Transcranial Sonography Findings in Alzheimer’s Disease: A New Imaging Biomarker

Abstract

Objective To validate transcranial sonography (TCS) as a novel imaging tool for the assessment of medial temporal lobe (MTL) atrophy (MTA).

Materials and Methods Participants with Alzheimer’s disease (AD, n = 30) and age-sex-matched controls (n = 30) underwent TCS and MRI. On TCS, MTL structures (choroidal fissure (CF) and temporal horn (TH)) were measured and combined to create an MTA score in sonography (MTA-S). Furthermore, both THs and the third ventricle were combined to form the ventricle enlargement score in sonography (VES-S). On MRI, the MTL was evaluated by linear measurements, MTA scale and hippocampal volumetry. Validation was performed by comparing imaging methods and the patient group.

Results Intraclass correlations for CF and TH showed substantial intra/inter-rater reliability (> 0.80). TCS and MRI showed strong to moderate correlation regarding TH (right = 0.88, left = 0.89) and CF (right = 0.70, left = 0.47). MTA-S correlated significantly with the hippocampal volume (right = –0.51, left = –0.47), predicted group membership in logistic regression (Exp(B) right = 3.0, left = 2.7), and could separate AD patients from controls (AUC = 0.93). An MTA-S of 6 mm and 10 mm discriminated MRI MTA scores 0–1 (from 2–4) and MTA score 4 (from 0–3) with 100 % specificity, respectively. VES-S also showed a moderate correlation with the hippocampal volume (r = –0.66) and could differentiate AD patients from controls (AUC = 0.93).

Conclusion Our results suggest that TCS may be an alternative imaging tool for the assessment of MTL atrophy and ventricular enlargement for patients in whom MRI scanning is not possible. Additionally, TCS offers a practical, patient-friendly and inexpensive option for the screening and follow-up of individuals with AD.

Zusammenfassung

Ziel Validierung der transkraniellen Sonografie (TCS) als neue Bildgebung zur Beurteilung der MTA, der Atrophie des medialen Temporallappens (MTL).

Material und Methoden Bei allen Teilnehmern, Patienten mit Morbus Alzheimer (n = 30) sowie alters- und geschlechtsspezifischen Kontrollen (n = 30), wurde eine TCS und MRT durchgeführt. Bei der TCS wurden die MTL-Strukturen (Choroidalfissur (CF) und Temporalhorn (TH)) gemessen und zu einem sonografischen MTA-Score (MTA-S) kombiniert. Darüber hinaus wurden die beiden THs und der dritte Ventrikel kombiniert, um einen sonografischen Score für die Ventrikelerweiterung (VES-S) zu erstellen. In der MRT wurden der MTL durch lineare Messungen, die MTA-Skala und die Hippocampus-Volumetrie bewertet. Die Validierung erfolgte durch den Vergleich der bildgebenden Verfahren und der Patientengruppe.

Ergebnis Die Intraklassenkorrelationen für CF und TH zeigten eine beträchtliche Intra-/Interrater-Reliabilität (> 0,80). TCS und MRI zeigten eine starke bis moderate Übereinstimmung in Bezug auf die TH (rechts = 0,88; links = 0,89) und die CF (rechts = 0,70; links = 0,47). Der MTA-S zeigte eine signifikante Korrelation mit dem Hippocampus-Volumen (rechts = –0,51; links = –0,47), prognostizierte die Zugehörigkeit zu der Gruppe in der logistischen Regression (Exp(B) rechts = 3,0; links = 2,7) und konnte zwischen Patienten und Kontrollen trennen (AUC = 0,93). Ein MTA-S von 6 mm bzw. 10 mm konnte jeweils einen MRT-MTA-Score 0–1 (von 2–4) von einen MTA-Score 4 (von 0–3) mit 100 % Spezifität unterscheiden. Der VES-S zeigte auch eine moderate Übereinstimmung mit dem Hippocampus-Volumen (r = –0,66) und konnte zwischen Alzheimer-Patienten und Kontrollen differenzieren (AUC = 0,93).

Schlussfolgerung Unsere Ergebnisse deuten darauf hin, dass die TCS ein alternatives bildgebendes Verfahren zur Beurteilung des MTL und der Ventrikelerweiterung bei Patienten sein könnte, bei denen eine MRT-Untersuchung nicht durchführbar ist. Darüber hinaus ist die TCS für das Screening und die Nachsorge von Alzheimer-Patienten eine praktische, patientenfreundliche und kostengünstige Option.

Key words

Alzheimer’s disease - dementia - medial temporal lobe - transcranial sonography

^* These authors share senior authorship.

Publication History

Received: 29 October 2019

Accepted: 28 February 2020

Article published online:
03 June 2020

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