Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
Department of Neurology, Nagoya City Koseiin Medical Welfare Center, Nagoya, Aichi, Japan.
J Alzheimers Dis. 2021;84(4):1719-1727. doi: 10.3233/JAD-210638.
Although hippocampal atrophy is a well-known imaging biomarker of Alzheimer's disease (AD), this finding is not useful to differentiate AD from argyrophilic grain disease (AGD) which is a common AD mimicker presenting with similar amnestic symptoms and medial temporal atrophy. Instead, we propose use of the "sloping shoulders sign", defined as a distinct configuration of the bilateral hippocampal heads showing lateral and downward slopes on axial magnetic resonance imaging (MRI).
We investigated the diagnostic utility of the "sloping shoulders sign" as a simple radiological discriminator of AD from AGD.
Using axial and coronal three-dimensional MRI, our newly proposed "sloping shoulders sign", other quantitative indices including the axial hippocampal head angle (AHHA), and well-known medial temporal atrophy (MTA) score were evaluated in pathologically-proven 24 AD and 11 AGD patients.
Detection rate of the "sloping shoulders sign" was significantly higher in all AD groups (83%; 20/24) and AD with Braak neurofibrillary tangle V/VI stage subgroup (88%; 15/17) than in AGD patients (18% - 2/11; p < 0.001 and p < 0.001, respectively). In contrast to the MTA score, this sign as well as AHHA demonstrated higher diagnostic performance and reproducibility, especially to differentiate all AD patients from AGD ones (accuracies of 71.4% , 82.9% and 82.9%; Cohen's kappa of 0.70 and 0.81, and intraclass correlation coefficient of 0.96, respectively).
The "sloping shoulders sign" is useful to differentiate advanced-stage AD from AGD. Its simplicity and reproducibility based on visual inspection using axial MRI make it suitable for routine clinical practice.
尽管海马萎缩是阿尔茨海默病（AD）的一种众所周知的影像学生物标志物，但这一发现并不能用于区分 AD 与嗜银颗粒病（AGD），后者是一种常见的 AD 模拟物，具有相似的遗忘症状和内侧颞叶萎缩。相反，我们提出使用“斜肩征”，定义为双侧海马头部的明显形态，在轴位磁共振成像（MRI）上显示出侧向和向下的倾斜。
我们研究了“斜肩征”作为 AD 与 AGD 的简单影像学鉴别诊断的诊断效用。
使用轴位和冠状三维 MRI，我们新提出的“斜肩征”，以及其他定量指标，包括轴向海马头角（AHHA）和众所周知的内侧颞叶萎缩（MTA）评分，在经病理证实的 24 例 AD 和 11 例 AGD 患者中进行了评估。
在所有 AD 组（83%，20/24）和 AD 与 Braak 神经纤维缠结 V/VI 阶段亚组（88%，15/17）中，“斜肩征”的检出率明显高于 AGD 患者（18%，2/11；p<0.001 和 p<0.001）。与 MTA 评分相比，该征象以及 AHHA 表现出更高的诊断性能和可重复性，尤其是将所有 AD 患者与 AGD 患者区分开来（准确率分别为 71.4%、82.9%和 82.9%；Cohen's kappa 值分别为 0.70 和 0.81，以及内类相关系数分别为 0.96）。
“斜肩征”有助于区分晚期 AD 与 AGD。其基于轴位 MRI 的视觉检查的简单性和可重复性使其适合常规临床实践。
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