD syndromes
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- Frontotemporal dementia (FTD) with motor symptoms
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- Corticobasal degeneration (CBD)
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- Progressive supranuclear palsy (PSP)
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- FTD with motor neuron disease
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- FTD with amyotrophic lateral sclerosis (ALS)
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- ## Synonyms
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- Pick disease no longer used
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- Referred to pathologic variant with Pick bodies
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- ## Definitions
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- Heterogeneous family of neurodegenerative disorders characterized by focal lobar degeneration of frontal &/or temporal lobes
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# IMAGING
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- ## General Features
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- ### Best diagnostic clue
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- Structural & functional imaging are supportive but not diagnostic of FTD
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- PET showing frontotemporal ↓ glucose metabolism
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- Anterior frontotemporal atrophy with knife-like gyri
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- ### Location
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- Anterior temporal/frontal lobes, orbitofrontal cortex, medial temporal region
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- Relative sparing of parietooccipital lobes
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- ### Morphology
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- Knife blade appearance of atrophic gyri
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- ± marked asymmetry
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- May have worst atrophy in dominant hemisphere
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- ## CT Findings
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- ### NECT
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- Frontal lobe atrophy often most prominent feature
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- ↑ size of frontal horns (larger than rest of lateral ventricles)
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- ## MR Findings
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- ### T1WI
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- Atrophy of frontal & temporal lobes, often asymmetric
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- Knife-like gyri with normal signal
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- Dilated frontal sulci reflecting atrophy
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- Relative sparing of parietooccipital lobes
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- ### T2WI
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- ± hyperintensity in frontotemporal white matter (WM)
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- ### FLAIR
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- ± hyperintensity in frontotemporal WM
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- ### MRS
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- ↓ NAA glutamate + glutamine (neuronal loss), ↑ myoinositol (↑ glial content) in frontal lobes
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- ↓ NAA in posterior cingulate gyri
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- Reflects ↓ neuronal population, viability
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- ± lactate peak in frontal lobes
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- MR voxel-based morphometry
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- Subtypes have characteristic cortical atrophy patterns
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- Frontal vs. temporal, left vs. right help discriminate
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- **bvFTD**: Atrophy of frontal & temporal lobes
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- Anterior insula, anterior cingulate, orbitofrontal cortex, & amygdala (early changes occur in right hemisphere)
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- **sv-PPA**: Typically anterior temporal lobe atrophy (asymmetric to left)
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- Entire temporal lobe can be involved
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- Ventromedial & superior frontal lobes
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- Right temporal atrophy as disease progresses
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- **nfv-PPA**: Selective left posterior frontoinsular region
