用于区分晚期阿尔茨海默病和其他边缘系统 tau 病的简单定量指标。

Simple Quantitative Indices for the Differentiation of Advanced-Stage Alzheimer's Disease and Other Limbic Tauopathies.

机构信息

Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Choju Medical Institute, Fukushimura Hospital, Toyohashi, Japan.

出版信息

J Alzheimers Dis. 2021;81(3):1093-1102. doi: 10.3233/JAD-210043.

DOI:10.3233/JAD-210043

PMID:33843680

Abstract

BACKGROUND

The differentiation of Alzheimer's disease (AD) from age-related limbic tauopathies (LT), including argyrophilic grain disease (AGD) and senile dementia of the neurofibrillary tangle type (SD-NFT), is often challenging because specific clinical diagnostic criteria have not yet been established. Despite the utility of specific biomarkers evaluating amyloid and tau to detect the AD-related pathophysiological changes, the expense and associated invasiveness preclude their use as first-line diagnostic tools for all demented patients. Therefore, less invasive and costly biomarkers would be valuable in routine clinical practice for the differentiation of AD and LT.

OBJECTIVE

The purpose of this study is to develop a simple reproducible method on magnetic resonance imaging (MRI) that could be adopted in daily clinical practice for the differentiation of AD and other forms of LT.

METHODS

Our newly proposed three quantitative indices and well-known medial temporal atrophy (MTA) score were evaluated using MRI of pathologically-proven advanced-stage 21 AD, 10 AGD, and 2 SD-NFT patients.

RESULTS

Contrary to MTA score, hippocampal angle (HPA), inferior horn area (IHA), and ratio between HPA and IHA (i.e., IHPA index) demonstrated higher diagnostic performance and reproducibility, especially to differentiate advanced-stage AD patients with Braak neurofibrillary tangle stage V/VI from LT patients (the area under the receiver-operating-characteristic curve of 0.83, 089, and 0.91; intraclass correlation coefficients of 0.930, 0.998, and 0.995, respectively).

CONCLUSION

Quantitative indices reflecting hippocampal deformation with ventricular enlargement are useful to differentiate advanced-stage AD from LT. This simple and convenient method could be useful in daily clinical practice.

摘要

背景

阿尔茨海默病（AD）与年龄相关的边缘叶 tau 病（LT），包括嗜银颗粒病（AGD）和神经原纤维缠结型老年痴呆（SD-NFT），很难区分，因为尚未建立特定的临床诊断标准。尽管评估淀粉样蛋白和 tau 的特定生物标志物可用于检测 AD 相关的病理生理变化，但费用和相关的侵袭性排除了它们作为所有痴呆患者的一线诊断工具的使用。因此，在常规临床实践中，侵入性较小且成本较低的生物标志物对于 AD 和 LT 的鉴别具有重要价值。

目的

本研究旨在开发一种简单、可重复的磁共振成像（MRI）方法，以便在日常临床实践中用于 AD 和其他 LT 形式的鉴别。

方法

我们评估了新提出的三个定量指标和众所周知的内侧颞叶萎缩（MTA）评分，这些指标是在病理证实的 21 例 AD 晚期、10 例 AGD 和 2 例 SD-NFT 患者的 MRI 上评估的。

结果

与 MTA 评分相比，海马角（HPA）、下角面积（IHA）和 HPA 与 IHA 之间的比值（即 IHPA 指数）显示出更高的诊断性能和可重复性，特别是区分具有 Braak 神经原纤维缠结阶段 V/VI 的 AD 晚期患者和 LT 患者（受试者工作特征曲线下面积分别为 0.83、0.89 和 0.91；内类相关系数分别为 0.930、0.998 和 0.995）。