Mai Yingren, Cao Zhiyu, Zhao Lei, Yu Qun, Xu Jiaxin, Liu Wenyan, Liu Bowen, Tang Jingyi, Luo Yishan, Liao Wang, Fang Wenli, Ruan Yuting, Lei Ming, Mok Vincent C T, Shi Lin, Liu Jun
Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
CNS Neurosci Ther. 2024 Apr;30(4):e14492. doi: 10.1111/cns.14492. Epub 2023 Oct 21.
Medial temporal lobe atrophy (MTA) is a diagnostic marker for mild cognitive impairment (MCI) and Alzheimer's disease (AD), but the accuracy of quantitative MTA (QMTA) in diagnosing early AD is unclear. This study aimed to investigate the accuracy of QMTA and its related components (inferior lateral ventricle [ILV] and hippocampus) with MTA in the early diagnosis of MCI and AD.
This study included four groups: normal (NC), MCI stable (MCIs), MCI converted to AD (MCIs), and mild AD (M-AD) groups. Magnetic resonance image analysis software was used to quantify the hippocampus, ILV, and QMTA. MTA was rated by two experienced neurologists. Receiver operating characteristic area under the curve (AUC) analysis was performed to compare their capability in differentiating AD from NC and MCI, and optimal thresholds were determined using the Youden index.
QMTA distinguished M-AD from NC and MCI with higher diagnostic accuracy than MTA, hippocampus, and ILV (AUC = 0.976, AUC = 0.836, AUC = 0.894, AUC = 0.730). The diagnostic accuracy of QMTA was superior to that of MTA, the hippocampus, and ILV in differentiating MCI from AD. The diagnostic accuracy of QMTA was found to remain the best across age, sex, and pathological subgroups analyzed. The sensitivity (92.45%) and specificity (90.64%) were higher in this study when a cutoff value of 0.635 was chosen for QMTA.
QMTA may be a better choice than the MTA scale or the associated quantitative components alone in identifying AD patients and MCI individuals with higher progression risk.
内侧颞叶萎缩（MTA）是轻度认知障碍（MCI）和阿尔茨海默病（AD）的诊断标志物，但定量MTA（QMTA）在早期AD诊断中的准确性尚不清楚。本研究旨在探讨QMTA及其相关成分（下外侧脑室[ILV]和海马体）联合MTA在MCI和AD早期诊断中的准确性。
本研究包括四组：正常组（NC）、稳定型MCI组（MCIs）、转化为AD的MCI组（MCIs）和轻度AD组（M-AD）。使用磁共振图像分析软件对海马体、ILV和QMTA进行量化。由两位经验丰富的神经科医生对MTA进行评分。进行曲线下面积（AUC）分析以比较它们区分AD与NC和MCI的能力，并使用约登指数确定最佳阈值。
QMTA区分M-AD与NC和MCI的诊断准确性高于MTA、海马体和ILV（AUC分别为0.976、0.836、0.894、0.730）。在区分MCI与AD方面，QMTA的诊断准确性优于MTA、海马体和ILV。在分析的各个年龄、性别和病理亚组中，QMTA的诊断准确性均保持最佳。当选择0.635作为QMTA的临界值时，本研究中的敏感性（92.45%）和特异性（90.64%）更高。
在识别AD患者和具有较高进展风险的MCI个体方面，QMTA可能比单独使用MTA量表或相关定量成分是更好的选择。
