Verhagen Martijn V, Guit Gerard L, Hafkamp Gerrit Jan, Kalisvaart Kees
Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
Department of Geriatrics, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
Eur Radiol. 2016 Jun;26(6):1716-22. doi: 10.1007/s00330-015-3957-z. Epub 2015 Aug 29.
Dementia is foremost a clinical diagnosis. However, in diagnosing dementia, it is advocated to perform at least one neuroimaging study. This has two purposes: to rule out potential reversible dementia (PRD), and to help determine the dementia subtype. Our first goal was to establish if MRI combined with visual rating scales changes the clinical diagnosis. The second goal was to demonstrate if MRI contributes to a geriatrician's confidence in the diagnosis.
The dementia subtype was determined prior to and after MRI. Scoring scales used were: global cortical atrophy (GCA), medial temporal atrophy (MTA), and white matter hyperintensity measured according to the Fazekas scale. The confidence level of the geriatrician was determined using a visual analogue scale.
One hundred and thirty-five patients were included. After MRI, the diagnosis changed in 23.7 % (CI 17.0 %-31.1 %) of patients. Change was due to vascular aetiology in 13.3 % of patients. PRD was found in 2.2 % of all patients. The confidence level in the diagnosis increased significantly after MRI (p = 0.001).
MRI, combined with visual rating scales, has a significant impact on dementia subtype diagnosis and on a geriatrician's confidence in the final diagnosis.
• MRI with visual rating scales changes the dementia subtype diagnosis significantly. • MRI is essential in demonstrating vascular disease as a cause of dementia. • All suspected dementia patients should undergo an MRI with visual rating scales. • MRI improves a geriatrician's confidence in the diagnosis of the dementia subtype. • MRI remains essential during the workup of dementia to exclude reversible causes.
痴呆首先是一种临床诊断。然而，在诊断痴呆时，提倡至少进行一项神经影像学检查。这有两个目的：排除潜在的可逆性痴呆（PRD），并有助于确定痴呆亚型。我们的第一个目标是确定MRI结合视觉评定量表是否会改变临床诊断。第二个目标是证明MRI是否有助于提高老年科医生对诊断的信心。
在MRI检查前后确定痴呆亚型。使用的评分量表包括：根据Fazekas量表测量的全脑皮质萎缩（GCA）、内侧颞叶萎缩（MTA）和白质高信号。使用视觉模拟量表确定老年科医生的信心水平。
纳入135例患者。MRI检查后，23.7%（置信区间17.0%-31.1%）的患者诊断发生改变。13.3%的患者诊断改变是由于血管病因。在所有患者中发现2.2%患有PRD。MRI检查后诊断的信心水平显著提高（p = 0.001）。
MRI结合视觉评定量表对痴呆亚型诊断以及老年科医生对最终诊断的信心有显著影响。
• MRI结合视觉评定量表可显著改变痴呆亚型诊断。• MRI对于证明血管疾病是痴呆病因至关重要。• 所有疑似痴呆患者均应接受MRI结合视觉评定量表检查。• MRI可提高老年科医生对痴呆亚型诊断的信心。• 在痴呆检查过程中，MRI对于排除可逆病因仍然至关重要。
