Article Figures & Data
Figures
- Fig 1.
Gross pathologic coronal (A) and axial (B) images showing the 2-mm section where the rWTH should be measured. Note.—Am indicates amygdala; hip, hippocampus. Bar = 10 mm. Adapted from Duvernoy, 1998 (54).
- Fig 2.
CT scans chosen for rWTH measures. Represented are eight contiguous 2-mm-thick sections spanning the whole caudal-to-rostral extension of the temporal horns of a patient with AD. The scans in which the right and left horns can be appreciated in their full length are C and D, and these are chosen for the measurements. Parallel lines are drawn tangentially to the tip of the temporal horns where the width is maximum (arrows).
- Fig 3.
Known-group validity of CT- (left) and MR-based (right) rWTH measures compared with that of other CT- and MR-based linear and volumetric measures of MTL atrophy in patients with AD (open circles) and control subjects (solid circles). Solid lines represent regression lines of the measures on age in control subjects. Dotted lines represent age-specific cutoffs that correctly classify 95% of control subjects.
Tables
Baseline Characteristics Control Group (n = 29) AD Group (n = 42) P value* Sociodemographics and anthropometrics Mean age at observation ± SD (y) 69 ± 9 76 ± 8 .0007 (range) (51–82) (57–90) Women 19 (65%) 33 (75%) NS Mean education ± SD (y) 9.4 ± 4.9 6.0 ± 3.3 .001 (range) (2–18) (2–17) Mean head size on axial plane ± SD, cm2 136 ± 12 138 ± 12 NS (range) (115–164) (117–166) Dementia-related variables MMSE score† 27.0 ± 0.9 21.1 ± 2.3 <.0001 (range) (23.4–27.4) (18–27) CDR of 0/.5/1/2 or 3 29/0/0/0 0/18/24/0 <.0001 Mean disease duration ± SD (mo) — 37 ± 20 (range) — (9–96) ApoE ε4 allele‡ 8/56 (14%) 32/82 (39%) .003 Lacunes 9 (33%) 7 (17%) NS Mean leukoaraiosis score ± SD 5.7 ± 5.0 6.9 ± 5.2 NS (range) (0–17) (0–16) Physical diseases Ischemic heart disease 3 (9%) 6 (14%) NS Cancer 3 (9%) 6 (14%) NS Hypertension 10 (35%) 18 (41%) NS Diabetes mellitus 1 (4%) 2 (5%) NS * t test for independent samples, or chi-square test.
† In control subjects, computed on the basis of the telephone version of the test (26, 27).
‡ Data available for 28 historical control subjects and 41 patients with AD (12, 16).
- TABLE 2:
Test-Retest and Interrater Reliability Versus Other Linear Measures of MTL Atrophy in 20 Patients with AD and 20 Control Subjects in the CT Group
Mean Difference Between Measurements Intraclass Correlation Crude Values (mm) Test Crude (mm) Standardized (z) Coefficient 1st Rater, Test 1st Rater, Retest 2nd Rater Within Rater Between Raters Within Rater Between Raters Within Rater Between Raters Mean radial width of the temporal horn ± SD Right 4.6 ± 3.0 4.4 ± 2.9 4.5 ± 2.7 0.21 ± .67 −0.20 ± 0.77 0.07 ± 0.22 −0.09 ± 0.25 0.97 0.96 Left 4.0 ± 2.8 3.9 ± 2.7 4.1 ± 2.7 0.11 ± .48 −0.19 ± 0.65 0.04 ± 0.17 −0.05 ± 0.23 0.98 0.95 Largest 5.1 ± 3.0 4.9 ± 2.8 5.2 ± 3.0 0.25 ± .56 −0.29 ± 0.81 0.09 ± 0.19 −0.12 ± 0.26 0.98 0.94 Mean transverse widthof the temporal horn ± SD Right 3.6 ± 1.5 3.7 ± 1.6 3.7 ± 1.5 −0.09 ± .34 −0.05 ± 0.59 −0.06 ± 0.23 −0.03 ± 0.41 0.97 0.93 Left 4.7 ± 2.5 4.8 ± 2.5 4.8 ± 2.3 −0.14 ± .46 −0.16 ± 0.58 −0.05 ± 0.18 −0.06 ± 0.23 0.98 0.97 Largest 5.1 ± 2.4 5.2 ± 2.2 5.3 ± 2.3 −0.09 ± .42 −0.18 ± 0.64 −0.04 ± 0.18 −0.08 ± 0.27 0.98 0.96 Mean minimum thickness of the MLT ± SD Right 13.5 ± 3.3 14.2 ± 3.0 14.0 ± 4.1 −0.71 ± 2.36 −0.51 ± 2.47 −0.22 ± 0.72 −0.16 ± 0.76 0.71 0.73 Left 14.1 ± 3.4 14.3 ± 2.7 14.4 ± 3.9 −0.20 ± 2.43 −0.36 ± 2.68 −0.06 ± 0.71 −0.10 ± 0.78 0.69 0.66 Smallest 12.9 ± 3.3 13.4 ± 2.7 13.3 ± 4.1 −0.43 ± 2.20 −0.39 ± 2.42 −0.13 ± 0.67 −0.12 ± 0.73 0.74 0.78 Note.—Standardized (z) differences are computed by considering control subjects as the reference group.
