Structural imaging findings on non-enhanced computed tomography are severely underreported in the primary care diagnostic work-up of subjective cognitive decline

Abstract

PurposeThe purpose of this study was to investigate how structural imaging findings of medial temporal lobe atrophy (MTA), posterior cortical atrophy (PCA), global cortical atrophy (GCA), white matter changes (WMC), and Evans’ index/width of lateral ventricles (EI/WLV) are reported in the primary care diagnostic work-up of patients with subjective cognitive decline or mild cognitive impairment.MethodsWe included 197 patients referred to a non-enhanced computed tomography (NECT) as part of the diagnostic work-up. We compared the frequencies of reported findings in radiology reports written by neuroradiologists and general radiologists with actual pathological findings in a second view done by a single neuroradiologist using the MTA, PCA, GCA, WMC, and EI/WLV visual rating scales. Structural findings were also compared to cognitive tests.ResultsWe found that MTA and PCA were clearly underreported by both neuroradiologists and general radiologists. The presence of GCA and WMC was also underreported among general radiologists. Only MTA showed a clear association with cognitive test results.ConclusionsWe believe that the use of visual rating scales should be put into clinical practice to increase the yield of clinical NECT exams in the investigation of cognitive impairment. Special emphasis should be put on reporting MTA.

Reporting frequency of radiology findings increases after introducing visual rating scales in the primary care diagnostic work up of subjective and mild cognitive impairment

“…MTA medial temporal lobe atrophy, GCA global cortical atrophy, WMC white matter changes, WLV width of lateral ventricles "after") for MTA and it cannot be excluded that a study population with a higher prevalence of moderate to severe MTA would have resulted in better TPR and compliance. In line with previous studies, excellent intra-rater and substantial inter-rater agreement was observed for MTA [14,29]. With respect to the clinical importance of MTA and previously observed underreporting, we believe our results regarding MTA have an important clinical impact [12,14].…”

“…Also, the use of our template was not enforced by the department leadership. Previous studies have shown that abnormal findings, in particular MTA, are underreported in radiology reports even when assessment is warranted [12,14]. Medial temporal lobe atrophy is an important structural finding in Alzheimer's disease (AD) but it can also be found in other dementias [27,28].…”

“…For rating of GCA, Pasquier's scale was used on axial reformats in 5 mm slices (parallel to the orbitomeatal plane) and graded from 0 = no cortical atrophy to 3 = severe cortical atrophy [11,19]. Grades were dichotomized into normal (0-1 regardless of age) and abnormal (2-3 regardless of age) based on previous studies [12,14]. Fazekas' scale was used to grade WMC with four grades from 0 = none or a single lesion to 3 = confluent lesions and dichotomized into normal (0 < 65 years, 0-1 ≥ 65 years) and abnormal (1-3 < 65 years, 2-3 ≥ 65 years) [11,12,20].…”

“…Previous studies have shown that structural findings are underreported in the diagnostic work up of cognitive impairment [12][13][14]. A recent European survey showed that VRS were used in 75% of responding centers but structural reporting was used in only 28% [15].…”

Medial temporal atrophy in preclinical dementia: visual and automated assessment during six year follow-up

“…1 we provide examples of each score. Several studies have reported on the diagnostic ability and relevant clinical cut-offs of the MTA scale (Westman et al, 2011;Scheltens et al, 1992;Ferreira et al, 2015), and others have argued for the importance of reporting MTA in the clinical routing (Torisson et al, 2015;Håkansson et al, 2019;.…”