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Mai Y, Cao Z, Zhao L, Yu Q, Xu J, Liu W, Liu B, Tang J, Luo Y, Liao W, Fang W, Ruan Y, Lei M, Mok VCT, Shi L, Liu J. The role of visual rating and automated brain volumetry in early detection and differential diagnosis of Alzheimer's disease. CNS Neurosci Ther 2024; 30:e14492. [PMID: 37864441 PMCID: PMC11017425 DOI: 10.1111/cns.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Medial temporal lobe atrophy (MTA) is a diagnostic marker for mild cognitive impairment (MCI) and Alzheimer's disease (AD), but the accuracy of quantitative MTA (QMTA) in diagnosing early AD is unclear. This study aimed to investigate the accuracy of QMTA and its related components (inferior lateral ventricle [ILV] and hippocampus) with MTA in the early diagnosis of MCI and AD. METHODS This study included four groups: normal (NC), MCI stable (MCIs), MCI converted to AD (MCIs), and mild AD (M-AD) groups. Magnetic resonance image analysis software was used to quantify the hippocampus, ILV, and QMTA. MTA was rated by two experienced neurologists. Receiver operating characteristic area under the curve (AUC) analysis was performed to compare their capability in differentiating AD from NC and MCI, and optimal thresholds were determined using the Youden index. RESULTS QMTA distinguished M-AD from NC and MCI with higher diagnostic accuracy than MTA, hippocampus, and ILV (AUCNC = 0.976, AUCMCI = 0.836, AUCMCIs = 0.894, AUCMCIc = 0.730). The diagnostic accuracy of QMTA was superior to that of MTA, the hippocampus, and ILV in differentiating MCI from AD. The diagnostic accuracy of QMTA was found to remain the best across age, sex, and pathological subgroups analyzed. The sensitivity (92.45%) and specificity (90.64%) were higher in this study when a cutoff value of 0.635 was chosen for QMTA. CONCLUSIONS QMTA may be a better choice than the MTA scale or the associated quantitative components alone in identifying AD patients and MCI individuals with higher progression risk.
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Affiliation(s)
- Yingren Mai
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Zhiyu Cao
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Lei Zhao
- BrainNow Research InstituteShenzhenChina
| | - Qun Yu
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jiaxin Xu
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Wenyan Liu
- BrainNow Research InstituteShenzhenChina
| | - Bowen Liu
- Department of Statistics, College of Liberal Art and SciencesUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Jingyi Tang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yishan Luo
- BrainNow Research InstituteShenzhenChina
| | - Wang Liao
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Wenli Fang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yuting Ruan
- Department of RehabilitationThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Ming Lei
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Vincent C. T. Mok
- BrainNow Research InstituteShenzhenChina
- Division of Neurology, Department of Medicine and Therapeutics, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong, SARChina
| | - Lin Shi
- BrainNow Research InstituteShenzhenChina
- Department of Imaging and Interventional RadiologyThe Chinese University of Hong KongHong Kong, SARChina
| | - Jun Liu
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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Park HY, Park CR, Suh CH, Shim WH, Kim SJ. Diagnostic performance of the medial temporal lobe atrophy scale in patients with Alzheimer's disease: a systematic review and meta-analysis. Eur Radiol 2021; 31:9060-9072. [PMID: 34510246 DOI: 10.1007/s00330-021-08227-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/02/2021] [Accepted: 07/22/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance and reliability of the medial temporal lobe atrophy (MTA) scale in patients with Alzheimer's disease. METHODS A systematic literature search of MEDLINE and EMBASE databases was performed to select studies that evaluated the diagnostic performance or reliability of MTA scale, published up to January 21, 2021. Pooled estimates of sensitivity and specificity were calculated using a bivariate random-effects model. Pooled correlation coefficients for intra- and interobserver agreements were calculated using the random-effects model based on Fisher's Z transformation of correlations. Meta-regression was performed to explain the study heterogeneity. Subgroup analysis was performed to compare the diagnostic performance of the MTA scale and hippocampal volumetry. RESULTS Twenty-one original articles were