PROGNOSTIC UTILITY OF MRI ATROPHY MEASURES IN AMCI PATIENTS WITH MINIMAL COGNITIVE DECLINE
PROGNOSTIC UTILITY OF MRI ATROPHY MEASURES IN AMCI PATIENTS WITH MINIMAL COGNITIVE DECLINE
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MRI 萎缩测量对认知能力下降程度最低的 AMCI 患者的预后效用
DOI：
10.1016/j.jalz.2014.05.212
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
S. Duchesne
中科院分区：
文献类型：
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作者：
Y. Bodryzlova;Olivier Potvin;S. Duchesne
背景MRI萎缩测量用于预测遗忘型MCI（aMCI）向阿尔茨海默病（AD）的进展的效用是有限的，如已证实的预后似然比（LR;阳性LR= 2，9;阴性LR= 0，49-0，56）所证明的（Frisoni等，Neurology 2013），超出临床实施通常要求的范围（LR+≥ 5.0和LR-≤ 0.2）。我们检验了根据整体认知功能对患者进行分层可以提高MRI预后价值的假设。方法4502我们从ADNI-1数据库中选择了147名基线MMSE=[28-30]的aMCI受试者和195名基线MMSE=[24-27]的aMCI受试者，我们有完整的MRI体积结果（FreeSurfer）和一般初级信息。我们建立了一个预后模型，在36个月内进展到AD的基础上，这些measurements.ResultsThe模型，包括左海马体积和左颞中皮层厚度，当调整颅内体积，年龄和性别，有一个87.4%的ROC曲线下面积（AUC），80.3%的分类准确性，53.8%的敏感性，88.2%的特异性，LR+= 4，81，LR-= 0.49（疾病概率分类临界点= 0.4）。在排除统计离群值（3名受试者;影响卡方（dl 6）= 12.59）后，相同模型的AUC为91.1%，分类准确度为81.9%，灵敏度为71.4%，特异性为85.3%，LR+= 4.9，LR-= 0.3（分类临界点为0.3）。将相同的模型应用于基线MMSE在[24-27]范围内的ADNI aMCI受试者，得到的AUC为64.5%。事实上，简单地在MRI模型中增加一个二分变量，（即基线MMSE在[24-27]或[28-30]范围内）对于ADNI-1人群中的所有aMCI给出了73.3%的AUC。在基线MMSE在[28-30]范围内的ADNI-1 aMCI受试者中观察到。在这些分层中观察到的预后LR+和LR-高于先前描述的更一般人群，并达到临床适用性。
BackgroundThe utility of MRI atrophy measures for predicting progression of amnestic MCI (aMCI) to Alzheimer's disease (AD) is limited, as evidenced by proven prognostic likelihood ratios (LR; positive LR= 2, 9; negative LR= 0, 49-0, 56)(Frisoni et al., Neurology 2013) that are outside the ranges usually required for clinical implementation (LR+≥ 5, 0 and LR-≤ 0, 2). We tested the hypothesis that stratification of patients by global cognitive function could improve the prognostic value of MRI.Methods4502We selected 147 aMCI subjects from the ADNI-1 database with MMSE=[28-30] at baseline and 195 with MMSE=[24-27] for which we had complete MRI volumetric results (FreeSurfer) and general primary-level information. We created a prognostic model for progression to AD within 36 months based on these measures.ResultsThe model that included left hippocampal volume and left mid-temporal cortical thickness, when adjusted for intracranial volume, age and sex, had a 87, 4% area under ROC curve (AUC), 80.3% classification accuracy, 53, 8% sensitivity, 88, 2% specificity, LR+= 4, 81 and LR-= 0.49 (with classification cut-point of disease probability= 0.4). After excluding statistical outliers (three subjects; impact chi-square (dl 6)= 12.59), the same model had AUC of 91, 1%, 81.9% classification accuracy, 71.4% sensitivity, 85.3% specificity, LR+= 4.9 and LR-= 0.3 (with classification cut-point of 0.3). Applying the same model to the ADNI aMCI subjects with baseline MMSE in the [24-27] range gave a AUC of 64.5%. In fact, simply adding a dichotomous variable in the MRI model for cognitive status (ie baseline MMSE in range [24-27] or [28-30]) gives a AUC of 73.3% for all aMCI in the ADNI-1 population.ConclusionsA clinically relevant prognostic significance for left hippocampal volume and left mid-temporal cortical thickness, when adjusted for intracranial volume, age and sex, has been observed in ADNI-1 aMCI subjects with baseline MMSE in the [28-30] range. The prognostic LR+ and LR-observed in these strata is higher than previously described for a more general population and reaches clinical applicability.