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- **lv-PPA**: Predominant atrophy of left posterior temporal cortex & parietal lobe
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- DTI
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- Widespread damage to WM tracts reported
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- **bvFTD**: Uncinate fasciculus, inferior longitudinal fasciculus, & anterior commissural fibers
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- **sv-PPA**: Inferior longitudinal & uncinate fasciculi
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- **nfv-FTD**: Left superior longitudinal fasciculus
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- **lv-PPA**: Widespread dorsal & ventral WM tracts
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- ## Nuclear Medicine Findings
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- ### PET
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- Functional imaging more sensitive than MR in early-stage disease
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- FDG PET: ↓ metabolic activity in frontotemporal cortex
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- Amyloid PET helps differentiate FTLD from Alzheimer disease (AD)
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- HMPAO-SPECT
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- Sensitive technique for early detection of FTD
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- Occurs before atrophy is evident
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- **bvFTD**: ↓ perfusion frontal & anterior temporal lobes
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- Asymmetric, left or right dominant
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- **sv-PPA**: Prominent anterior temporal hypoperfusion, left > right
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- **nfv-PPA**: Asymmetric frontal hypoperfusion often involving insular cortex
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- **lv-PPA**: ↓ perfusion in left parietal inferior lobule & posterolateral temporal lobe
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- SPECT perfusion deficits predominantly in frontal & anterior temporal lobes with preserved perfusion posteriorly
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- Helps distinguish FTD from AD
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- Reduced frontal perfusion is not specific to FTD but also occurs in some cases of schizophrenia, depression, HIV encephalopathy, Creutzfeldt-Jakob disease, AD
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- ## Imaging Recommendations
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- ### Best imaging tool
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- PET/SPECT; MR voxel-based morphometry
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- ### Protocol advice
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- Routine T1WI, T2WI, coronal T2WI MR
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# DIFFERENTIAL DIAGNOSIS
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- [Alzheimer Disease](/document/alzheimer-disease/f71f5cf5-b1af-4c6d-b145-b4c10eec7b58)
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- Parietal & temporal cortical atrophy with disproportionate hippocampal volume loss
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- Increased rate of atrophy in FTD compared to AD
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- Often coexisting microvascular disease, WM hyperintensities, microhemorrhages
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- Amyloid imaging (11C-labeled Pittsburgh Compound-B) helps to differentiate AD from other dementias
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- [Vascular Dementia](/document/vascular-dementia/f59dab57-c511-4369-8fcc-592421a4b8d1)
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- 2nd most common dementia (15-30%)
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- WM & deep gray lacunae
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- Hyperintense lesions on T2WI & focal atrophy is suggestive of chronic infarcts
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- [Corticobasal Degeneration](/document/corticobasal-degeneration/23f97d4e-8724-4229-b9f8-08f63906ebd8)
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- Prominent extrapyramidal, cortical symptoms
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- Severe frontoparietal atrophy contralateral to more severely affected clinically
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- Atrophy of paracentral structures
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- [Dementia With Lewy Bodies](/document/dementia-with-lewy-bodies/e8e46d1d-46d2-4e5a-880f-f025a84c5871)
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- Hypometabolism of entire brain, especially visual cortex
