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. 2019 Feb 28;19(1):59.
doi: 10.1186/s12877-019-1072-8.

A new age-related cutoff of medial temporal atrophy scale on MRI improving the diagnostic accuracy of neurodegeneration due to Alzheimer's disease in a Chinese population

Mingqing Wei  1 , Jing Shi  1 , Jingnian Ni  1 , Xuekai Zhang  1 , Ting Li  1 , Zilong Chen  1 , Mengling Zhou  1 , Liping Zhang  2 , Zhongjian Tan  2 , Yongyan Wang  3 , Jinzhou Tian  4
Affiliations

A new age-related cutoff of medial temporal atrophy scale on MRI improving the diagnostic accuracy of neurodegeneration due to Alzheimer's disease in a Chinese population

Mingqing Wei et al. BMC Geriatr. .

Abstract

Background: Visual rating scales are still the most popular tools in assessing atrophy degrees of whole brain and lobes. However, the false negative rate of the previous cutoff score of visual rating scales was relatively high for detecting dementia of Alzheimer's type (DAT). This study aimed to evaluate the diagnostic value of new cutoffs of visual rating scales on magnetic resonance imaging for discriminating DAT in a Chinese population.

Methods: Out of 585 enrolled subjects, 296 participants were included and diagnosed as normal cognition (NC)(n = 87), 138 diagnosed as amnestic mild cognitive impairment (aMCI), and 71 as dementia of Alzheimer's type (DAT). Receiver operating characteristic (ROC) curve analyses were used to calculate the diagnostic value of visual rating sales (including medial temporal atrophy (MTA), posterior atrophy rating scale (PA),global cortical atrophy scale (GCA) and medial temporal-lobe atrophy index (MTAi))for detecting NC from DAT .

Results: Scores of MTA correlated to age and Mini-mental state examination score. When used to detect DAT from NC, the MTA showed highest diagnostic value than other scales, and when the cutoff score of 1.5 of MTA scale, it obtained an optimal sensitivity (84.5%) and specificity (79.1%) respectively, with a 15.5% of false negative rate. Cutoff scores and diagnostic values were calculated stratified by age. For the age ranges 50-64, 65-74, 75-84 years, the following cut-offs of MTA should be used, ≥1.0(sensitivity and specificity were 92.3 and 68.4%), ≥1.5(sensitivity and specificity were 90.4 and 85.2%), ≥ 2.0(sensitivity and specificity were 70.8 and 82.3%) respectively. All of the scales showed relatively lower diagnostic values for discriminating aMCI from NC.

Conclusions: The new age-based MTA cutoff showed better diagnostic accuracy for detecting DAT than previous standard, the list of practical cut-offs proposed here might be useful in clinical practice.

Keywords: Alzheimer’s disease; Global cortical atrophy scale; Medial temporal atrophy scale; Medial temporal-lobe atrophy index; Posterior atrophy rating scale.

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Conflict of interest statement

Ethics approval and consent to participate

The protocol was approved by Dongzhimen Hospital, Beijing University of Chinese Medicine Institutional Ethics Committee. All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All the patients and responsible caregivers provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Standard study flow chart of medial temporal atrophy scale
Fig. 2
Fig. 2
Receiver operating characteristic curve of visual rating scales in the differentiation of dementia of Alzheimer’s type from normal cognition. Notes: MTA = medial temporal atrophy; PA = posterior atrophy rating scale; GCA = global cortical atrophy scale; MTAi = medial temporal-lobe atrophy index
Fig. 3
Fig. 3
Receiver operating characteristic curve of visual rating scales in the differentiation of aMCI from normal cognition. Notes: MTA = medial temporal atrophy; PA = posterior atrophy rating scale; GCA = global cortical atrophy scale; MTAi = medial temporal-lobe atrophy index; aMCI = amnestic mild cognitive impairment
Fig. 4
Fig. 4
Receiver operating characteristic curve of visual rating scales in the differentiation of dementia of Alzheimer’s type from aMCI. Notes: MTA = medial temporal atrophy; PA = posterior atrophy rating scale; GCA = global cortical atrophy scale; MTAi = medial temporal-lobe atrophy index; aMCI = amnestic mild cognitive impairment
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