Clinical significance of lobar atrophy in frontotemporal dementia: Application of an MRI visual rating scale
Clinical significance of lobar atrophy in frontotemporal dementia: Application of an MRI visual rating scale
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DOI：
10.1159/000100973
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发表时间：
2007-01-01
影响因子：
2.4
通讯作者：
Hodges, John R.
中科院分区：
文献类型：
--
作者：
Kipps, Christopher M.;Davies, R. Rhys;Hodges, John R.
背景/目标：额颞叶痴呆（FTD）的临床诊断中的影像学检查结果的地位仍然不确定;虽然它们可能支持额颞叶痴呆的诊断，但它们不是强制性的。我们的目的是使用磁共振成像（MRI）评级量表评估临床定义的前瞻性研究患者的大样本中的脑叶萎缩模式，以（1）确定影像学检查结果是否在FTD诊断中占据更突出的位置，（2）将脑叶萎缩的程度与临床数据相关联。方法：我们采用了最近设计的FTD死后评定量表来评定MRI扫描上的肺叶萎缩。评定的区域包括额叶皮质和双侧的前后颞区。使用剑桥痴呆诊所诊断为FTD的所有患者（n = 258）和对照组（n = 20）的所有可用脑扫描图评估该方法的可靠性。其中一个子集（n = 121）用于临床解剖分析。结果：该量表快速、可靠（评定者内、评定者间k值分别为0.80，0.67）.大多数患者（75%）的MRI扫描异常，100%的语义性痴呆（SD）患者存在局灶性萎缩。相比之下，近一半（47%）的临床行为变异型FTD患者的扫描结果在正常范围内。与扫描正常的行为病例相比，扫描正常的行为病例通常具有较少的认知缺陷和较轻的功能障碍，但表现出临床上难以区分的行为综合征。然而，他们并不只是处于疾病的早期阶段。结论：MRI结果应构成SD诊断标准的一部分;在许多行为病例中，MRI上无萎缩，这提出了FTD行为综合征对神经退行性疾病患者无特异性的前景。版权所有（C）2007 S. Karger AG，巴塞尔。
Background/Aims: The status of imaging findings in the clinical diagnosis of frontotemporal dementia (FTD) remains uncertain; while they may be supportive of a diagnosis of frontotemporal dementia, they are not mandatory. Our aim was to assess patterns of lobar atrophy in a large sample of clinically defined, prospectively studied, patients using a magnetic resonance image (MRI) rating scale, to ( 1) determine whether imaging findings warrant a more prominent position in FTD diagnosis and ( 2) correlate the extent of lobar atrophy with clinical data. Methods: We adapted a recently devised post mortem rating scale for FTD to rate lobar atrophy on MRI scans. The areas rated included the frontal cortex and both anterior and posterior temporal regions bilaterally. All available brain scans from all patients seen in the Cambridge Dementia Clinic (n = 258) diagnosed as having FTD, together with controls ( n = 20), were used to assess the reliability of the method. A subset of these ( n = 121) were used for clinico-anatomic analysis. Results: The scale proved quick and reliable (intra-, inter- rater k = 0.80, 0.67). MRI scans were abnormal in the majority of patients (75%), with focal atrophy present in 100% of semantic dementia (SD) patients. By contrast, nearly half (47%) of the patients with clinical behavioural variant FTD had scans within the normal range. Behavioural cases with normal scans generally had fewer cognitive deficits and milder functional impairment than those with abnormal scans, yet displayed a clinically indistinguishable behavioural syndrome. They were not, however, simply at an earlier stage of the disease. Conclusions: MRI findings should form part of the diagnostic criteria for SD; the absence of atrophy on MRI in many behavioural cases raises the prospect that the behavioural syndrome of FTD is not specific for patients with a neurodegenerative disease. Copyright (C) 2007 S. Karger AG, Basel.