Visual assessment of medial temporal atrophy on MR films in Alzheimer’s disease: comparison with volumetry

Background and aims: To test the agreement of a visual rating scale of medial temporal lobe atrophy (MTA) with linear and volumetric assessments, and to test its accuracy in discriminating between Alzheimer’s disease (AD) patients and controls. Methods: Participants were 28 patients with AD and 29 healthy controls. MTA was evaluated according to Scheltens’ five-point scale. Its accuracy in distinguishing AD patients from controls was evaluated as a stand-alone measure and in association with linear [width of the temporal horn (WTH)] and volumetric [hippocampal volume (HV)] measures. Results: The agreement of this visual rating scale with the other MTA measures was statistically significant (vs WTH and vs HV, p for trend <0.00005). The visual rating scale showed a good accuracy in distinguishing AD patients from controls [area under the curve (AUC) 0.89, 95% confidence interval (CI) 0.79-0.98]. Although the accuracy of the visual rating scale improved in association with linear WTH (AUC 0.91, 95% CI 0.82–0.99) and in association with HV (AUC 0.93, 95% CI 0.86–1.00), the improvement was not significant. Conclusions: The visual rating scale of MTA, easily applicable in clinical practice, shows good agreement with more demanding quantitative methods, and can discriminate AD patients from controls with good accuracy.