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- Visual & auditory hallucinations, paranoid delusions
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# PATHOLOGY
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- ## General Features
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- ### Etiology
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- Tau protein (hyperphosphorylated microtubular protein) or TDP-43 (TAR DNA-binding protein-43)
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- Rare cases change on fused-in-sarcoma (FUS) protein
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- ### Genetics
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- FTD is highly heritable without clear inheritance pattern
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- 25-40% of FTD is familial, > 50% of bvFTD is autosomal dominant
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- Mutations in following 3 genes together constitute 15% of FTD cases
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- Most common: Hexanucleotide expansion in chromosome 9 open reading frame 72 (*C9orf72*) gene
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- Microtubule-associated protein tau (*MAPT*) gene
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- Granulin precursor (*GRN*) gene
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- ## Staging, Grading, & Classification
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- Histopathologic classification of FTLD based on abnormal inclusions
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- FTLD-tau: Tau inclusion (hyperphosphorylated tau protein)/Pick bodies
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- FTLD-TDP: Tau-negative & TDP-43-positive inclusions (subtypes: Type A, B, C, & D)
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- FTLD-FUS: Tau-/TDP-negative & FUS-positive inclusions
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- FTLD-ALS/dipeptide repeats (DPR): TDP-negative DPR protein aggregates
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- FTLD-ni: No inclusions
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- FTD clinical syndromes correlate with brain atrophy patterns & not with pathologic subtypes
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- ## Gross Pathologic & Surgical Features
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- Gross atrophy of frontal &/or anterior temporal lobes
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- Firm cortical gray matter (gliosis) &/or basal ganglia atrophy
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- Soft, retracted subcortical WM
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- ## Microscopic Features
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- Loss of pyramidal neurons & microvacuolar degeneration in layer II & III of frontal & temporal cortex
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- Subjacent WM shows axonal & myelin loss
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- FTLD-related tauopathies
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- Pick disease: Prototypical tauopathy of FTLD
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- Characterized by Pick bodies: Solitary, round or oval, argyrophilic inclusions in cytoplasm of neurons
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- Commonly found in dentate gyrus of hippocampus, amygdala, frontal & temporal neocortex
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# CLINICAL ISSUES
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- ## Presentation
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- ### Most common signs/symptoms
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- Personality, behavior, & language changes
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- Memory loss, confusion, cognitive & speech dysfunction, apathy, & abulia
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- ### Clinical profile
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- **bvFTD**: Disinhibition, apathy & loss of empathy, hyperorality, & compulsive behavior
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- 15-20% may develop concomitant motor neuron disease (MND)
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- **sv-PPA**: Impaired single-word comprehension & object naming with preserved fluency, repetition, & grammar
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- **nfv-PPA**: Effortful speech production of phonemes (linguistic units of sound) & orofacial apraxia
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- **lv-PPA**: Impaired word finding & repetition with errors in speech & naming
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- ## Demographics
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- ### Age
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- More common cause of early-onset (midlife) dementia
