The ERICA Score: An MR Imaging–based Visual Scoring System for the Assessment of Entorhinal Cortex Atrophy in Alzheimer Disease

Abstract

Purpose To establish and evaluate a visual score focused on entorhinal cortex atrophy (ERICA), as the entorhinal cortex is one of the first brain structures affected in Alzheimer disease (AD). Materials and Methods In this retrospective study, ERICA was visually evaluated with magnetic resonance imaging (2009-2016). First, a four-point ERICA score was developed by using data in 48 consecutive subjects (20 patients with AD and 28 control subjects). Then, in the main analysis, ERICA and the standard medial temporal lobe atrophy (MTA) scores were determined in an independent cohort of 60 patients suspected of having AD (mean age, 69.4 years; range, 46-86 years) and in 60 age-matched patients with subjective cognitive decline (SCD) (mean age, 72.4 years; range 50-87 years). Score performances were evaluated with κ statistics, receiver operating characteristic analysis, t tests, and analysis of variance according to the Standards for Reporting of Diagnostic Accuracy Studies. Results Patients with AD had higher MTA scores (mean, 2.13) and ERICA scores (mean, 2.05) than patients with SCD (P < .001). An ERICA score of 2 or greater achieved a higher diagnostic accuracy (91%) than the MTA score (74%), with a sensitivity of 83% versus 57% and a specificity of 98% versus 92% in discriminating dementia caused by AD from SCD (P < .001). The ERICA score was correlated with amyloid β 42/40 ratio (ρ = -0.54, P < .001) and with cerebrospinal fluid tau (ρ = 0.35, P = .001) and p-tau (ρ = 0.31, P = .004). In multivariable linear regression analysis, ERICA was associated with verbal learning and recall (β = -.40 and -.41), nonverbal recall (β = -.28), and cued recall (β = -.41, P ≤ .002 for all). Conclusion An ERICA score of 2 or greater indicates probable AD with high diagnostic accuracy. RSNA, 2018 Online supplemental material is available for this article.

Regional Cerebral Blood Flow in the Posterior Cingulate and Precuneus and the Entorhinal Cortical Atrophy Score Differentiate Mild Cognitive Impairment and Dementia Due to Alzheimer Disease

“…17 It has also been shown to be better than the previously described medial temporal lobe atrophy score in differentiating AD from subjectively reported cognitive impairment in patients. 17 The ERICA score is a 4-point atrophy rating scale from 0 to 3, where 0 indicates no evidence for atrophy of the entorhinal cortex, and 3, marked atrophy (Fig 1). This was shown to be handy because the scoring system is very simple, but powerful enough to be used for the distinction of these conditions.…”

“…13 The entorhinal cortex has been shown to undergo graded atrophy in the MCI-AD complex and is thought to be one of the early areas of the brain that shows gray matter atrophy in AD. 17 A recently described numeric atrophy scale of the entorhinal cortex (ERICA) score has been shown to correlate well with the cognitive changes and the diagnosis of AD. 17 It has also been shown to be better than the previously described medial temporal lobe atrophy score in differentiating AD from subjectively reported cognitive impairment in patients.…”

“…17 A recently described numeric atrophy scale of the entorhinal cortex (ERICA) score has been shown to correlate well with the cognitive changes and the diagnosis of AD. 17 It has also been shown to be better than the previously described medial temporal lobe atrophy score in differentiating AD from subjectively reported cognitive impairment in patients. 17 The ERICA score is a 4-point atrophy rating scale from 0 to 3, where 0 indicates no evidence for atrophy of the entorhinal cortex, and 3, marked atrophy (Fig 1).…”

MRT bei neurodegenerativen Erkrankungen

“…Enkirch und Mitarbeitern haben hierfür eine Skala von 0 bis 3 Punkten eingeführt, wobei das Stadium 1 durch einen erweiterten Sulcus collateralis und die Stadien 2 und 3 u. a. durch das sog. "tentorial cleft sign", also einen sichtbaren Spalt zwischen entorhinalem Kortex und dem Tentorium cerebelli, charakterisiert sind[18]. Visuelle und planimetrische Atrophie-Scores.…”

MRT bei neurodegenerativen Erkrankungen

“…Punkten eingeführt, wobei das Stadium 1 durch einen erweiterten Sulcus collateralis und die Stadien 2 und 3 u. a. durch das sog. "tentorial cleft sign", also einen sichtbaren Spalt zwischen entorhinalem Kortex und dem Tentorium cerebelli, charakterisiert sind[18].Die parietale Atrophie wird im Koedam-Score auf einer Skala von 0 bis 3 beurteilt, auf der 0 Punkte keine und 3 Punkte das Vollbild einer parietalen Atrophie mit einer deutlichen Erweiterung des Ramus marginalis des Sulcus cinguli (Sulcus marginalis) und des Sulcus parietooccipitalis auf den parasagittalen Bildern bzw. eine Erweiterung der intraparietalen Sulci auf den axialen bzw.…”