- TABLE 3:
Convergent and Discriminant Validity in 42 Patients with AD and 29 Control Subjects in the CT Group
Volumetric Measures Pearson’s r (95% confidence interval), rWTH Right Left Largest Transverse width of the temporal horn HL 0.74 (0.61–0.83) 0.79 (0.68–0.86) 0.76 (0.64–0.84) CL 0.60 (0.43–0.73) 0.74 (0.61–0.83) Minimum thickness of the medial temporal lobe HL −0.71 (−0.81–0.57) −0.69 (−0.80–−0.54) −0.78 (−0.86–−0.67) CL −0.63 (−0.75–−0.47) −0.68 (−0.79–−0.53) Interuncal distance 0.49 (0.29–0.65) 0.50 (0.30–0.66) 0.48 (0.28–0.64) Frontal index HL 0.42 (0.21–0.60) 0.40 (0.18–0.58) 0.40 (0.18–0.58) CL 0.42 (0.21–0.60) 0.35 (0.13–0.54) Note.—HL indicates homolateral; CL, contralateral.
- TABLE 4:
Comparison of Known-Group Validity (Discrimination of 42 Patients with AD from 29 Control Subjects) with Other Linear CT-Based Measures of MTL Lobe Atrophy in CT Group
Control Group AD Group Sensitivity (95% CI)* Mean Crude Measure ± SD (mm) Mean Crude Measure ± SD (mm) Mean W-score ± SD Radial width of the temporal horn Right 2.9 ± 1.4 7.8 ± 3.0 3.6 ± 2.2 86% (71%–94%) Left 2.4 ± 1.3 7.8 ± 3.2 4.1 ± 2.4 83% (68%–92%) Largest 3.2 ± 1.2 9.1 ± 3.0 4.7 ± 2.4 93% (80%–98%) Transverse width of the temporal horn Right 1.0 ± 1.1 3.7 ± 1.9 2.2 ± 1.7 62% (46%–76%) Left 1.2 ± 1.3 4.3 ± 2.4 2.3 ± 1.9 57% (41%–72%) Largest 1.5 ± 1.3 4.7 ± 2.3 2.4 ± 1.9 64% (48%–78%) Minimum thickness of the medial temporal lobe Right 17.4 ± 2.3 10.9 ± 3.4 −2.7 ± 1.4 74% (58%–86%) Left 17.0 ± 3.1 11.6 ± 3.6 −1.9 ± 1.2 57% (41%–72%) Smallest 16.4 ± 2.8 10.2 ± 3.3 −2.4 ± 1.2 74% (58%–86%) Note.—P < .001 for difference between groups on t test for all measures. W scores are age-standardized values; that is, the number of SD away from the age-specific atrophy value of control subjects (W scores in control subjects, 0.0 ± 1.0). Greater absolute values indicate greater atrophy.
* Values computed by modeling W scores of patients with AD and control subjects with specificity set at 95%.
Baseline Characteristics Control Group (n = 28) AD Group (n = 28) P value* Sociodemographics and anthropometrics Mean age at observation ± SD (y) 69 ± 8 74 ± 9 .05 (range) (54–83) (53–86) Women 19 (68%) 22 (79%) NS Mean education ± SD (y) 8 ± 3 7 ± 4 NS (range) (5–19) (2–18) Dementia-related variables MMSE score ± SD 29.2 ± 1.5 20.5 ± 4.2 <.0001 (range) (25–30) (12–27) CDR 0/.5/1/2 or 3 28/0/0/0 0/8/12/8 <.0001 Mean disease duration ± SD (mo) — 42 ± 26 — (range) (9–120) ApoE ε4 allele† 6/52 (12%) 17/52 (33%) .02 * t test for independent samples or chi-square test.