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- Mean age of onset is 58 years; rare < 40 & > 75 years
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- Peak incidence 45-65 years
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- ### Sex
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- bvFTD & sv-FTD: Male preponderance
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- nfv-PPA: Female predominance
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- ### Ethnicity
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- Familial forms of Pick complex dementias particularly common in people of Scandinavian origin
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- ### Epidemiology
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- FTLD more common cause of early-onset (< 65 years) dementia
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- Age > 65 years account for 20-25% of cases of FTLD
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- Prevalence: 3.5-15/100,000 person-years
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- FTLD accounts for ~ 5% of all pathologic diagnoses in patients with dementia
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- ## Natural History & Prognosis
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- Insidious onset of behavioral & cognitive dysfunction
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- Speech & language disturbance are often more profound than memory disorder
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- Median survival 6-11 years from symptom onset & 3-4 years from diagnosis
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- Currently no FDA-approved disease-modifying drugs available for treatment of FTD
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- Some patients develop artistic talents during course of dementia (disinhibition of "creative" brain areas)
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# DIAGNOSTIC CHECKLIST
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- ## Consider
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- Other common forms of dementia (AD, dementia with Lewy bodies)
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- ## Image Interpretation Pearls
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- Bilateral frontal lobe atrophy should make one consider diagnosis of FTD
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- Bilateral asymmetric anterior temporal lobe atrophy: sv-PPA
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- ## Reporting Tips
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- Report pattern of cortical volume loss
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52f7139c-657b-4ff0-8be5-0f3d7523130e
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## References
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# Selected References
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||||
1. [Ishii K: Diagnostic imaging of dementia with Lewy bodies, frontotemporal lobar degeneration, and normal pressure hydrocephalus. Jpn J Radiol. 38(1):64-76, 2020](http://www.ncbi.nlm.nih.gov/pubmed/?term=31549279%5Bpmid%5D)
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1. [Raji CA et al: Overview of MR imaging volumetric quantification in neurocognitive disorders. Top Magn Reson Imaging. 28(6):311-5, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31794503%5Bpmid%5D)
|
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1. [Risacher SL et al: Neuroimaging in aging and neurologic diseases. Handb Clin Neurol. 167:191-227, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31753134%5Bpmid%5D)
|
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1. [Shepherd TM et al: Clinical use of integrated positron emission tomography-magnetic resonance imaging for dementia patients. Top Magn Reson Imaging. 28(6):299-310, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31794502%5Bpmid%5D)
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||||
1. [Zukotynski K et al: PET/CT of dementia. AJR Am J Roentgenol. 211(2):246-59, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=29949415%5Bpmid%5D)
|
||||
1. [Mann DM et al: Frontotemporal lobar degeneration: pathogenesis, pathology and pathways to phenotype. Brain Pathol. 27(6):723-36, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28100023%5Bpmid%5D)
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1. [Bang J et al: Frontotemporal dementia. Lancet. 386(10004):1672-82, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=26595641%5Bpmid%5D)
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||||
1. [Shivamurthy VK et al: Brain FDG PET and the diagnosis of dementia. AJR Am J Roentgenol. 204(1):W76-85, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25539279%5Bpmid%5D)
|
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1. [Bott NT et al: Frontotemporal dementia: diagnosis, deficits and management. Neurodegener Dis Manag. 4(6):439-54, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=25531687%5Bpmid%5D)
