磁共振成像上颞叶萎缩在早期阿尔茨海默病诊断中的应用

Temporal lobe atrophy on magnetic resonance imaging in the diagnosis of early Alzheimer's disease.

作者信息

Erkinjuntti T, Lee D H, Gao F, Steenhuis R, Eliasziw M, Fry R, Merskey H, Hachinski V C

机构信息

Department of Clinical Neurological Sciences, University of Western Ontario.

出版信息

Arch Neurol. 1993 Mar;50(3):305-10. doi: 10.1001/archneur.1993.00540030069017.

DOI:10.1001/archneur.1993.00540030069017

PMID:8442711

Abstract

OBJECTIVE

To evaluate the use of simple ratings and linear measures of atrophy in the temporal lobe structures obtained with magnetic resonance imaging coronal scans in the diagnosis of early Alzheimer's disease.

DESIGN

Prospective series. The National Institute for Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease. Blinded assessment.

SETTING

Dementia study in a university hospital.

SUBJECTS

Patients with Alzheimer's disease (n = 34), scoring 150 or more on the Extended Scale for Dementia, and age-matched healthy community volunteers (n = 39) who had both magnetic resonance imaging coronal scans and a psychometric assessment using the Extended Scale for Dementia within 6 months were included.

MAIN MEASURES

T1-weighted magnetic resonance imaging coronal scans, a 1.5-T system. The degree of atrophy rated (0 to 4) in both sides of the temporal neocortex, entorhinal cortex, hippocampal formation, temporal horns, third ventricle, lateral ventricles, and frontal and parietal cortex. Linear measures: the area of hippocampus and the maximal transverse width of temporal horns.

RESULTS

Differentiation between patients with Alzheimer's disease and controls was limited by considerable variations in sensitivity and specificity. Receiver operating characteristics analysis revealed a clear order of discrimination, the entorhinal cortex and the temporal neocortex being the two best, followed by the temporal horns and hippocampal formation. For a given specificity of 90%, the corresponding sensitivity for the entorhinal cortex, temporal neocortex, temporal horns, and hippocampal formation was 95%, 63%, 56%, and 41%, respectively. Linear measures differed significantly but showed considerable overlap.

CONCLUSION

The presence of rated atrophy in selected temporal structures makes the diagnosis of Alzheimer's disease more likely, but the absence does not rule out the possibility of early Alzheimer's disease.

摘要

目的

评估利用磁共振成像冠状扫描获得的颞叶结构的简单评分和萎缩线性测量方法在早期阿尔茨海默病诊断中的应用。

设计

前瞻性系列研究。采用美国国立神经疾病和中风研究所 - 阿尔茨海默病及相关疾病协会可能的阿尔茨海默病标准。盲法评估。

地点

大学医院的痴呆症研究。

研究对象

纳入阿尔茨海默病患者（n = 34），其在扩展痴呆量表上得分150分及以上，以及年龄匹配的健康社区志愿者（n = 39），这些志愿者在6个月内进行了磁共振成像冠状扫描，并使用扩展痴呆量表进行了心理测量评估。

主要测量指标

使用1.5-T系统进行T1加权磁共振成像冠状扫描。对颞叶新皮质、内嗅皮质、海马结构、颞角、第三脑室、侧脑室以及额叶和顶叶皮质两侧的萎缩程度进行评分（0至4分）。线性测量指标：海马面积和颞角最大横径。

结果

阿尔茨海默病患者与对照组之间的区分受到敏感性和特异性显著差异的限制。受试者工作特征分析显示出明显的鉴别顺序，内嗅皮质和颞叶新皮质是两个最佳指标，其次是颞角和海马结构。对于给定的90%特异性，内嗅皮质、颞叶新皮质、颞角和海马结构的相应敏感性分别为95%、63%、56%和41%。线性测量指标有显著差异，但存在相当大程度的重叠。