Transcranial sonography of the medial temporal lobe in Alzheimer’s disease patients


Authors: D. Školoudík 1;  P. Krulová 1;  H. Kisvetrová 2;  R. Herzig 3;  J. Blahuta 4;  T. Soukup 4
Authors‘ workplace: Neurologická klinika FN Ostrava 1;  Centrum vědy a výzkumu, Fakulta, zdravotnických věd, UP v Olomouci 2;  Neurologická klinika, Komplexní, cerebrovaskulární centrum, LF UK a FN Hradec Králové 3;  Ústav informatiky, Filozofi cko-přírodovědecká, fakulta, Slezská Univerzita, v Opavě 4
Published in: Cesk Slov Neurol N 2020; 83(2): 189-193
Category: Original Paper
doi: 10.14735/amcsnn2020189

V současné době žije celosvětově okolo 50 milionů pacientů s demencí, přičemž odhady ukazují, že do roku 2050 se tento počet téměř ztrojnásobí. Regionální odhady prevalence demence u osob nad 60 let se pohybují od 4,6 % ve střední Evropě, vč. ČR, po 8,7 % v severní Africe a na Středním východě [1–3]. Nejčastějším typem demence je Alzheimerova demence (AD). Výskyt AD roste s věkem a kvůli narůstající délce dožití a stárnutí populace v rozvinutých zemích významně stoupá počet pacientů s tímto onemocněním [4,5]. Ačkoli v současnosti neexistuje kauzální léčba AD, vyvíjí se velké množství nových sloučenin, které mají potenciál modifikovat průběh nemoci a zpomalit její progresi. Pro budoucí úspěšnou léčbu je však nezbytná časná diagnostika. Neurozobrazovací metody umožňují detekovat strukturální změny mozku nejen v období plně rozvinutých klinických příznaků AD, ale již v presymptomatickém období. Nejvýznamnější strukturou v diagnostice AD se zdá být mediotemporální lalok (MTL) a jeho část – hipokampus. Zlatým standardem v detekci atrofie MTL a hipokampu je MR, která je předmětem výzkumu již po celá desetiletí.

Overview

Aim: Atrophy of the medial temporal lobe (MTL) is one of the anatomical hallmarks of Alzheimer‘s disease (AD). Transcranial sonography (TCS) is able to visualize and measure the MTL. Study aimed to test the digital image analysis of the MTL TCS image in patients with AD compared to healthy controls.

Methods: Patients with AD and healthy controls were enrolled to the study. MTL and the surrounding space were imaged in the coronal plane on TCS from both sides in all enrolled subjects. All images were encoded and evaluated using B-Mode Assist software by counting the black/white ratio of the MTL. The receiver operating characteristic curve, optimal cut-off value, sensitivity, specificity, and positive and negative predictive values were statistically evaluated.

Results: A total of 78 subjects were enrolled to the study during 6 months; 31 patients with AD (14 males, mean age 76.2 ± 5.8 years) and 47 healthy controls (21 males, mean age 75.5 ± 6.4 years). A significantly lower value of MTL black/white ratio was found in patients with AD compared with healthy controls (1.63 ± 0.75 vs. 3.43 ± 1.01; P < 0.001). The optimal cut-off value of MTL black/white ratio for differentiation between patients with AD and healthy controls was 2.5 with a sensitivity of 90.3%, specificity of 87.2%, positive predictive value of 82.3% and negative predictive value of 93.2%.

Conclusion: Digital image analysis of the TCS MTL images enables the measurement of the black/white ratio as a marker of MTL atrophy in patients with AD.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Keywords:

transcranial sonography – medial temporal lobe – Alzheimer´s disease – echogenicity


Sources

1. Ferri CP, Prince M, Brayne C et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366 (9503): 2112–2117. doi: 10.1016/S0140-6736 (05) 6 7889-0.

2. Lobo A, Launer LJ, Fratiglioni L et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic diseases in the elderly research group. Neurology 2000; 54 (11 Suppl 5): S4–S9.

