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Marcus Likeman, FRCR; Valerie M. Anderson, BSc; John M. Stevens, DRACR, FRCR; Adam D. Waldman, PhD, MRCP, FRCR; Alison K. Godbolt, MA, MRCP; Chris Frost, MA, DipStat; Martin N. Rossor, MD, FRCP; Nick C. Fox, MD, FRCP

Arch Neurol. 2005;62:1410-1415.

Objectives  To investigate the diagnostic accuracy of visual inspection of magnetic resonance imaging (MRI) in a range of pathologically confirmed diseases causing young-onset dementia and to assess the sensitivity and specificity of atrophy patterns for Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD).

Design  Sixty-two patients with pathologically confirmed diseases that may present as young-onset dementia were selected from a biopsy and postmortem series. The first diagnostic T1-weighted volumetric MRI was obtained for each patient, together with images from 22 healthy control subjects. All MRIs were assessed for regional atrophy independently by 3 neuroradiologists, blinded to all clinical details except age. Observers were also asked to use their clinical judgment to form a diagnosis.

Results  Eighty-seven percent of dementia cases were distinguished from controls after visual inspection of MRI, and a correct pathologically confirmed diagnosis was given in 58% of cases. Hippocampal atrophy was noted in 92% of AD cases but was commonly seen in other dementias and controls. A bilateral symmetrical pattern of hippocampal atrophy discriminated AD from FTLD with 47% specificity, while posterior greater than anterior gradient of atrophy was 92% specific for AD. Atrophy of the anterior, inferior, and lateral temporal lobes was suggestive of FTLD pathology (90% sensitivity), while anterior greater than posterior gradient of atrophy and hemispheric asymmetry of atrophy were each at least 85% specific for FTLD.

Conclusion  Despite variation and overlap of atrophy patterns, visual inspection of regional atrophy on MRI may aid in discriminating AD and FTLD.

Author Affiliations: National Hospital for Neurology and Neurosurgery (Drs Likeman and Rossor); Dementia Research Centre, Institute of Neurology (Ms Anderson, Drs Waldman, Godbolt, and Fox, and Mr Frost), and Department of Radiology (Dr Stevens); Department of Imaging, Charing Cross Hospital (Dr Waldman); Medical Statistics Unit, London School of Hygiene and Tropical Medicine (Mr Frost); and Division of Neuroscience and Psychological Medicine, Imperial College (Dr Rossor); London, England.

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