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Ultraschall Med 2017; 38(03): 294-300
DOI: 10.1055/s-0042-107150
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Structural Ultrasound of the Medial Temporal Lobe in Alzheimer’s Disease

Struktureller Ultraschall des medialen Temporallappens bei Alzheimer-Demenz
Rezzak Yilmaz
1   Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
,
Andrea Pilotto
1   Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
2   Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
,
Benjamin Roeben
1   Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
3   Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
,
Oliver Preische
3   Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
4   Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
,
Ulrike Suenkel
1   Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
,
Sebastian Heinzel
1   Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
,
Florian G. Metzger
4   Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
5   Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
,
Christoph Laske
3   Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
4   Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
5   Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
6   Section for Dementia Research, University of Tuebingen, Tuebingen, Germany
,
Walter Maetzler
1   Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
3   Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
,
Daniela Berg
1   Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
3   Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
7   Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
› Author Affiliations
Further Information

Publication History

08 February 2016

08 April 2016

Publication Date:
07 June 2016 (online)

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Corrected by:

Erratum: Pitfalls of Ultrasonographic Yolk Sac MeasurementUltraschall Med 2011; 32(S 02): e202-e202
DOI: 10.1055/s-0031-1282063

Corrected by:

Erratum: Structural Ultrasound of the Medial Temporal Lobe in Alzheimer’s DiseaseUltraschall Med 2017; 38(03): e16-e16
DOI: 10.1055/s-0035-1567111

Abstract

Purpose One of the anatomical hallmarks of Alzheimer’s disease (AD) is the atrophy of the medial temporal lobe (MTL), yet cost-effective and broadly available methodological alternatives to the current imaging tools for screening of this brain area are not currently available.

Materials and Methods Using structural transcranial ultrasound (TCS), we attempted to visualize and measure the MTL, and compared the results of 32 AD patients and 84 healthy controls (HC). The MTL and the surrounding space were defined in the coronal plane on TCS. A ratio of the height of the MTL/height of the choroidal fissure (M/F) was calculated in order to obtain a regional proportion.

Results An insufficient temporal bone window was identified in 22 % of the AD patients and 12 % of the HCs. The results showed that the ratio of M/F was significantly smaller in the AD group on both sides (p = 0.004 right, p = 0.007 left side). Furthermore, the M/F ratio made it possible to discriminate AD patients from HCs with a sensitivity of 83 % (right)/73 % (left) and a specificity of 76 % (right)/72 % (left) which is basically comparable to results published for magnetic resonance imaging. The measurements showed substantial intra/interrater reliability (ICC:0.79/0.69).

Conclusion These results suggest that utilization of structural TCS may possibly constitute a cheap and easy-to-use supplement to other techniques for the diagnosis of AD. It may be especially useful as a screening tool in the large population of individuals with cognitive decline. Further studies are needed to validate this novel method.

Zusammenfassung

Ziel Eines der charakteristischen anatomischen Kennzeichen der Alzheimer-Demenz (AD) ist die Atrophie des medialen Temporallappens (MTL), jedoch fehlen bisher preiswerte und breit verfügbare Alternativen zu den üblichen Bildgebungsverfahren um Veränderungen dieser Gehirnregion darzustellen.

Material und Methoden Mittels transkranieller B-Bild-Sonografie (TCS) haben wir den MTL dargestellt, vermessen und die Messungen von 32 AD-Patienten und 84 gesunder Kontrollen miteinander verglichen. Der MTL und die umgebenden Strukturen wurden zunächst in der koronaren Ebene in der TCS identifiziert. Der Quotient aus der Höhe des MTL und der Höhe der choroidalen Fissur (M/F) wurde als regionales Maß berechnet.

Ergebnisse Bei 22 % der AD-Patienten und bei 12 % der gesunden Kontrollen lag ein insuffizientes Knochenfenster vor. Der M/F-Quotient ergab auf beiden Seiten signifikant kleinere Werte in der AD-Gruppe (p = 0,004 rechte Seite, p = 0,007 linke Seite). Weiterhin konnten AD-Patienten von gesunden Kontrollen mittels des M/F-Quotienten mit einer Sensitivität von 83 % (rechts) / 73 % (links) und einer Spezifität von 76 % (rechts) / 72 % (links) von einander differenziert werden, was mit publizierten Werten für die Magnetresonanztomografie vergleichbar ist. Es ergaben sich zudem eine substanzielle Intra- und Interrater-Reliabilität (ICC:0,79/0,69).

Schlussfolgerung Unsere Ergebnisse legen die Nutzung der TCS als günstige und einfach anzuwendende Ergänzung zu anderen Verfahren in der Diagnostik von AD nahe. TCS könnte insbesondere als Screening-Instrument in großen Kollektiven von Menschen mit kognitiven Defiziten sinnvoll sein. Weitere Studien sind notwendig, um diese neue Methode zu validieren.

Key words

transcranial sonography - medial temporal lobe - Alzheimer's disease
 

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