American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which diagnosis is associated with cortical ribboning on MRI?

  1. Multiple sclerosis

  2. Creutzfeldt-Jakob disease

  3. Alzheimer's disease

  4. Parkinson's disease

The correct answer is: Creutzfeldt-Jakob disease

Cortical ribboning on MRI is a classic imaging feature associated with Creutzfeldt-Jakob disease (CJD). This finding refers to the hyperintense appearance of the cortex on certain MRI sequences, particularly T2-weighted images or fluid-attenuated inversion recovery (FLAIR) sequences. In the context of CJD, the pattern of cortical ribboning indicates the presence of cortical degeneration and spongiform change, which are characteristic features of this prion disease. This distinctive pattern can assist in differentiating CJD from other neurodegenerative disorders, as each has unique neuroimaging features. While multiple sclerosis, Alzheimer's disease, and Parkinson's disease might exhibit various changes on MRI, they do not typically present with the specific cortical ribboning phenomenon seen in CJD. Thus, recognizing this finding is crucial for clinicians in diagnosing and managing Creutzfeldt-Jakob disease effectively.

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