3. Rizzi L, Rosset I, Roriz-Cruz M. Global epidemiology of dementia: Alzheimer‘s and vascular types. Biomed Res Int 2014; 2014: 908915. doi: 10.1155/2014/908915.

4. Ressner P, Hort J, Rektorová I et al. Doporučené postupy pro diagnostiku Alzheimerovy nemoci a dalších onemocnění spojených s demencí. Cesk Slov Neurol N 2008; 71/104 (4): 494–501.

5. Sheardová K, Hort J, Rusina R et al. Doporučené postupy pro terapii Alzheimerovy nemoci a ostatních demencí. Neurol Praxi 2009; 10 (1): 28–31.

6. Kehoe EG, McNulty JP, Mullins PG et al. Advances in MRI biomarkers for the diagnosis of Alzheimer‘s disease. Biomark Med 2014; 8: 1151–1169. doi: 10.2217/bmm. 14.42.

7. Harper L, Barkhof F, Scheltens P et al. An algorithmic approach to structural imaging in dementia. J Neurol Neurosurg Psychiatry 2014; 85 (6): 692–698. doi: 10.1136/ jn np-2013-306285.

8. Bartoš A, Zach P, Diblíková F et al. Vizuální kategorizace mediotemporální atrofie na MR mozku u Alzheimerovy nemoci. Psychiatrie 2007; 11 (Suppl 3): 49–52.

9. Liu Y, Paajanen T, Zhang Y et al. Analysis of region al MRI volumes and thicknes ses as predictors of conversion from mild cognitive impairment to Alzheimer‘s disease. Neurobiol Aging 2010; 31 (8): 1375–1385. doi: 10.1016/ j. neurobio laging.2010.01.022.

10. Fennema-Notestine C, McEvoy LK, Hagler DJ et al. Structural neuroimag ing in the detection and prognosis of pre-clinical and early AD. Behav Neurol 2009; 21 (1): 3–12. doi: 10.3233/ BEN-2009-0230.

11. Tomek A, Urbanová B, Magerová H et al. Neurosonologické markery predikce kognitivní deteriorace. Cesk Slov Neurol N 2017; 80/113 (4): 409–417. doi: 10.14735/amcsnn2017409.

12. Yilmaz R, Pilotto A, Roeben B et al. Structural ultrasound of the medial temporal lobe in Alzheimer’s disease. Ultraschall Med 2017; 38 (3): 294–300. doi: 10.1055/s-0042-107150.

13. Frisoni GB, BocchettaM, Chetelat G et al. Imaging markers for Alzheimer disease: which vs how. Neurology 2013; 81 (5): 487–500. doi: 10.1212/WNL.0b013e31829d8 6e8.

14. Školoudík D, Walter U. Method and validity of transcranial sonography in movement disorders. In Rev Neurobiol 2010; 90: 7–34. doi: 10.1016/S0074-7742 (10) 90002-0.

15. Mašková J, Školoudík D, Burgetová A et al. Comparison of transcranial sonography-magnetic resonance fusion imaging in Wilson‘s and early-onset Parkinson‘s diseases. Parkinsonism Relat Disord 2016; 28: 87–93. doi: 10.1016/j.parkreldis.2016.04.031.

16. McKhann GM, Knopman DS, Chertkow H et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diag-nostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7 (3): 263–269. doi: 10.1016/j.jalz.2011.03.005.

17. Yilmaz R. Detection of medial temporal lobe atrophy using transcranial sonography in Alzheimer’s disease. Ultraschall Med. In press 2020.

18. Scheltens P, Leys D, Barkhof F et al. Atrophy ofmedial temporal lobes on MRI in „probable“ Alzheimer‘s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 1992; 55 (10): 967–972. doi: 10.1136/jnnp.55.10.967.

19. Kaneko T, Kaneko K, Matsushita M et al. New visual rating system for medial temporal lobe atrophy: a simple diagnostic tool for routine examinations. Psychogeriatrics 2012; 12 (2): 88–92. doi: 10.1111/j.1479-8301.2011.00390.x.