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1. [Chare L et al: New criteria for frontotemporal dementia syndromes: clinical and pathological diagnostic implications. J Neurol Neurosurg Psychiatry. 85(8):865-70, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=24421286%5Bpmid%5D)
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1. [Diehl-Schmid J et al: Imaging frontotemporal lobar degeneration. Curr Neurol Neurosci Rep. 14(10):489, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=25171901%5Bpmid%5D)
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1. [Bhogal P et al: The common dementias: a pictorial review. Eur Radiol. 23(12):3405-17, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=24081643%5Bpmid%5D)
|
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1. [Risacher SL et al: Neuroimaging biomarkers of neurodegenerative diseases and dementia. Semin Neurol. 33(4):386-416, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=24234359%5Bpmid%5D)
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1. [Gorno-Tempini ML et al: Classification of primary progressive aphasia and its variants. Neurology. 76(11):1006-14, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21325651%5Bpmid%5D)
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1. [Rascovsky K et al: Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 134(Pt 9):2456-77, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21810890%5Bpmid%5D)
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1. [Krueger CE et al: Longitudinal rates of lobar atrophy in frontotemporal dementia, semantic dementia, and Alzheimer's disease. Alzheimer Dis Assoc Disord. 24(1):43-8, 2010](http://www.ncbi.nlm.nih.gov/pubmed/?term=19571735%5Bpmid%5D)
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1. [Mackenzie IR et al: Nomenclature and nosology for neuropathologic subtypes of frontotemporal lobar degeneration: an update. Acta Neuropathol. 119(1):1-4, 2010](http://www.ncbi.nlm.nih.gov/pubmed/?term=19924424%5Bpmid%5D)
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1. [King RD et al: Characterization of atrophic changes in the cerebral cortex using fractal dimensional analysis. Brain Imaging Behav. 3(2):154-66, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=20740072%5Bpmid%5D)
|
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1. [Lindberg O et al: Cortical morphometric subclassification of frontotemporal lobar degeneration. AJNR Am J Neuroradiol. 30(6):1233-9, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19346314%5Bpmid%5D)
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1. [Moon WJ et al: Atrophy measurement of the anterior commissure and substantia innominata with 3T high-resolution MR imaging: does the measurement differ for patients with frontotemporal lobar degeneration and Alzheimer disease and for healthy subjects? AJNR Am J Neuroradiol. 29(7):1308-13, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18436612%5Bpmid%5D)
|
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1. [Mihara M et al: Magnetic resonance spectroscopic study of Alzheimer's disease and frontotemporal dementia/Pick complex. Neuroreport. 17(4):413-6, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16514368%5Bpmid%5D)
|
||||
1. [Whitwell JL et al: Magnetic resonance imaging signatures of tissue pathology in frontotemporal dementia. Arch Neurol. 62(9):1402-8, 2005](http://www.ncbi.nlm.nih.gov/pubmed/?term=16157747%5Bpmid%5D)
|
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## Tables
|
||||
|
||||
# Imaging Features for Various Clinical Subtypes of Frontotemporal Dementia
|
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|
||||
| Clinical Subtypes | Imaging Features |
|
||||
| --- | --- |
|
||||
| bvFTD | MR: Atrophy of frontal & temporal lobes; asymmetric right frontal &/or temporal lobe atrophy may occur NM: Decreased perfusion & metabolism in frontal &/or temporal lobes, usually asymmetric to right side |
|
||||
| sv-PPA | MR: Typically atrophy of left anterior & inferior temporal lobe; right temporal lobe atrophies as disease progresses NM: Decreased perfusion & metabolism in anterior temporal lobes (L > > R) |
|
||||
| nfv-PPA | MR: Selective left perisylvian & frontal atrophy NM: Asymmetric decreased perfusion & metabolism in frontal lobes (L > > R) often involving insular cortex |
|
||||
| lv-PPA | MR: Prominent atrophy of left angular & middle temporal gyri NM: Decreased perfusion & metabolism in left parietal inferior lobule & posterolateral temporal lobe |
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
*Graphic depicts the classic disproportionate frontal lobe atrophy of late-stage frontotemporal dementia (FTD). The sulci are widened & gyri are knife-like <img src='img/arrows/CS.png'/>. Parietooccipital lobes are spared. Gyri around the central sulcus are normal.*
|
||||
|
||||
|
||||
