Varon Daniel, Barker Warren, Loewenstein David, Greig Maria, Bohorquez Adriana, Santos Isael, Shen Qian, Harper Molly, Vallejo-Luces Tatiana, Duara Ranjan
Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA; Department of Neurology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
Int J Geriatr Psychiatry. 2015 Feb;30(2):192-200. doi: 10.1002/gps.4126. Epub 2014 May 12.
This study aims to determine the clinical utility of visual ratings and volumetric measurements of medial temporal atrophy among subjects from the Alzheimer's Disease Neurorimaging Initiative (ADNI) cohort.
A sample of 189 subjects from the ADNI, Phase 1 (ADNI-1), was chosen as follows: 49 cognitively normal (CN), 89 with mild cognitive impairment (MCI), and 50 with Alzheimer's disease (AD). Structural MRI images were downloaded from the ADNI website, and a visual rating system (VRS) was used to obtain semi-quantitative ratings of the hippocampus (HPC) and entorhinal cortex (ERC). VRS ratings and FreeSurfer measures of the HPC and ERC were used to predict (i) baseline diagnosis and (ii) progression to AD among subjects with MCI at baseline.
VRS and FreeSurfer measures of ERC were equivalent in classifying subjects at baseline, but FreeSurfer measures of HPC were superior to VRS measures for classifying CN versus MCI subjects. VRS and FreeSurfer measures of both HPC and ERC were significant predictors of progression from MCI to AD. However, VRS ratings of ERC were superior to other MRI measures. MCI subjects with minimal ERC atrophy by VRS had a threefold lower progression rate to AD at 3.2 years compared with those with mild, moderate, or severe atrophy (23% vs 63%, 69%, and 87%, respectively).
Visual ratings of HPC and ERC provide useful information to a physician in a clinical setting. Visual ratings of ERC may be especially useful in following patients with MCI.
本研究旨在确定阿尔茨海默病神经影像倡议（ADNI）队列中受试者内侧颞叶萎缩的视觉评分和体积测量的临床效用。
从ADNI第一阶段（ADNI-1）中选取189名受试者作为样本，具体如下：49名认知正常（CN）者、89名轻度认知障碍（MCI）者和50名阿尔茨海默病（AD）患者。从ADNI网站下载结构MRI图像，并使用视觉评分系统（VRS）获得海马体（HPC）和内嗅皮质（ERC）的半定量评分。使用HPC和ERC的VRS评分及FreeSurfer测量值来预测：（i）基线诊断；（ii）基线时患有MCI的受试者进展为AD的情况。
在基线时对受试者进行分类时，ERC的VRS和FreeSurfer测量值相当，但在区分CN与MCI受试者方面，HPC的FreeSurfer测量值优于VRS测量值。HPC和ERC的VRS及FreeSurfer测量值均是MCI进展为AD的显著预测指标。然而，ERC的VRS评分优于其他MRI测量指标。与轻度、中度或重度萎缩的MCI受试者相比，VRS显示ERC萎缩最小的MCI受试者在3.2年时进展为AD的比率低三倍（分别为23%对63%、69%和87%）。
HPC和ERC的视觉评分可为临床医生提供有用信息。ERC的视觉评分在随访MCI患者时可能特别有用。
