Silvia Ingala1,2, Ingrid S van Maurik3,4, Daniele Altomare3,5,6, Raphael Wurm7,8, Ellen Dicks3, Ronald A van Schijndel7, Marissa Zwan3, Femke Bouwman3, Niki Schoonenboom9, Leo Boelaarts9, Gerwin Roks10, Rob van Marum11,12, Barbera van Harten13, Inge van Uden14, Jules Claus15, Viktor Wottschel7, Hugo Vrenken7, Mike P Wattjes7,16, Wiesje M van der Flier3,4, Frederik Barkhof7,17. 1. Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. s.ingala@amsterdamumc.nl. 2. Department of Radiology and Nuclear Medicine, Noordwest Hospital Group, Alkmaar, The Netherlands. s.ingala@amsterdamumc.nl. 3. Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands. 4. Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands. 5. Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland. 6. Memory Clinic, University Hospitals of Geneva, Geneva, Switzerland. 7. Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. 8. Department of Neurology, Medical University of Vienna, Vienna, Austria. 9. Geriatric Department, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands. 10. Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands. 11. Department of Geriatrics, Jeroen Bosch Hospital, 'S-Hertogenbosch, The Netherlands. 12. Department of Family Medicine and Elderly Care Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands. 13. Department of Neurology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands. 14. Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands. 15. Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands. 16. Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany. 17. Institutes of Neurology and Healthcare Engineering, UCL, London, UK.
Abstract
OBJECTIVES: Neurodegeneration in suspected Alzheimer's disease can be determined using visual rating or quantitative volumetric assessments. We examined the feasibility of volumetric measurements of gray matter (GMV) and hippocampal volume (HCV) and compared their diagnostic performance with visual rating scales in academic and non-academic memory clinics. MATERIALS AND METHODS: We included 231 patients attending local memory clinics (LMC) in the Netherlands and 501 of the academic Amsterdam Dementia Cohort (ADC). MRI scans were acquired using local protocols, including a T1-weighted sequence. Quantification of GMV and HCV was performed using FSL and FreeSurfer. Medial temporal atrophy and global atrophy were assessed with visual rating scales. ROC curves were derived to determine which measure discriminated best between cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's dementia (AD). RESULTS: Patients attending LMC (age 70.9 ± 8.9 years; 47% females; 19% CN; 34% MCI; 47% AD) were older, had more cerebrovascular pathology, and had lower GMV and HCV compared to those of the ADC (age 64.9 ± 8.2 years; 42% females; 35% CN, 43% MCI, 22% AD). While visual ratings were feasible in > 95% of scans in both cohorts, quantification was achieved in 94-98% of ADC, but only 68-85% of LMC scans, depending on the software. Visual ratings and volumetric outcomes performed similarly in discriminating CN vs AD in both cohorts. CONCLUSION: In clinical settings, quantification of GM and hippocampal atrophy currently fails in up to one-third of scans, probably due to lack of standardized acquisition protocols. Diagnostic accuracy is similar for volumetric measures and visual rating scales, making the latter suited for clinical practice. In a real-life clinical setting, volumetric assessment of MRI scans in dementia patients may require acquisition protocol optimization and does not outperform visual rating scales. KEY POINTS: • In a real-life clinical setting, the diagnostic performance of visual rating scales is similar to that of automatic volumetric quantification and may be sufficient to distinguish Alzheimer's disease groups. • Volumetric assessment of gray matter and hippocampal volumes from MRI scans of patients attending non-academic memory clinics fails in up to 32% of cases. • Clinical MR acquisition protocols should be optimized to improve the output of quantitative software for segmentation of Alzheimer's disease-specific outcomes.
OBJECTIVES: Neurodegeneration in suspected Alzheimer's disease can be determined using visual rating or quantitative volumetric assessments. We examined the feasibility of volumetric measurements of gray matter (GMV) and hippocampal volume (HCV) and compared their diagnostic performance with visual rating scales in academic and non-academic memory clinics. MATERIALS AND METHODS: We included 231 patients attending local memory clinics (LMC) in the Netherlands and 501 of the academic Amsterdam Dementia Cohort (ADC). MRI scans were acquired using local protocols, including a T1-weighted sequence. Quantification of GMV and HCV was performed using FSL and FreeSurfer. Medial temporal atrophy and global atrophy were assessed with visual rating scales. ROC curves were derived to determine which measure discriminated best between cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's dementia (AD). RESULTS: Patients attending LMC (age 70.9 ± 8.9 years; 47% females; 19% CN; 34% MCI; 47% AD) were older, had more cerebrovascular pathology, and had lower GMV and HCV compared to those of the ADC (age 64.9 ± 8.2 years; 42% females; 35% CN, 43% MCI, 22% AD). While visual ratings were feasible in > 95% of scans in both cohorts, quantification was achieved in 94-98% of ADC, but only 68-85% of LMC scans, depending on the software. Visual ratings and volumetric outcomes performed similarly in discriminating CN vs AD in both cohorts. CONCLUSION: In clinical settings, quantification of GM and hippocampal atrophy currently fails in up to one-third of scans, probably due to lack of standardized acquisition protocols. Diagnostic accuracy is similar for volumetric measures and visual rating scales, making the latter suited for clinical practice. In a real-life clinical setting, volumetric assessment of MRI scans in dementia patients may require acquisition protocol optimization and does not outperform visual rating scales. KEY POINTS: • In a real-life clinical setting, the diagnostic performance of visual rating scales is similar to that of automatic volumetric quantification and may be sufficient to distinguish Alzheimer's disease groups. • Volumetric assessment of gray matter and hippocampal volumes from MRI scans of patients attending non-academic memory clinics fails in up to 32% of cases. • Clinical MR acquisition protocols should be optimized to improve the output of quantitative software for segmentation of Alzheimer's disease-specific outcomes.
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