*Graphic depicts the classic disproportionate frontal lobe atrophy of late-stage frontotemporal dementia (FTD). The sulci are widened & gyri are knife-like <img src='img/arrows/CS.png'/>. Parietooccipital lobes are spared. Gyri around the central sulcus are normal.*
|
||||
|
||||
|
||||
*Graphic depicts the classic disproportionate frontal lobe atrophy of late-stage frontotemporal dementia (FTD). The sulci are widened & gyri are knife-like <img src='img/arrows/CS.png'/>. Parietooccipital lobes are spared. Gyri around the central sulcus are normal.*
|
||||
|
||||
|
||||
*Graphic depicts the classic disproportionate frontal lobe atrophy of late-stage frontotemporal dementia (FTD). The sulci are widened & gyri are knife-like <img src='img/arrows/CS.png'/>. Parietooccipital lobes are spared. Gyri around the central sulcus are normal.*
|
||||
|
||||
|
||||
*Graphic depicts the classic disproportionate frontal lobe atrophy of late-stage frontotemporal dementia (FTD). The sulci are widened & gyri are knife-like <img src='img/arrows/CS.png'/>. Parietooccipital lobes are spared. Gyri around the central sulcus are normal.*
|
||||
|
||||
|
||||
*Graphic depicts the classic disproportionate frontal lobe atrophy of late-stage frontotemporal dementia (FTD). The sulci are widened & gyri are knife-like <img src='img/arrows/CS.png'/>. Parietooccipital lobes are spared. Gyri around the central sulcus are normal.*
|
||||
|
||||
|
||||
*Coronal NECT MPR through the frontal lobes of a 62-year-old man with behavioral variant frontotemporal dementia (bvFTD) shows asymmetric atrophy of right frontal lobe <img src='img/arrows/CS.png'/> with relatively preserved left frontal lobe volume <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
*Coronal NECT MPR through the frontal lobes of a 62-year-old man with behavioral variant frontotemporal dementia (bvFTD) shows asymmetric atrophy of right frontal lobe <img src='img/arrows/CS.png'/> with relatively preserved left frontal lobe volume <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
*Coronal T2WI MR of a 55-year-old woman with nfv-PPA shows diffuse brain parenchymal atrophy, which is more pronounced in the left perisylvian region <img src='img/arrows/CS.png'/> due to atrophy of adjacent inferior & lateral temporal convexity <img src='img/arrows/CC.png'/> and frontal operculum <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
*Coronal T2WI MR of a 55-year-old woman with nfv-PPA shows diffuse brain parenchymal atrophy, which is more pronounced in the left perisylvian region <img src='img/arrows/CS.png'/> due to atrophy of adjacent inferior & lateral temporal convexity <img src='img/arrows/CC.png'/> and frontal operculum <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
*Parasagittal T1WI MR through left (top) & right (bottom) temporal lobes of a 55-year-old man with sv-PPA shows asymmetric temporal lobe atrophy on left <img src='img/arrows/CS.png'/> vs. right <img src='img/arrows/CO.png'/>. Also note relatively preserved frontal lobe <img src='img/arrows/CC.png'/> volume.*
|
||||
|
||||
|
||||
*Parasagittal T1WI MR through left (top) & right (bottom) temporal lobes of a 55-year-old man with sv-PPA shows asymmetric temporal lobe atrophy on left <img src='img/arrows/CS.png'/> vs. right <img src='img/arrows/CO.png'/>. Also note relatively preserved frontal lobe <img src='img/arrows/CC.png'/> volume.*
|
||||
|
||||
|
||||
*FDG PET raw data & 3D-SSP images of a 59-year-old man with sv-PPA demonstrate decreased metabolic activity in the anterior & medial left temporal lobe <img src='img/arrows/CO.png'/> & to a lesser degree in anterior & medial temporal lobe <img src='img/arrows/CS.png'/>. (Courtesy M. Matesan, MD.)*
|
||||
|
||||
|
||||
*FDG PET raw data & 3D-SSP images of a 59-year-old man with sv-PPA demonstrate decreased metabolic activity in the anterior & medial left temporal lobe <img src='img/arrows/CO.png'/> & to a lesser degree in anterior & medial temporal lobe <img src='img/arrows/CS.png'/>. (Courtesy M. Matesan, MD.)*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with classic FTD shows predominantly frontal lobar atrophy with knife-like gyri <img src='img/arrows/CO.png'/>. In this case, an associated region of hyperintense white matter <img src='img/arrows/CC.png'/> is present.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with classic FTD shows predominantly frontal lobar atrophy with knife-like gyri <img src='img/arrows/CO.png'/>. In this case, an associated region of hyperintense white matter <img src='img/arrows/CC.png'/> is present.*
|
||||
|
||||
|
||||
*Axial FDG PET of a 55-year-old woman with sv-PPA (clinical subtype of FTD) shows decreased metabolic activity in the left temporal lobe <img src='img/arrows/CO.png'/> & to a lesser degree in the right temporal lobe <img src='img/arrows/CS.png'/>. Note relative sparing of parietal & occipital lobes <img src='img/arrows/BS.png'/>.*
|
||||
|
||||
|
||||