20. Leung KK, Barnes J, Ridgway GR et al. Automated cross-sectional and longitudinal hippocampal volume measurement in mild cognitive impairment and Alzheimer‘s disease. Neuroimage 2010; 51 (4): 1345–1359. doi: 10.1016/j.neuroimage.2010.03.018.

21. de Flores R, La Joie R, Chetelat G. Structural imaging of hippocampal subfields in healthy aging and Alzheimer‘s disease. Neuroscience 2015; 309: 29–50. doi: 10.1016/j.neuroscience.2015.08.033.

22. Teipel S, Drzezga A, Grothe MJ et al. Multimodal imaging in Alzheimer‘s disease: validity and usefulness for early detection. Lancet Neurol 2015; 14 (10): 1037–1053. doi: 10.1016/S1474-4422 (15) 00093-9.

23. Jack CR Jr, Petersen RC, Xu Y et al. Rates of hippocampal atrophy correlate with change in clinical status in aging and AD. Neurology 2000; 55 (4): 484–489. doi: 10.1212/wnl.55.4.484.

24. Devanand DP, Pradhaban G, Liu X et al. Hippocampal and entorhinal atrophy in mild cognitive impairment: prediction of Alzheimer disease. Neurology 2007; 68 (11): 828–836. doi: 10.1212/01.wnl.0000256697.20968.d7.

25. Ten Kate M, Barkhof F, Boccardi M et al. Task force for the roadmap of Alzheimer’s biomarkers. Clinical validity of medial temporal atrophy as a bio marker for Alzheimer’s disease in the context of a structured 5-phase development framework. Neurobiol Aging 2017; 52: 167–182. doi: 10.1016/ j.neurobio laging.2016.05. 024.

26. Jack CR, Shiung MM, Gunter JL et al. Comparison of different MRI brain atrophy rate measures with clinical disease progression in AD. Neurology 2004; 62 (4): 591–600. doi: 10.1212/01.wnl.0000110315.26026.ef.

27. Vemuri P, Jack CR. Role of structural MRI in Alzheimer’s disease. Alzheimers Res Ther 2010; 2 (4): 23. doi: 10.1186/ alzrt47.

28. Šilhán D, Ibrahim I, Tintěra J et al. Parietální atrofie na magnetické rezonanci mozku u Alzheimerovy nemoci s pozdním začátkem. Cesk Slov Neurol N 2019; 82/115 (1): 91–95. doi: 10.14735/amcsnn201991.

29. Harper L, Fumagalli GG, Barkhof F et al. MRI visual rating scales in the diagnosis of dementia: evaluation in 184 post-mortem confirmed cases. Brain 2016; 139 (Pt 4): 1211–1225. doi: 10.1093/ brain/ aww005.

30. Reitz C, Brayne C, Mayeux R. Epidemiology of Alzheimer disease. Nat Rev Neurol 2011; 7 (3): 137–152. doi: 10.1038/nrneurol.2011.2.

31. Janoutová J, Ambroz P, Kovalová M et al. Epidemiologie mírné kognitivní poruchy. Cesk Slov Neurol N 2018; 81/114 (3): 284–289. doi: 10.14735/amcsnn2018284.

32. Kalaria R. Similarities between Alzheimer‘s disease and vascular dementia. J Neurol Sci 2002; 203–204: 29–34. doi: 10.1016/s0022-510x (02) 00256-3.

33. Školoudík D. Transkraniální sonografie – možnosti zobrazení intrakraniálních struktur v B obraze. Cesk Slov Neurol N 2017; 80/113 (1): 8–23. doi: 10.14735/ amcsnn20178.

34. Walter U, Skoloudik D, Berg D. Transcranial sonography findings related to non-motor features of Parkinson‘s disease. J Neurol Sci 2010; 289 (1–2): 123–127. doi: 10.1016/j.jns.2009.08.027.

35. Favaretto S, Walter U, Baracchini C et al. Accuracy of transcranial brain parenchyma sonography in the diagnosis of dementia with Lewy bodies. Eur J Neurol 2016; 23 (8): 1322–1328. doi: 10.1111/ene.13028.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2020 Issue 2

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account