title: Diagnostic Efficacy of Structural MRI in Patients With Mild-to-Moderate Alzheimer Disease: Automated Volumetric Assessment Versus Visual Assessment.
abstract: OBJECTIVE
  The purpose of this study was to compare the diagnostic efficacies of an automated volumetric assessment tool and visual assessment in the evaluation of medial temporal lobar atrophy in mild-to-moderate Alzheimer disease (AD).
  
  
  METHODS
  This retrospective study included 30 patients with mild-to-moderate AD and 25 age-matched healthy control subjects undergoing MRI with a 3D fast spoiled gradient recalled-echo sequence at 3 T. The images were processed with fully automated volumetric analysis software. To assess medial temporal lobe (MTL) atrophy, two MTL indexes, which took into account the volumes of the hippocampus and the inferior lateral ventricle, were calculated with the automated volumetric assessment software. In addition, two neuroradiologists assessed MTL atrophy visually using the Scheltens scale. ROC curve analysis was used to compare the diagnostic performances of the two methods. The weighted kappa statistic was used to assess the intrarater and interrater reliability of visual inspection.
  
  
  RESULTS
  The automated volumetric assessment tool had moderate sensitivity (63.3%) and high specificity (100%) in differentiating patients with mild-to-moderate AD from control subjects. Visual inspection showed sensitivity of 63.3% and specificity of 92.0%. The diagnostic performance was not significantly different between the two methods (p = 0.536-0.906). Intraobserver reliability for visual inspection was 0.858 and 0.902 for the two reviewers, and interobserver reliability was 0.692-0.780.
  
  
  CONCLUSIONS
  Both the automated volumetric assessment tool and visual inspection can be used to evaluate MTL atrophy and differentiate patients with AD from healthy individuals with good diagnostic accuracy. Thus, the automated tool can be a useful and efficient adjunct in clinical practice for evaluating MTL atrophy in the diagnosis of AD.
authors.affiliation: 1 Department of Radiology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea.
authors.forename: Jeeyoung
authors.initials: J
authors.lastname: Min
authors.affiliation: 1 Department of Radiology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea.
authors.forename: Won-Jin
authors.initials: WJ
authors.lastname: Moon
authors.affiliation: 1 Department of Radiology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea.|2 Department of Radiology, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Jeon
authors.affiliation: 1 Department of Radiology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Choi
authors.affiliation: 3 Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Yeon-Sil
authors.initials: YS
authors.lastname: Moon
authors.affiliation: 3 Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Seol-Heui
authors.initials: SH
authors.lastname: Han
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D000069550:Machine Learning; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Alzheimer disease; MRI; Scheltens scale; medial temporal lobe; quantitative; volumetry