*Axial FDG PET of a 55-year-old woman with sv-PPA (clinical subtype of FTD) shows decreased metabolic activity in the left temporal lobe <img src='img/arrows/CO.png'/> & to a lesser degree in the right temporal lobe <img src='img/arrows/CS.png'/>. Note relative sparing of parietal & occipital lobes <img src='img/arrows/BS.png'/>.*
|
||||
|
||||
|
||||
*Axial FLAIR MR in the same patient shows asymmetric atrophy of bilateral temporal lobes (left > right) with knife-like gyri <img src='img/arrows/CC.png'/>. (Courtesy M. Matesan, MD.)*
|
||||
|
||||
|
||||
*Axial FLAIR MR in the same patient shows asymmetric atrophy of bilateral temporal lobes (left > right) with knife-like gyri <img src='img/arrows/CC.png'/>. (Courtesy M. Matesan, MD.)*
|
||||
|
||||
|
||||
*Axial color-coded FDG PET in a 65-year-old man with apathy & slowly progressive behavioral changes with clinical diagnosis of bvFTD shows decreased metabolic activity in bilateral anterior & medial temporal lobes <img src='img/arrows/CS.png'/> with relative sparing of bilateral parietooccipital lobes <img src='img/arrows/CC.png'/>.*
|
||||
|
||||
|
||||
*Axial color-coded FDG PET in a 65-year-old man with apathy & slowly progressive behavioral changes with clinical diagnosis of bvFTD shows decreased metabolic activity in bilateral anterior & medial temporal lobes <img src='img/arrows/CS.png'/> with relative sparing of bilateral parietooccipital lobes <img src='img/arrows/CC.png'/>.*
|
||||
|
||||
|
||||
*Sagittal reformat of color-coded FDG PET in the same patient shows decreased metabolic activity in the frontal lobe <img src='img/arrows/CO.png'/>. (Courtesy J. Singh, MD.)*
|
||||
|
||||
|
||||
*Sagittal reformat of color-coded FDG PET in the same patient shows decreased metabolic activity in the frontal lobe <img src='img/arrows/CO.png'/>. (Courtesy J. Singh, MD.)*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
*Sagittal T1WI MR demonstrates marked atrophy of the frontal lobe in a patient with FTD.*
|
||||
|
||||
|
||||
*Sagittal T1WI MR demonstrates marked atrophy of the frontal lobe in a patient with FTD.*
|
||||
|
||||
|
||||
*Coronal T1WI MR in a patient with FTD shows prominent atrophy of both frontal lobes, which appears more pronounced on the left side.*
|
||||
|
||||
|
||||
*Coronal T1WI MR in a patient with FTD shows prominent atrophy of both frontal lobes, which appears more pronounced on the left side.*
|
||||
|
||||
|
||||
*Axial NECT demonstrates predominantly frontal lobe volume loss from FTD.*
|
||||
|
||||
|
||||
*Axial NECT demonstrates predominantly frontal lobe volume loss from FTD.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with FTD shows marked frontal lobe atrophy.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with FTD shows marked frontal lobe atrophy.*
|
||||
|
||||
|
||||
*Axial FLAIR MR shows frontal lobe volume loss as well as associated hyperintense signal in white matter.*
|
||||
|
||||
|
||||
*Axial FLAIR MR shows frontal lobe volume loss as well as associated hyperintense signal in white matter.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with FTD demonstrates marked volume loss as well as associated hyperintense signal within bilateral temporal lobes.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with FTD demonstrates marked volume loss as well as associated hyperintense signal within bilateral temporal lobes.*
|
||||
|
||||
|
||||
*FDG PET in a patient with FTD & dementia depicts glucose hypometabolism (green regions in the cortex) in the frontal lobes. (Courtesy N. Foster, MD & the University of Michigan PET Center.)*
|
||||
|
||||
|
||||
*FDG PET in a patient with FTD & dementia depicts glucose hypometabolism (green regions in the cortex) in the frontal lobes. (Courtesy N. Foster, MD & the University of Michigan PET Center.)*
|
||||
|
||||
|
||||
*FDG PET in the same patient shows a decreased rate of glucose metabolism in the frontal & temporal lobes, consistent with FTD. (Courtesy N. Foster, MD & the University of Michigan PET Center.)*
|
||||
|
||||
|
||||
*FDG PET in the same patient shows a decreased rate of glucose metabolism in the frontal & temporal lobes, consistent with FTD. (Courtesy N. Foster, MD & the University of Michigan PET Center.)*
|
||||
|
||||
|
||||
*Axial T2WI MR in a 57-year-old woman with probable FTD shows temporal lobe atrophy with knife-like gyri <img src='img/arrows/WS.png'/>. The parietal & occipital lobes are relatively well preserved.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a 57-year-old woman with probable FTD shows temporal lobe atrophy with knife-like gyri <img src='img/arrows/WS.png'/>. The parietal & occipital lobes are relatively well preserved.*
|
||||
|
||||
|
||||
*FDG PET in a patient with FTD shows marked hypometabolism in the frontal <img src='img/arrows/WS.png'/> & temporal <img src='img/arrows/WC.png'/> lobes. There is relative preservation of glucose metabolism in the occipital & parietal lobes <img src='img/arrows/WO.png'/>.*