included. The pooled sensitivity and specificity of the MTA scale in differentiating Alzheimer's disease from healthy control were 74% (95% CI, 68-79%) and 88% (95% CI, 83-91%), respectively. The area under the curve of the MTA scale was 0.88 (95% CI, 0.84-0.90). Meta-regression demonstrated that the difference in the method of rating the MTA scale was significantly associated with study heterogeneity (p = 0.04). No significant difference was observed in five studies regarding the diagnostic performance between MTA scale and hippocampal volumetry (p = 0.40). The pooled correlation coefficients for intra- and interobserver agreements were 0.85 (95% CI, 0.69-0.93) and 0.83 (95% CI, 0.66-0.92), respectively. CONCLUSIONS Our meta-analysis demonstrated a good diagnostic performance and reliability of the MTA scale in Alzheimer's disease. KEY POINTS • The pooled sensitivity and specificity of the MTA scale in differentiating Alzheimer's disease from healthy control were 74% and 88%, respectively. • There was no significant difference in the diagnostic performance between MTA scale and hippocampal volumetry. • The reliability of MTA scale was excellent based on the pooled correlation coefficient for intra- and interobserver agreements.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae Ri Park
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Håkansson C, Tamaddon A, Andersson H, Torisson G, Mårtensson G, Truong M, Annertz M, Londos E, Björkman-Burtscher IM, Hansson O, van Westen D. Inter-modality assessment of medial temporal lobe atrophy in a non-demented population: application of a visual rating scale template across radiologists with varying clinical experience. Eur Radiol 2021; 32:1127-1134. [PMID: 34328536 PMCID: PMC8794965 DOI: 10.1007/s00330-021-08177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess inter-modality agreement and accuracy for medial temporal lobe atrophy (MTA) ratings across radiologists with varying clinical experience in a non-demented population. METHODS Four raters (two junior radiologists and two senior neuroradiologists) rated MTA on CT and MRI scans using Scheltens' MTA scale. Ratings were compared to a consensus rating by two experienced neuroradiologists for estimation of true positive and negative rates (TPR and TNR) and over- and underestimation of MTA. Inter-modality agreement expressed as Cohen's κ (dichotomized data), Cohen's κw, and two-way mixed, single measures, consistency ICC (ordinal data) were determined. Adequate agreement was defined as κ/κw ≥ 0.80 and ICC ≥ 0.80 (significance level at 95% CI ≥ 0.65). RESULTS Forty-nine subjects (median age 72 years, 27% abnormal MTA) with cognitive impairment were included. Only junior radiologists achieved adequate agreement expressed as Cohen's κ. All raters achieved adequate agreement expressed as Cohen's κw and ICC. True positive rates varied from 69 to 100% and TNR varied from 85 to 100%. No under- or overestimation of MTA was observed. Ratings did not differ between radiologists. CONCLUSION We conclude that radiologists with varying experience achieve adequate inter-modality agreement and similar accuracy when Scheltens' MTA scale is used to rate MTA on a non-demented population. However, TPR varied between radiologists which could be attributed to rating style differences. KEY POINTS • Radiologists with varying experience achieve adequate inter-modality agreement with similar accuracy when Scheltens' MTA scale is used to rate MTA on a non-demented population. • Differences in rating styles might affect accuracy, this was most evident for senior neuroradiologists, and only junior radiologists achieved adequate agreement on dichotomized (abnormal/normal) ratings. • The use of an MTA scale template might compensate for varying clinical experience which could make it applicable for clinical use.
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Affiliation(s)
- Claes Håkansson
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden.
- Department of Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden.
| | - Ashkan Tamaddon
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Henrik Andersson
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Gustav Torisson
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Gustav Mårtensson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - My Truong
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Mårten Annertz
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | | | - Oskar Hansson
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Danielle van Westen
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
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