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Updated: Aug 23, 2026
A Comprehensive Protocol for Manual Segmentation of the Medial Temporal Lobe Structures
Published on: July 2, 2014
Medial temporal lobe atrophy on MRI predicts dementia in patients with mild cognitive impairment
Esther S C Korf1, Lars-Olof Wahlund, Pieter Jelle Visser
1Department of Neurology and Alzheimer Center, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands. e.pelgrim@vumc.nl
Background:
Although detailed volumetric MRI assessment of medial temporal lobe atrophy (MTA) can predict dementia in patients with mild cognitive impairment (MCI), it is not easily applied to routine clinical practice.
Objective:
To test the predictive accuracy of visually assessed MTA in MCI patients using a standardized visual rating scale.
Methods:
Seventy-five MCI patients (mean age 63 years) underwent a coronal three-dimensional magnetization-prepared rapid gradient echo brain MRI sequence. MTA was rated visually using a 5-point rating scale.
Results:
The mean follow-up period for the cohort was 34 months. At follow-up, 49% of the enrolled MCI patients fulfilled criteria for dementia. MTA assessed using a standardized visual rating scale was significantly associated with dementia at follow-up, with a hazard ratio of 1.5 for every point increase in atrophy score (p < 0.001) and of 3.1 for the presence of atrophy based on the dichotomized atrophy score (p = 0.003). The predictive accuracy of visually assessed MTA was independent of age, gender, education, Mini-Mental State Examination score, Clinical Dementia Rating Sum of Boxes score, Verbal Delayed Recall, and the presence of hypertension, depression, the APOE epsilon4 allele, and white matter hyperintensities.
Conclusions:
Visual assessment of MTA on brain MRI using a standardized rating scale is a powerful and independent predictor of conversion to dementia in relatively young MCI patients. As overlap existed in MTA scores between patients with and without dementia at follow-up, the results should be interpreted in the light of the odds for the individual patient.
Insights
Visual assessment of medial temporal lobe atrophy (MTA) on MRI reliably predicts dementia in mild cognitive impairment (MCI) patients. This accessible method offers powerful insights into dementia progression.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Medial temporal lobe atrophy (MTA) assessment via volumetric MRI predicts dementia in mild cognitive impairment (MCI).
- Volumetric MRI is not practical for routine clinical use.
- A simpler method for MTA assessment is needed.
Purpose of the Study:
- To evaluate the predictive accuracy of visually assessed MTA in MCI patients.
- To utilize a standardized visual rating scale for MTA evaluation.
Main Methods:
- Seventy-five MCI patients (mean age 63) underwent brain MRI.
- Coronal 3D magnetization-prepared rapid gradient echo sequence was used.
- MTA was rated visually using a 5-point scale.
Main Results:
- 49% of MCI patients developed dementia within a 34-month follow-up.
- Visually assessed MTA significantly predicted dementia (HR 1.5 per point increase, p < 0.001).
- Predictive accuracy was independent of various clinical and demographic factors.
Conclusions:
- Standardized visual MTA assessment on MRI is a strong, independent predictor of dementia conversion in younger MCI patients.
- This method is valuable for routine clinical practice.
- Individual patient odds should be considered due to score overlap.
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