Visual Rating Scale Reference Material. Lorna Harper Dementia Research Centre University College London

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1 Visual Rating Scale Reference Material Lorna Harper Dementia Research Centre University College London

2 Background The reference materials included in this document were compiled and used in relation to the study: Harper et al: MRI visual rating scales in the diagnosis of dementia: evaluation in 184 post-mortem confirmed cases. Brain Apr; 139(4): Please acknowledge this source when publicly presenting any work that benefited from the use of this material. Such presentations include but are not limited to papers, books, book chapters, conference posters, and talks. Slice Selection provides information on selecting the brain slice to rate. Rating Guide provides information on scoring.

3 Orbito-Frontal Ra.ng Protocol a) b) c) Corpus callosum not yet visible (prera'ng slice) Corpus callosum just visible (rate olfactory sulcus and cingulate sulcus on this slice) Post-ra'ng slice CC - corpus callosum, OS - olfactory sulcus, CS - cingulate sulcus 0: Closed sulcus 1: Small sulcal slit, just revealing CSF 2: Opening of the sulcus, CSF clearly visible 3: Severe widening of the sulcus

4 Rostral Anterior Cingulate Ra.ng Protocol a) b) c) Corpus callosum not yet visible (prera'ng slice) Corpus callosum just visible (rate olfactory sulcus and cingulate sulcus on this slice) Post-ra'ng slice CC - corpus callosum, OS - olfactory sulcus, CS - cingulate sulcus 0: Closed sulcus 1: Sulcal opening (CSF visible), although narrower towards the peak 2: Sulcal widening along the length of the sulcus 3: Severe widening of the sulcus

5 Anterior Temporal Ra.ng Protocol a) b) c) Connec'on between the frontal and temporal lobes is s'll visible (prera'ng slice) No visible connec'on between the frontal and temporal lobes (rate this slice) Post-ra'ng slice 0: Normal appearances 1: Slight prominence of anterior temporal sulci 2: Temporal sulci definitely widened 3: Gyri severely atrophic and ribbon-like. WM and GM cannot be dis'nguished (normal temporal lobe at this level is less substan'al than the frontal lobe, ribbon-like gyri of stage 3 temporal lobe are similar to stage 4 frontal gyri) 4: Temporal pole has a simple linear profile or is not seen at all

6 Fronto-Insula Ra.ng Protocol a) b) Anterior commissure (AC) not yet visible (pre-ra'ng slice) Anterior commisure just visible (rate this slice and the 2 posterior) CIS: Circular insular sulcus, AC: Anterior commissure (Average the score over the 3 slices) 0: Closed sulcus 1: Sulcal opening, CSF clearly visible 2: Sulcal widening and the emergence of an arrow head shape poin'ng towards the midline 3: Severe widening along the length of the sulcus

7 Also take these structures into account: CF choroid fissure TH - temporal horn PHG - parahippocampal gyrus CoS - collateral sulcus FS - fusiform sulcus 0: Normal, 1: Widened choroid fissure 2: Increased widening of the choroid fissure, widening of the temporal horn, opening of other sulci (i.e. collateral/fusiform sulcus) 3: Pronounced volume loss of the hippocampus, 4: End stage atrophy Medial Temporal Ra.ng Protocol In the middle of the hippocampal body, in front of the pons or halfway through the pons depending on the angle of the scan Scroll though the hippocampus to get an impression of the atrophy throughout Don t rate too close to the amygdala. If the hippocampus curls up, the slice is too close to the hippocampal head. At the origin of the fornix, the slice is too close to the tail. A score of 0 can s'll be given if there is some opening of the choroid fissure on a few slices through the hippocampal body if the remainder are closed. A score of 1 is given if the choroid fissure is opened over the en're length of the hippocampal body. (References images from h@p:// CF CF

8 Posterior Atrophy Ra.ng Protocol 0 1 0: Closed sulci of parietal lobes and cuneus 1: Mild widening of posterior cingulate and parieto-occipital sulci 2: Substan'al widening of the sulci 3: Extreme widening of the posterior cingulate and parieto-occipital sulci 2 3 No slice selec'on just scroll through PAR - parietal lobe PCS - posterior cingulate sulcus POS - parieto-occipital sulcus PRE -precuneus Image from Lehmann et al, Neurobiol Aging Mar;33(3):627.e1-627.e12.

9 References Frontal Scales were adapted by Fumagalli et al from the following papers (anterior temporal scale from the same authors): Ambikairajah A et al. A visual MRI atrophy rating scale for the amyotrophic lateral sclerosis-frontotemporal dementia continuum. Amyotroph Lateral Scler Front. Degener 2014 Davies RR et al. Progression in frontotemporal dementia: identifying a benign behavioral variant by magnetic resonance imaging. Arch Neurol 2006; 63: Davies RR et al. Development of an MRI rating scale for multiple brain regions: comparison with volumetrics and with voxel-based morphometry. Neuroradiology 2009; 51: Kipps CM et al. Clinical significance of lobar atrophy in frontotemporal dementia: application of an MRI visual rating scale. Dement Geriatr Cogn Disord 2007; 23: Fumagalli GG et al. 9th International Conference on Frontotemporal Dementias P.252 Development of a visual rating scale for atrophy of the anterior cingulate, insula and frontal lobes. Am J Neurodegener Dis 2014; 3: Medial Temporal Scale: Scheltens P et al. Atrophy of medial temporal lobes on MRI in probable Alzheimer s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 1992; 55: Posterior Scale: Koedam ELGE et al. Visual assessment of posterior atrophy development of a MRI rating scale. Eur Radiol 2011; 21: Lehmann M et al. Posterior cerebral atrophy in the absence of medial temporal lobe atrophy in pathologicallyconfirmed Alzheimer s disease. Neurobiol Aging 2012; 33: 627.e1 627.e12.