|
||||
|
||||
|
||||
*FDG PET in a patient with FTD shows marked hypometabolism in the frontal <img src='img/arrows/WS.png'/> & temporal <img src='img/arrows/WC.png'/> lobes. There is relative preservation of glucose metabolism in the occipital & parietal lobes <img src='img/arrows/WO.png'/>.*
|
||||
|
||||
|
||||
*Sagittal SSP FDG PET scan in a 72-year-old man with FTD shows a normal elderly control map (2nd row), the patient's glucose metabolism (3rd row), & Z-score statistical map (bottom row). The frontal lobes <img src='img/arrows/WS.png'/> are strikingly hypometabolic. The temporal lobes <img src='img/arrows/WO.png'/> are somewhat less severely affected.*
|
||||
|
||||
|
||||
*Sagittal SSP FDG PET scan in a 72-year-old man with FTD shows a normal elderly control map (2nd row), the patient's glucose metabolism (3rd row), & Z-score statistical map (bottom row). The frontal lobes <img src='img/arrows/WS.png'/> are strikingly hypometabolic. The temporal lobes <img src='img/arrows/WO.png'/> are somewhat less severely affected.*
|
||||
|
||||
|
||||
*Coronal T1WI MR in the same patient shows focal atrophy of the olfactory gyri <img src='img/arrows/WO.png'/>. This finding was initially overlooked & the patient was given the imaging diagnosis of Alzheimer disease. Review & subsequent clinical evaluation confirmed FTD.*
|
||||
|
||||
|
||||
*Coronal T1WI MR in the same patient shows focal atrophy of the olfactory gyri <img src='img/arrows/WO.png'/>. This finding was initially overlooked & the patient was given the imaging diagnosis of Alzheimer disease. Review & subsequent clinical evaluation confirmed FTD.*
|
||||
|
||||
|
||||
*Axial FDG PET in a patient with FTD shows decreased glucose metabolism in frontal <img src='img/arrows/WS.png'/> & temporal <img src='img/arrows/WC.png'/> lobes. The parietal & occipital lobes <img src='img/arrows/WO.png'/> are spared.*
|
||||
|
||||
|
||||
*Axial FDG PET in a patient with FTD shows decreased glucose metabolism in frontal <img src='img/arrows/WS.png'/> & temporal <img src='img/arrows/WC.png'/> lobes. The parietal & occipital lobes <img src='img/arrows/WO.png'/> are spared.*
|
||||
|
||||
|
||||
*Sagittal FDG PET in the same patient with FTD depicts glucose hypometabolism in the frontal lobes <img src='img/arrows/WS.png'/>. The occipital lobes <img src='img/arrows/WO.png'/> are normal.*
|
||||
|
||||
|
||||
*Sagittal FDG PET in the same patient with FTD depicts glucose hypometabolism in the frontal lobes <img src='img/arrows/WS.png'/>. The occipital lobes <img src='img/arrows/WO.png'/> are normal.*
|
||||
|
||||
|
||||
*Coronal FDG PET in a patient with FTD exhibits glucose hypometabolism in frontal <img src='img/arrows/WC.png'/> and temporal lobes <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
*Coronal FDG PET in a patient with FTD exhibits glucose hypometabolism in frontal <img src='img/arrows/WC.png'/> and temporal lobes <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with semantic dementia subtype of FTLD shows marked atrophy of anterolateral temporal lobes <img src='img/arrows/WO.png'/>. Note the relative preservation of the hippocampi <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
*Axial T2WI MR in a patient with semantic dementia subtype of FTLD shows marked atrophy of anterolateral temporal lobes <img src='img/arrows/WO.png'/>. Note the relative preservation of the hippocampi <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
*Axial NECT in a 78-year-old patient diagnosed with late-stage FTD through the upper lateral ventricles shows striking frontal lobar atrophy with classic knife-like gyri <img src='img/arrows/WO.png'/> characteristic of FTD. In contrast, the parietal & occipital lobes appear relatively spared.*
|
||||
|
||||
|
||||
*Axial NECT in a 78-year-old patient diagnosed with late-stage FTD through the upper lateral ventricles shows striking frontal lobar atrophy with classic knife-like gyri <img src='img/arrows/WO.png'/> characteristic of FTD. In contrast, the parietal & occipital lobes appear relatively spared.*
|
||||
|
||||
|
||||
*Axial FLAIR MR in a patient with early findings of FTD shows relatively mild frontal lobe volume loss <img src='img/arrows/WS.png'/> compared to the normal appearance of the parietal lobes.*
|
||||
|
||||
|
||||
*Axial FLAIR MR in a patient with early findings of FTD shows relatively mild frontal lobe volume loss <img src='img/arrows/WS.png'/> compared to the normal appearance of the parietal lobes.*
|
||||
|
||||
|
||||
*Axial FLAIR MR shows atrophy of both the frontal & temporal lobes. Note compensatory enlargement of the temporal horns <img src='img/arrows/WS.png'/> due to temporal lobe volume loss.*
|
||||
|
||||
|
||||
*Sagittal T1WI MR shows predominantly frontal & temporal lobe atrophy. Some gyri demonstrate a classic knife-like appearance (<img src='img/arrows/WS.png'/>) reflecting severe atrophy of a gyrus.*
|
||||
|
||||
Reference in New Issue
Block a user