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. 2021 Jul 24;21(1):289.
doi: 10.1186/s12883-021-02325-2.

Validity and reliability of the medial temporal lobe atrophy scale in a memory clinic population

Anna Molinder  1   2 , Doerthe Ziegelitz  3 , Stephan E Maier  3   4 , Carl Eckerström  5   6
Affiliations

Validity and reliability of the medial temporal lobe atrophy scale in a memory clinic population

Anna Molinder et al. BMC Neurol. .

Abstract

Background: Visual rating of medial temporal lobe atrophy (MTA) is often performed in conjunction with dementia workup. Most prior studies involved patients with known or probable Alzheimer's disease (AD). This study investigated the validity and reliability of MTA in a memory clinic population.

Methods: MTA was rated in 752 MRI examinations, of which 105 were performed in cognitively healthy participants (CH), 184 in participants with subjective cognitive impairment, 249 in subjects with mild cognitive impairment, and 214 in patients with dementia, including AD, subcortical vascular dementia and mixed dementia. Hippocampal volumes, measured manually or using FreeSurfer, were available in the majority of cases. Intra- and interrater reliability was tested using Cohen's weighted kappa. Correlation between MTA and quantitative hippocampal measurements was ascertained with Spearman's rank correlation coefficient. Moreover, diagnostic ability of MTA was assessed with receiver operating characteristic (ROC) analysis and suitable, age-dependent MTA thresholds were determined.

Results: Rater agreement was moderate to substantial. MTA correlation with quantitative volumetric methods ranged from -0.20 (p< 0.05) to -0.68 (p < 0.001) depending on the quantitative method used. Both MTA and FreeSurfer are able to distinguish dementia subgroups from CH. Suggested age-dependent MTA thresholds are 1 for the age group below 75 years and 1.5 for the age group 75 years and older.

Conclusions: MTA can be considered a valid marker of medial temporal lobe atrophy and may thus be valuable in the assessment of patients with cognitive impairment, even in a heterogeneous patient population.

Keywords: Alzheimer’s disease; Atrophy; Dementia; Magnetic resonance imaging; Medial temporal lobe atrophy (MTA); Mild cognitive impairment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Coronal T1-weighted slices at the level of the hippocampus body of four different study participants with different levels of medial temporal lobe atrophy (MTA). a MTA 0 bilaterally. b MTA 1 bilaterally. c MTA 2 right side, MTA 3 left side. d MTA 4 bilaterally. Images (a-c) were acquired with a 1.5 Tesla scanner, whereas image (d) was acquired with a 0.5 Tesla scanner
Fig. 2
Fig. 2
Tukey boxplot for hippocampal volume vs MTA determined with a manual volumetry and b FreeSurfer volumetry. Line inside box indicates median. Whiskers indicate ± 1.5 IQR (interquartile range). White boxes: right side. Hatched boxes: left side
See this image and copyright information in PMC

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