내측 측두엽 위축의 T1-축영상 시각 척도제안: Schelten의 관영상 시각척도와 비교연구
T1-Axial Medial Temporal Atrophy Visual Rating: A Comparable Study with Schelten’s T1-Coronal Visual Rating
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Background: Medial temporal atrophy (MTA) is the earliest pathological characteristic and a sensitive biologic marker for Alzheimer’s disease. The Schelten’s coronal visual rating scale has been commonly used for assessing MTA. But sometimes it has been difficult to apply Schelten’s coronal visual rating scale in large epidemiologic studies because it needs more sophisticated knowledge of hippocampal anatomy of each raters. The purposes of this study is to 1) suggest a new and easier visual rating scale using T1 axial images, 2) compare visual assessment of MTA using modified T1-coronal Schelten’s visual rating scale with T1-axial visual rating scale, and 3) test whether the degree of MTA in T1-axial visual rating scale correlates with the severity of cognitive impairment. Methods: Participants were 27 Alzheimer’s patients (23 women, 4 men) and 26 non-demented normal control (18 women, 8 men). Two neurologists blinded to diagnosis and age of the subjects assessed MTA by axial visual rating scale which assessed for the maximal hippocampal width and parahippocampal cerebrospinal fluid space. Intra-rater and inter-rater reliability were obtained. Hippocampal volume was assessed by manual tracing in 5 participants representing each visual axial grade. Results: The visual rating scale using T1-axial image was comparable to T1-coronal visual rating scale, showing significant agreement (kappa=0.745, p< 0.001). Inter-and intra-rater reliability in T1-axial visual rating scale of MTA was higher than those in Schelten’s T1-coronal visual rating scale. The degree of MTA in T1 axial visual rating scale showed negative correlation with MMSE (r=-0.460, p<0.001) and clinical dementia rating scale (sum of box) (r=0.563, p<0.001). Hippocampal volume tended to decrease according to visual axial grade. Conclusions: The T1-axial visual rating scale of MTA showed good agreement with Schelten’s T1-coronal visual rating scale and cognitive functions. Inter-and intra-rater reliability for T1-axial visual rating scale of MTA was higher than those of Schelten’s T1-coronal visual rating scale, which suggests of possibilities of application for axial visual rating scale in clinical practice. The correlation of degree of MTA in T1- axial visual rating scale with hippocampal volume should be studied in large number of subjects.
Abstract
Background: Medial temporal atrophy (MTA) is the earliest pathological characteristic and a sensitive biologic marker for Alzheimer’s disease. The Schelten’s coronal visual rating scale has been commonly used for assessing MTA. But sometimes it has been difficult to apply Schelten’s coronal visual rating scale in large epidemiologic studies because it needs more sophisticated knowledge of hippocampal anatomy of each raters. The purposes of this study is to 1) suggest a new and easier visual rating scale using T1 axial images, 2) compare visual assessment of MTA using modified T1-coronal Schelten’s visual rating scale with T1-axial visual rating scale, and 3) test whether the degree of MTA in T1-axial visual rating scale correlates with the severity of cognitive impairment. Methods: Participants were 27 Alzheimer’s patients (23 women, 4 men) and 26 non-demented normal control (18 women, 8 men). Two neurologists blinded to diagnosis and age of the subjects assessed MTA by axial visual rating scale which assessed for the maximal hippocampal width and parahippocampal cerebrospinal fluid space. Intra-rater and inter-rater reliability were obtained. Hippocampal volume was assessed by manual tracing in 5 participants representing each visual axial grade. Results: The visual rating scale using T1-axial image was comparable to T1-coronal visual rating scale, showing significant agreement (kappa=0.745, p< 0.001). Inter-and intra-rater reliability in T1-axial visual rating scale of MTA was higher than those in Schelten’s T1-coronal visual rating scale. The degree of MTA in T1 axial visual rating scale showed negative correlation with MMSE (r=-0.460, p<0.001) and clinical dementia rating scale (sum of box) (r=0.563, p<0.001). Hippocampal volume tended to decrease according to visual axial grade. Conclusions: The T1-axial visual rating scale of MTA showed good agreement with Schelten’s T1-coronal visual rating scale and cognitive functions. Inter-and intra-rater reliability for T1-axial visual rating scale of MTA was higher than those of Schelten’s T1-coronal visual rating scale, which suggests of possibilities of application for axial visual rating scale in clinical practice. The correlation of degree of MTA in T1- axial visual rating scale with hippocampal volume should be studied in large number of subjects.
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