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DOI: 10.1055/a-2563-0725
Review

MRI for diagnosing dementia – update 2025

MRT zur Demenzdiagnostik – Update 2025
Estelle Akl
1   Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)
,
Martin Dyrba
2   Clinical Dementia Research Group, German Center for Neurodegenerative Diseases Site Rostock/Greifswald, Rostock, Germany (Ringgold ID: RIN581365)
,
Doreen Görß
2   Clinical Dementia Research Group, German Center for Neurodegenerative Diseases Site Rostock/Greifswald, Rostock, Germany (Ringgold ID: RIN581365)
3   Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)
,
Julia Schumacher
2   Clinical Dementia Research Group, German Center for Neurodegenerative Diseases Site Rostock/Greifswald, Rostock, Germany (Ringgold ID: RIN581365)
4   Department of Neurology, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)
,
Marc-André Weber 
1   Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)
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Abstract

Background

Magnetic resonance imaging (MRI) plays a crucial role alongside clinical and neuropsychological assessments in diagnosing dementia. The recent and ongoing advancements in MRI technology have significantly enhanced the detection and characterization of the specific neurostructural changes seen in various neurodegenerative diseases, thereby significantly increasing the precision of diagnosis. Within this context of perpetual evolution, this review article explores the recent advances in MRI with regard to diagnosing dementia.

Methods

A retrospective literature review was conducted by searching the PubMed and ScienceDirect databases for the keywords “dementia”, “imaging”, and “MRI”. The inclusion criteria were scientific papers in English that revolved around the role of MRI as a diagnostic tool in the field of dementia. A specific time frame was not determined but the focus was on current articles, with an overall of 20 articles dating from the last 6 years (after 2018), corresponding to 55% of the total number of articles.

Results

This review provides a comprehensive overview of the latest advances in the radiologic diagnosis of dementia using MRI, with a particular focus on the last 6 years. Technical aspects of image acquisition for clinical and research purposes are discussed. MRI findings typical of dementia are described. The findings are divided into non-specific findings of dementia and characteristic findings for certain dementia subtypes. This provides information about possible causes of dementia. In addition, developed scoring systems that support MRI findings are presented, including the MTA score for Alzheimer’s disease with corresponding illustrative figures.

Conclusion

The symbiosis of clinical evaluation with high-field MRI methodologies enhances dementia diagnosis and offers a holistic and nuanced understanding of structural brain changes associated with dementia and its various subtypes. The latest advances, mainly involving the emergence of ultra-high-field (7T) MRI, despite having limited use in clinical practice, mark a pragmatic shift in the field of research.

Key Points

  • High-field MRI (3T) and specialized sequences allow for the detection of early structural changes indicative of dementia.

  • Characteristic neuroanatomical MRI patterns enable the differentiation between various subtypes of dementia.

  • Established scales provide added value to the quantification and categorization of MRI findings in dementia.

Citation Format

  • Akl E, Dyrba M, Görß D et al. MRI for diagnosing dementia – update 2024. Rofo 2025; DOI 10.1055/a-2563-0725

Zusammenfassung

Hintergrund

Die Magnetresonanztomografie (MRT) spielt neben klinischen und neuropsychologischen Untersuchungen eine entscheidende Rolle bei der Diagnose von Demenzerkrankungen. Die laufenden Fortschritte in der MRT-Technologie haben die Erkennung und Charakterisierung der spezifischen neurostrukturellen Veränderungen bei verschiedenen neurodegenerativen Erkrankungen erheblich verbessert, was die Genauigkeit der Demenzdiagnose deutlich erhöht. Dieser Übersichtsartikel untersucht die jüngsten Fortschritte der MRT bei der Diagnose von Demenzerkrankungen.

Methoden

Im Rahmen einer retrospektiven Literaturrecherche wurden die Datenbanken PubMed und ScienceDirect nach den Stichworten „dementia“, „imaging“ und „MRI“ durchsucht. Die Aufnahmekriterien waren wissenschaftliche Arbeiten in englischer Sprache, die sich mit MRT-Aspekten der Demenz befassen. Ein bestimmter Zeitrahmen wurde nicht festgelegt, der Schwerpunkt lag aber auf aktuelle Artikeln, wobei insgesamt 20 Artikel aus den letzten 6 Jahren stammen (nach 2018), was 55% der Gesamtzahl der Artikel entspricht.

Ergebnisse

Diese Übersicht gibt einen umfassenden Überblick über die neuesten Fortschritte bei der radiologischen Diagnose von Demenz mittels MRT, mit besonderem Fokus auf die letzten 6 Jahre. Es werden technische Aspekte der Bilderfassung für klinische und Forschungszwecke erörtert. Es werden MRT-Befunde beschrieben, welche typisch für Demenzerkrankungen sind. Die Befunde werden unterteilt in unspezifische Befunde einer Demenz und in charakteristische Befunde für bestimmte Demenz-Subtypen. Dies gibt Aufschluss über mögliche Ursachen der Demenz. Darüber hinaus werden entwickelte Scoring-Systeme vorgestellt, die die MRT-Befundung unterstützen, darunter der MTA-Score für Alzheimer-Krankheit mit entsprechenden, illustrierenden Abbildungen.

Schlussfolgerung

Die Symbiose zwischen der klinischen Bewertung mit Hochfeld-MRT-Nutzung erweitert die Demenzdiagnose und bietet ein ganzheitliches und nuanciertes Verständnis der strukturellen Veränderungen des Gehirns im Zusammenhang mit Demenz und ihren verschiedenen Subtypen. Die jüngsten Fortschritte, die vor allem das Aufkommen der Ultrahochfeld-MRT (7 T) enthalten, markieren trotz ihres begrenzten Einsatzes in der klinischen Praxis ein Paradigmenwechsel im Bereich der Forschung.

Kernaussagen

  • Hochfeld-MRT (3T) und spezialisierte Sequenzen ermöglichen die Erkennung früher struktureller Veränderungen, die auf eine Demenz hindeuten.

  • Charakteristische neuroanatomische MRT-Muster erlauben die Unterscheidung verschiedener Demenzsubtypen.

  • Etablierte Skalen bieten einen zusätzlichen Mehrwert bei der Quantifizierung und Kategorisierung von MRT-Befunden bei Demenz.

Keywords

dementia - atrophy - neurodegenerative disorders


Publication History

Received: 11 May 2024

Accepted after revision: 09 March 2025

Article published online:
10 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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