The utility of age-specific cut-offs for visual rating of medial temporal atrophy in classifying Alzheimer's disease, MCI and cognitively normal elderly subjects.
The utility of age-specific cut-offs for visual rating of medial temporal atrophy in classifying Alzheimer's disease, MCI and cognitively normal elderly subjects.
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DOI：
10.3389/fnagi.2013.00047
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发表时间：
2013
影响因子：
4.8
通讯作者：
Potter H
中科院分区：
文献类型：
--
作者：
Duara R;Loewenstein DA;Shen Q;Barker W;Varon D;Greig MT;Curiel R;Agron J;Santos I;Potter H
背景：诊断轻度认知障碍阶段阿尔茨海默病(AD)的新研究标准(MCI-AD)纳入了生物标志物，以赋予诊断一定程度的确定性。结构磁共振广泛地用于评估AD早期受影响的结构的萎缩，如海马体(HP)，因为HP体积(HP-v)的量化需要特殊的专业知识，而标准值尚未建立。方法：将273例来自美国佛罗里达州ADRC的老年人分为无认知功能障碍(认知正常，CN)、遗忘性轻度认知功能障碍(AMCI)或AD。在结构磁共振扫描上测量海马区体积(HP-v)。采用有效的视觉评分系统测量内侧颞叶萎缩(VRS-MTA)，包括海马区、内嗅区皮质和周围区皮质萎缩。参与者被细分为年龄较小(小于或等于75岁)和年龄较大(大于75岁)的小组。结果：对于老年人(受试者操作曲线下面积[AROC]：0.652比0.723)和年轻受试者(ARRC：0.764比0.736)，容量测量和VRS-MTA测量在预测CN与AMCI的分类方面是相同的。然而，对于较年轻的AD受试者，VRS-MTA测量的AREC值(0.920)显著高于容量测量(0.847)。相对于HP-v，VRS-MTA评分与一系列记忆测试中的损害显著相关，并且与aMCI向AD的进展比HP-v更相关。结论：结构MRI结合VRS-MTA评价可作为MCI-AD诊断的生物标志物。年龄调整后的VRS-MTA评分在区分aMCI和AD与CN和预测从aMCI到AD进展方面至少与HP-v一样有效。VRS-MTA便于在临床和临床试验中使用，并可以很容易地纳入标准化的放射学报告。
Background: New research criteria for diagnosing Alzheimer's disease (AD) in the mild cognitive impairment stage (MCI-AD) incorporate biomarkers to assign a level of certainty to the diagnosis. Structural MRI is widely available but greatly under-utilized for assessing atrophy of structures affected in early AD, such as the hippocampus (HP), because the quantification of HP volumes (HP-v) requires special expertise, and normative values have not been established. Methods: Elderly subjects (n =273) from the Florida ADRC were classified as having no cognitive impairment (cognitively normal, CN), amnestic mild cognitive impairment (aMCI) or AD. Volumes for the hippocampus (HP-v) were measured on structural MRI scans. A validated visual rating system for measuring medial temporal atrophy (VRS-MTA), including hippocampal, entorhinal cortex and perirhinal cortex atrophy was employed. The participants were subdivided into younger (less than or equal to 75 years of age) and older (greater than 75 years of age) subgroups. Results: Volumetric and VRS-MTA measures were equivalent in predicting classification of CN vs. aMCI for older (area under the receiver operator curves [aROC]: 0.652 vs. 0.723) and younger subjects (aROC: 0.764 vs. 0.736). However, for younger AD subjects, aROC values were significantly higher for VRS-MTA measures (0.920) than for volumetric measures (0.847). Relative to HP-v, VRS-MTA score was significantly more correlated to impairment on a range of memory tests and was more associated with progression of aMCI to AD than HP-v. Conclusion: Structural MRI with VRS-MTA assessment can serve as a biomarker for supporting the diagnosis of MCI-AD. Age-adjusted VRS-MTA scores are at least as effective as HP-v for distinguishing aMCI and AD from CN and for predicting progression from aMCI to AD. VRS-MTA is convenient for use in the clinic as well as for clinical trials and can readily be incorporated into a standardized radiological report.