A comprehensive visual rating scale of brain magnetic resonance imaging: application in elderly subjects with Alzheimer's disease, mild cognitive impairment, and normal cognition.
BACKGROUND
Brain magnetic resonance imaging (MRI) shows cerebral structural changes. However, a unified comprehensive visual rating scale (CVRS) has seldom been studied. Thus, we combined brain atrophy and small vessel disease scales and used an MRI template as a CVRS.


OBJECTIVE
The aims of this study were to design a simple and reliable CVRS, validate it by investigating cerebral structural changes in clinical groups, and made comparison to the volumetric measurements.


METHODS
Elderly subjects (n = 260) with normal cognition (NC, n = 65), mild cognitive impairment (MCI, n = 101), or Alzheimer's disease (AD, n = 94) were evaluated with brain MRI according to the CVRS of brain atrophy and small vessel disease. Validation of the CVRS with structural changes, neuropsychological tests, and volumetric analyses was performed.


RESULTS
The CVRS revealed a high intra-rater and inter-rater agreement and it reflected the structural changes of subjects with NC, MCI, and AD better than volumetric measures (CVRS-coronal: F = 13.5, p < 0.001; CVRS-axial: F = 19.9, p < 0.001). The area under the receiver operation curve (aROC) of the CVRS showed higher accuracy than volumetric analyses. (NC versus MCI aROC: CVRS-coronal, 0.777; CVRS-axial, 0.773; MCI versus AD aROC: CVRS-coronal, 0.680; CVRS-axial, 0.681).


CONCLUSIONS
The CVRS can be used clinically to conveniently measure structural changes of brain. It reflected cerebral structural changes of clinical groups and correlated with the age better than volumetric measures.
Department of Neurology, Kangwon National University Hospital, Chuncheon, Republic of Korea.
Jae-Won
JW
Jang
Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
So Young
SY
Park
Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
Young Ho
YH
Park
Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Min Jae
MJ
Baek
Department of Neurology, Seoul National University College of Medicine, Seoul, Korea Department of Neurology, Seoul National University Boramae Hospital, Seoul, Republic of Korea.
Jae-Sung
JS
Lim
Department of Neurology, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
Young Chul
YC
Youn
Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
SangYun
S
Kim
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000473:pathology*; D000704:Analysis of Variance; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000150:complications / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012372:ROC Curve; D013223:Statistics as Topic
Alzheimer's disease; mild cognitive impairment; visual rating scale