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Diagnostic MRI in dementia has focused, to date almost exclusively, on atrophy patterns. Although sometimes useful, readers will be most familiar with ‘No focal lesion, a degree of volume loss possibly more than expected for age’ reports. Things get worse with differential diagnosis. This is particularly evident in frontotemporal dementia (FTD) in which most patients fall into one of the two pathological groups: TDP-43 or tau. There are no specific imaging markers for either, so one is left with known relationships to clinical phenotypes to guess at the pathology: semantic dementia, TDP-43 quite likely; non-fluent aphasia, tau somewhat likely; and behavioural variant, toss a coin. In fact, if one strictly controls for clinical …
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.