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Research ArticleNEURODEGENERATIVE DISORDER IMAGING

Comparison of Quantitative Hippocampal Volumes and Structured Scoring Scales in Predicting Alzheimer Disease Diagnosis

Michael Essien, James Lah, Brent D. Weinberg, Jason W. Allen and Ranliang Hu
American Journal of Neuroradiology November 2023, DOI: https://doi.org/10.3174/ajnr.A8049
Michael Essien
aFrom the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.), and Neurology (J.L.), Emory University School of Medicine, Atlanta, Georgia.
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James Lah
aFrom the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.), and Neurology (J.L.), Emory University School of Medicine, Atlanta, Georgia.
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Brent D. Weinberg
aFrom the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.), and Neurology (J.L.), Emory University School of Medicine, Atlanta, Georgia.
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Jason W. Allen
aFrom the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.), and Neurology (J.L.), Emory University School of Medicine, Atlanta, Georgia.
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Ranliang Hu
aFrom the Departments of Radiology and Imaging Sciences (M.E., B.D.W., J.W.A., R.H.), and Neurology (J.L.), Emory University School of Medicine, Atlanta, Georgia.
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  • FIG 1.
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    FIG 1.

    Flow chart of study participants. Only diagnoses made after MR imaging were considered for this study. PD indicates Parkinson disease; FTD, frontotemporal dementia.

  • FIG 2.
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    FIG 2.

    Coronal T1 noncontrast MR images with automated segmentation overlay obtained from NeuroQuant showing hippocampal volumes (yellow arrow) for patients with AD (A), mild cognitive impairment (B), and SCD (C). Note the marked hippocampal atrophy for AD compared with MCI and SCD.

  • FIG 3.
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    FIG 3.

    Boxplot graphs of the variables age at diagnosis (A), NTHV (B), maximum MTA (C), and maximum ERiCA (D) scores against the outcome variables AD, MCI, and SCD. The maximum and minimum values are represented at either end of the whiskers. The box represents the interquartile range (25th percentile to the 75th percentile), with the median represented by the line within the box, and the mean shown by the diamond. Outliers are shown by a circle. Maximum MTA and maximum ERiCA refer to the higher score of the right and left values of the respective parameters.

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    FIG 4.

    ROC curves for AD versus SCD. The overall model includes normalized total hippocampal volume, maximum MTA, maximum ERiCA, and age at diagnosis. Maximum MTA and maximum ERiCA refer to the higher score of the right and left values of the respective parameters.

  • FIG 5.
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    FIG 5.

    ROC curves for AD versus MCI. The overall model includes normalized total hippocampal volume, maximum MTA, maximum ERiCA, and age at diagnosis. Maximum MTA and maximum ERiCA refer to the higher score of the right and left values of the respective parameters.

  • FIG 6.
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    FIG 6.

    ROC curves for MCI versus SCD. The overall model includes NTHV, maximum MTA, maximum ERiCA, and age at diagnosis. Maximum MTA and maximum ERiCA refer to the higher scores of the right and left values of the respective parameters.

Tables

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    Table 1:

    Descriptive statisticsa

    CharacteristicADMCISCDP Value
    Sex.93
     Male (%)39.841.942.1
     Female (%)60.258.157.9
    Race.23
     Caucasian or white (%) 58.568.060.5
     Other (%)41.532.039.5
    Highest education.15
     ≤High school (%)28.820.915.8
     >High school (%)71.279.184.2
    Arterial hypertension.45
     Yes (%)71.266.960.5
     No (%)28.833.139.5
    Diabetes mellitus.14
     Yes (%)18.623.334.2
     No (%)81.476.765.8
    Age at diagnosis (yr)78 (71–84)74 (69–78)67 (54–78)<.001b
    NTHV (%)0.35 (0.33–0.37)0.41 (0.40–0.43)0.48 (0.42–0.50)<.00b
    Maximum MTA score3.0 (2.0–3.0)1.0 (0.0–2.0)1.0 (0.0–2.0)<.001b
    Maximum ERiCA score2.0 (1.0–2.0)1.0 (0.0–2.0)1.0 (0.0–1.0)<.001b
    • a 50% median and interquartile ranges (in parentheses) are shown for age at diagnosis, NTHV, maximum MTA and maximum ERiCA scores. Maximum MTA and maximum ERiCA refer to the higher scores of the right and left values of the respective parameters.

    • ↵b Denotes statistical significance at α = .05.

    • View popup
    Table 2:

    Predictor diagnostic performances—AD versus SCDa

    ParameterCutoff ValueSensitivitySpecificityAccuracy
    NTHV (%)0.4199/118 (84) [76–90]28/38 (74) [60–88]127/156 (81) [75–87]
    Max MTA score: all ages2.099/118 (84) [77–91]25/38 (66) [51–81]124/156 (79) [73–86]
    MTA score: <75 years2.032/44 (73) [60–86]23/27 (85) [72–99]55/71 (77) [68–87]
    MTA score: ≥75 years3.050/74 (68) [57–78]8/11 (73) [46–99]58/85 (68) [58–78]
    Max ERiCA score2.082/118 (69) [61–78]33/38 (87) [76–98]115/156 (74) [67–81]
    • Note:—Max indicates maximum.

    • ↵a Patient numbers shown in sensitivity, specificity, and accuracy columns with percentage scores (in parentheses) and 95% confidence intervals [in brackets]. Maximum MTA and maximum ERiCA refer to the higher score of the right and left values of the respective parameters.

    • View popup
    Table 3:

    Predictor diagnostic performances—AD versus MCIa

    ParameterCutoff ValueSensitivitySpecificityAccuracy
    NTHV (%)0.3884/118 (71) [62–79]115/172 (67) [59–74]199/290 (69) [63–74]
    Max MTA score: all ages2.099/118 (84) [77–91]93/172 (54) [47–62]192/290 (66) [61–72]
    MTA score: <75 years2.032/44 (73) [60–86]63/90 (70) [61–79]95/134 (71) [63–79]
    MTA score: ≥75 years3.050/74 (68) [57–78]51/82 (62) [52–73]101/156 (65) [57–72]
    Max ERiCA score3.082/118 (69) [61–78]113/172 (66) [59–73]195/290 (67) [62–73]
    • Note:— Max indicates maximum.

    • ↵a Patient numbers shown in sensitivity, specificity, and accuracy columns with percentage scores (in parentheses) and 95% confidence intervals [in brackets].

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Comparison of Quantitative Hippocampal Volumes and Structured Scoring Scales in Predicting Alzheimer Disease Diagnosis
Michael Essien, James Lah, Brent D. Weinberg, Jason W. Allen, Ranliang Hu
American Journal of Neuroradiology Nov 2023, DOI: 10.3174/ajnr.A8049
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Michael Essien, James Lah, Brent D. Weinberg, Jason W. Allen, Ranliang Hu
Comparison of Quantitative Hippocampal Volumes and Structured Scoring Scales in Predicting Alzheimer Disease Diagnosis
American Journal of Neuroradiology Nov 2023, DOI: 10.3174/ajnr.A8049

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