KMID : 1100220090080010037
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Dementia and Neurocognitive Disorders 2009 Volume.8 No. 1 p.37 ~ p.44
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T1-Axial Medial Temporal Atrophy Visual Rating : A comparable study with Schelten¡¯s T1-Coronal Visual Rating
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Jeong Jee-H
Kim Geon-Ha
Kim Jung-Eun Park Gi-Duck Choi Kyoung-Gyu
Lee Jong-Min Na Duk-Lyul
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Abstract
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Background and Objectives: Medial temporal atrophy (MTA) is the earliest pathological characteristic and a sensitive biologic marker for Alzheimer¡¯s disease. The Schelten¡¯s coronal visual rating scale has been commonly used for assessing MTA. But sometimes it has been difficult to apply Schelten¡¯s coronal visual rating scale in large epidemiologic studies because it needs more sophisticated knowledge of hippocampal anatomy of each raters. The purposes of this study is to (1) suggest a new and easier visual rating scale using T1 axial images (2) compare visual assessment of MTA using modified T1-coronal Schelten¡¯s visual rating scale with T1-axial visual rating scale, and (3) test whether the degree of MTA in T1-axial visual rating scale correlates with the severity of cognitive impairment.
Methods: Participants were 27 Alzheimer¡¯s patients (23 women, 4 men) and 26 non-demented normal control(18 women, 8 men). Two neurologists blinded to diagnosis and age of the subjects assessed MTA by axial visual rating scale which assessed for the maximal hippocampal width and parahippocampal CSF space. Intra-rater and inter-rater reliability were obtained. Hippocampal volume was assessed by manual tracing in 5 participants representing each visual axial grade.
Results: The visual rating scale using T1-axial image was comparable to T1-coronal visual rating scale, showing significant agreement (kappa=0.745, p< 0.001). Inter-and intra- rater reliability in T1-axial visual rating scale of MTA was higher than those in Schelten¡¯s T1-coronal visual rating scale. The degree of MTA in T1 axial visual rating scale showed negative correlation with MMSE (r=-0.460, p <0.001) and CDR scale(sum of box) (r=0.563, p <0.001). Hippocampal volume tended to decrease according to visual axial grade.
Conclusion: The T1-axial visual rating scale of MTA showed good agreement with Schelten¡¯s T1-coronal visual rating scale and cognitive functions. Inter-and intra-rater reliability for T1-axial visual rating scale of MTA was higher than those of Schelten¡¯s T1-coronal visual rating scale, which suggests of possibilities of application for axial visual rating scale in clinical practice. The correlation of degree of MTA in T1-axial visual rating scale with hippocampal volume should be studied in large number of subjects.
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KEYWORD
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medial temporal atrophy, visual rating scale, Alzheimer¡¯s disease
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