† Genotyping available for 26 patients with AD and 26 control subjects.
- TABLE 6:
Convergent and Discriminant Validity in 28 Patients with AD and 28 Control Subjects in MR Group
Atrophy Measures Pearson’s r (95% CI), rWTH Right Left Largest Linear measures on coronal images HL Temporal horn 0.73 (0.58–0.83) 0.74 (0.59–0.84) 0.83 (0.73–0.90) Width CL 0.78 (0.65–0.87) 0.59 (0.39–0.74) Choroid fissure HL 0.47 (0.24–0.65) 0.58 (0.37–0.73) 0.53 (0.31–0.70) Width CL 0.46 (0.22–0.64) 0.41 (0.16–0.61) Hippocampal HL −0.57 (−0.72–−0.36) −0.46 (−0.64–−0.22) −0.47 (−0.65–−0.24) Height CL −0.48 (−0.66–−0.25) −0.48 (−0.66–−0.25) Interuncal distance 0.44 (0.20–0.63) 0.43 (0.19–0.62) 0.40 (0.15–0.60) Interhemispheric fissure width 0.16 (−0.11–0.41) 0.07 (−0.20–0.33) 0.15 (−0.12–0.40) Semiautomated volumetric measures Temporal horn HL 0.79 (0.67–0.87) 0.77 (0.64–0.86) 0.80 (0.68–0.88) CL 0.79 (0.67–0.87) 0.58 (0.37–0.73) Temporal lobe HL −0.62 (−0.76–0.43) −0.60 (−0.75–−0.40) −0.68 (0.51–0.80) CL −0.65 (−0.78–−0.47) −0.50 (−0.67–−0.27) Frontal lobe HL −0.50 (−0.67–−0.27) −0.44 (−0.63–−0.20) −0.49 (0.26–0.67) CL −0.54 (−0.70–−0.32) −0.40 (−0.60–−0.15) Manually traced volumetric measures Hippocampus HL −0.69 (−0.81–−0.52) −0.66 (−0.79–−0.48) −0.74 (−0.84–−0.59) CL −0.69 (−0.81–−0.52) −0.59 (−0.74–−0.39) Entorhinal cortex HL −0.56 (−0.72–−0.35) −0.50 (−0.67–−0.27) −0.58 (−0.73–−0.37) CL −0.50 (−0.67–−0.27) −0.52 (−0.69–−0.30) Note.—HL indicates homolateral; CL, contralateral.
- TABLE 7:
Comparison of Known-Group Validity (Discrimination of 28 Patients with AD from 28 Control Subjects) with Linear and Volumetric MR-Based Measures of MTL Atrophy in the MR Group
Control Group AD Group Sensitivity (95% CI)* Mean Crude Measure ± SD (mm) Mean Crude Measure ± SD (mm) Mean W-score ± SD Radial width of the temporal horn (mm) Right 3.7 ± 1.1 6.7 ± 2.0 3.0 ± 1.9 76% (56%–89%) Left 3.3 ± 1.5 5.8 ± 2.5 1.7 ± 1.6 51% (32%–70%) Largest 4.1 ± 1.2 7.2 ± 2.1 2.7 ± 1.7 73% (53%–87%) Coronal width of the temporal horn (mm) Right 3.0 ± 1.2 5.3 ± 2.3 2.4 ± 2.3 63% (43%–80%) Left 3.2 ± 1.1 6.1 ± 2.3 3.4 ± 2.7 74% (54%–88%) Largest 3.4 ± 1.2 6.5 ± 2.3 2.7 ± 2.1 69% (49%–84%) Hippocampal volume (mm3) Right 1951 ± 335 1309 ± 361 1.7 ± 1.2 52% (33%–71%) Left 1797 ± 288 1263 ± 344 1.7 ± 1.0 52% (33%–71%) Smallest 1774 ± 282 1191 ± 336 2.3 ± 1.2 71% (51%–86%) Note.—P < .0005 for difference between groups on t test for all measures. W scores are age-standardized values, that is, the number of SD away from the age-specific atrophy value of control subjects (control W scores, 0 ± 1.0). Greater absolute values indicate greater atrophy.
* Values computed by modeling W scores of Patients with AD and control subjects with specificity set at 95%.
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