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Normative brain volume reports may improve differential diagnosis of dementing neurodegenerative diseases in clinical practice

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Abstract

Objectives

Normative brain volume reports (NBVRs) are becoming more and more available for the workup of dementia patients in clinical routine. However, it is yet unknown how this information can be used in the radiological decision-making process. The present study investigates the diagnostic value of NBVRs for detection and differential diagnosis of distinct regional brain atrophy in several dementing neurodegenerative disorders.

Methods

NBVRs were obtained for 81 consecutive patients with distinct dementing neurodegenerative diseases and 13 healthy controls (HC). Forty Alzheimer’s disease (AD; 18 with dementia, 22 with mild cognitive impairment (MCI), 11 posterior cortical atrophy (PCA)), 20 frontotemporal dementia (FTD), and ten semantic dementia (SD) cases were analyzed, and reports were tested qualitatively for the representation of atrophy patterns. Gold standard diagnoses were based on the patients’ clinical course, FDG-PET imaging, and/or cerebrospinal fluid (CSF) biomarkers following established diagnostic criteria. Diagnostic accuracy of pattern representations was calculated.

Results

NBVRs improved the correct identification of patients vs. healthy controls based on structural MRI for rater 1 (p < 0.001) whereas the amount of correct classifications was rather unchanged for rater 2. Correct differential diagnosis of dementing neurodegenerative disorders was significantly improved for both rater 1 (p = 0.001) and rater 2 (p = 0.022). Furthermore, interrater reliability was improved from moderate to excellent for both detection and differential diagnosis of neurodegenerative diseases (κ = 0.556/0.894 and κ = 0.403/0.850, respectively).

Conclusion

NBVRs deliver valuable and observer-independent information, which can improve differential diagnosis of neurodegenerative diseases.

Key Points

• Normative brain volume reports increase detection of neurodegenerative atrophy patterns compared to visual reading alone.

• Differential diagnosis of regionally distinct atrophy patterns is improved.

• Agreement between radiologists is significantly improved from moderate to excellent when using normative brain volume reports.

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Abbreviations

Aβ42:

Beta amyloid 1–42

AD:

Alzheimer’s disease

CDR:

Clinical Dementia Rating scale

CDR-SOB:

Clinical Dementia Rating scale, Sum Of Boxes

CERAD:

Consortium to Establish a Registry for Alzheimer’s Disease

CSF:

Cerebrospinal fluid

DLB:

Dementia with Lewy bodies

EADC:

European Alzheimer’s Disease Consortium

FDG-PET:

Fluorodeoxyglucose positron emission tomography

FTD:

Frontotemporal dementia

GCA:

Global cortical atrophy

GM:

Gray matter

HC:

Healthy controls

LP:

Lumbar puncture

MCI:

Mild cognitive impairment

MMSE:

Mini-Mental State Examination

MPRAGE:

Magnetization prepared rapid gradient echo

MTA:

Mesial temporal atrophy

NBVR:

Normative brain volume report

NPV:

Negative predictive value

PCA:

Posterior cortical atrophy

PCC:

Posterior cingulate cortex

PiB:

Pittsburgh compound B

PPV:

Positive predictive value

pTau:

Phosphorylated Tau 181

SD:

Semantic dementia

TE:

Time to echo

TI:

Time to inversion

TIV:

Total intracranial volume

TPJ:

Temporoparietal junction

TR:

Time to repetition

tTau:

Total Tau

WM:

White matter

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Acknowledgments

We thank Dr. Lothar Spies and jung diagnostics GmbH for providing volumetric reports for the investigated MRI scans.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany

    Dennis M. Hedderich, Michael Dieckmeyer, Tiberiu Andrisan, Lioba Grundl, Simon Schön, Tom Finck, Kornelia Kreiser & Claus Zimmer

  2. Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany

    Marion Ortner & Timo Grimmer

  3. Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany

    Per Suppa

  4. Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany

    Igor Yakushev

Authors
  1. Dennis M. Hedderich
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Corresponding author

Correspondence to Dennis M. Hedderich.

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Guarantor

The scientific guarantor of this publication is Timo Grimmer, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: jung diagnostics GmbH, Hamburg, Germany. Jung diagnostics GmbH provided the volumetric reports for the current study. No further relationships exist between the authors and jung diagnostics and no conflict of interest is present. Per Suppa, MD was an employee of jung diagnostics until November 2018.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (Reference # 176/18s).

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• Retrospective

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• Performed at one institution

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Hedderich, D.M., Dieckmeyer, M., Andrisan, T. et al. Normative brain volume reports may improve differential diagnosis of dementing neurodegenerative diseases in clinical practice. Eur Radiol 30, 2821–2829 (2020). https://doi.org/10.1007/s00330-019-06602-0

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  • DOI: https://doi.org/10.1007/s00330-019-06602-0

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