title: Sensitivity and specificity of medial temporal lobe visual ratings and multivariate regional MRI classification in Alzheimer's disease.
abstract: BACKGROUND
  Visual assessment rating scales for medial temporal lobe (MTL) atrophy have been used by neuroradiologists in clinical practice to aid the diagnosis of Alzheimer's disease (AD). Recently multivariate classification methods for magnetic resonance imaging (MRI) data have been suggested as alternative tools. If computerized methods are to be implemented in clinical practice they need to be as good as, or better than experienced neuroradiologists and carefully validated. The aims of this study were: (1) To compare the ability of MTL atrophy visual assessment rating scales, a multivariate MRI classification method and manually measured hippocampal volumes to distinguish between subjects with AD and healthy elderly controls (CTL). (2) To assess how well the three techniques perform when predicting future conversion from mild cognitive impairment (MCI) to AD.
  
  
  METHODS
  High resolution sagittal 3D T1w MP-RAGE datasets were acquired from 75 AD patients, 101 subjects with MCI and 81 CTL from the multi-centre AddNeuroMed study. An automated analysis method was used to generate regional volume and regional cortical thickness measures, providing 57 variables for multivariate analysis (orthogonal partial least squares to latent structures using seven-fold cross-validation). Manual hippocampal measurements were also determined for each subject. Visual rating assessment of MTL atrophy was performed by an experienced neuroradiologist according to the approach of Scheltens et al.
  
  
  RESULTS
  We found prediction accuracies for distinguishing between AD and CTL of 83% for multivariate classification, 81% for the visual rating assessments and 89% for manual measurements of total hippocampal volume. The three different techniques showed similar accuracy in predicting conversion from MCI to AD at one year follow-up.
  
  
  CONCLUSIONS
  Visual rating assessment of the MTL gave similar prediction accuracy to multivariate classification and manual hippocampal volumes. This suggests a potential future role for computerized methods as a complement to clinical assessment of AD.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. eric.westman@ki.se
authors.forename: Eric
authors.initials: E
authors.lastname: Westman
authors.forename: Lena
authors.initials: L
authors.lastname: Cavallin
authors.forename: J-Sebastian
authors.initials: JS
authors.lastname: Muehlboeck
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Patrizia
authors.initials: P
authors.lastname: Mecocci
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.forename: Magda
authors.initials: M
authors.lastname: Tsolaki
authors.forename: Iwona
authors.initials: I
authors.lastname: Kłoszewska
authors.forename: Hilkka
authors.initials: H
authors.lastname: Soininen
authors.forename: Christian
authors.initials: C
authors.lastname: Spenger
authors.forename: Simon
authors.initials: S
authors.lastname: Lovestone
authors.forename: Andrew
authors.initials: A
authors.lastname: Simmons
authors.forename: Lars-Olof
authors.initials: LO
authors.lastname: Wahlund
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016018:Least-Squares Analysis; D016013:Likelihood Functions; D008279:Magnetic Resonance Imaging / Q000145:classification* / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013702:Temporal Lobe / Q000473:pathology*