A visual scale to rate amygdalar atrophy on MRI

Background Visual rating scales are routinely used in clinical radiology to assess brain atrophy on scans of patients with suspected neurodegenerative conditions. Limbic predominant age-related TDP-43 encephalopathy (LATE) has recently been described, featuring early and severe atrophy of the amygda...

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Bibliographic Details
Published in:European radiology Vol. 35; no. 7; pp. 4246 - 4256
Main Authors: Pizzini, Francesca B., Ribaldi, Federica, Natale, Valerio, Scheffler, Max, Rossi, Vittoria, Frisoni, Giovanni B.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2025
Springer Nature B.V
Subjects:
Age
Aged
Aged, 80 and over
Alzheimer Disease - pathology
Alzheimer's disease
Amygdala
Amygdala - diagnostic imaging
Amygdala - pathology
Atrophy
Atrophy - pathology
Automation
Autopsies
Autopsy
Clinical medicine
Cognitive ability
Dementia disorders
Diagnostic Radiology
Encephalopathy
Female
Humans
Imaging
Internal Medicine
Interventional Radiology
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Male
Medical imaging
Medicine
Medicine & Public Health
Memory
Middle Aged
Morphology
Neuro
Neurodegenerative diseases
Neuroimaging
Neuropathology
Neuropsychology
Neuroradiology
Pathology
Radiology
Ratings
Reproducibility of Results
Ultrasound
Validity
Atrophy
Amygdala
MRI
Dementia
ISSN:1432-1084, 0938-7994, 1432-1084
Online Access:Get full text
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Summary:Background Visual rating scales are routinely used in clinical radiology to assess brain atrophy on scans of patients with suspected neurodegenerative conditions. Limbic predominant age-related TDP-43 encephalopathy (LATE) has recently been described, featuring early and severe atrophy of the amygdala. However, there is currently no scoring system specifically designed to assess amygdalar atrophy on MRI. Objectives to develop and validate a visual rating scale for amygdalar atrophy. Materials and methods Stringent criteria were developed for no, mild/moderate, and severe amygdalar atrophy based on axial and coronal volumetric T1-weighted MRI scans. Inter- and intra-rater reliabilities were estimated by three independent expert neuroradiologists in 100 randomly selected scans from the Geneva Memory Center cohort selected to be representative of the variability of medial temporal atrophy. Convergent validity was evaluated versus amygdalar volumes extracted by FreeSurfer on 1943 consecutive patients. Criterion validity versus autopsy-confirmed LATE neuropathologic changes were studied in the pathological subset of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort ( N  = 96). Results Intra- and inter-rater agreements of amygdalar visual ratings were between substantial and almost perfect (weighted Cohen’s Kappa 0.71 to 0.93). Visual ratings were strongly associated with amygdalar volumes ( p  ≤ 0.001 on the Kruskal–Wallis test). LATE neuropathologic changes were associated with visual ratings of amygdalar atrophy ( p  = 0.057 on a test for trend). Conclusion The proposed visual amygdalar atrophy scale is a reliable and valid tool to assess amygdalar atrophy on MRI and can be a useful adjunct in routine radiological reporting. Key Points Question Assessment of amygdalar atrophy is crucial for diagnosing neurodegenerative diseases, as the limbic predominant age-related TDP-43 encephalopathy, yet no validated visual rating scale exists. Findings The proposed amygdalar atrophy scale demonstrated high intra-rater and inter-rater reliability, strong correlation with amygdalar volumetry, and association with limbic predominant age-related TDP-43 encephalopathy (LATE). Clinical relevance The amygdalar atrophy scale provides a reliable practical assessment tool that enhances diagnostic accuracy for dementia-related conditions, particularly aiding in identifying limbic predominant age-related TDP-43 encephalopathy.
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ISSN:1432-1084
0938-7994
1432-1084
DOI:10.1007/s00330-024-11249-7