0:00

I'm back with Dr. Ben Laser,

0:02

Neuroradiologist.

0:02

And I'm Dr. Stephen Pomeranz.

0:04

We're talking about neurodegenerative disease

0:05

and medial temporal atrophic grading,

0:09

which we will use in numerous diseases,

0:11

but specifically most relevant to ALZ

0:15

or Alzheimer's disease, which is a tauopathy.

0:18

Some other examples of tauopathies include TDP 43

0:21

proteinopathies and neurofilament disease

0:24

or neurofilamentopathies.

0:27

Let's look at the coronal projection where we can

0:29

best assess the status of the

0:31

mesial temporal region.

0:32

And the two temporal lobes are distinctly different.

0:35

Coronal T2 fast spin-echo on the left.

0:37

Coronal T1 spin-echo on the right.

0:40

On the left, the choroidal fissure,

0:42

pretty big.

0:43

In fact, very big.

0:44

It's big on the right, too,

0:46

but on the left,

0:47

the temporal horn is clearly dilated,

0:49

whereas on the right, it's not so dilated.

0:51

So, here's how we might grade the temporal region,

0:54

and some of it is admittedly subjective.

0:56

This material was described by Shelton's.

0:59

So, a zero would be no atrophy.

1:01

A one would be the choroidal fissure is big.

1:04

A two,

1:05

the temporal horn is big.

1:08

A three,

1:10

there is hippocampal atrophy.

1:12

A four,

1:13

there is profound hippocampal atrophy.

1:17

So, that's a very basic grading system.

1:19

Let's have a look.

1:20

Again, some subjectivity present.

1:23

On the right,

1:24

there is some choroidal fissure atrophy,

1:26

so we might give the right a one.

1:27

The temporal horn looks fine.

1:28

On the left,

1:29

clearly, the choroidal fissure is big

1:31

and the temporal horn is big.

1:33

So we'll give it a two-ish three-ish.

1:35

There is clearly hippocampal volume loss.

1:38

Look at the hippocampus on the right.

1:40

The dentate gyrus, the amygdala,

1:42

the gyrus dentatus,

1:44

all of these are nice and full and juicy,

1:48

pressing up on the temporal horn.

1:50

On the other side, not so much.

1:51

It looks like a little knuckle.

1:53

So this would be closer to an MTA 3 on the left

1:57

and an MTA 1 on the right.

2:00

Mesial temporal assessment in tauopathies,

2:03

specifically relevant in Alzheimer's disease and

2:06

also in various forms of cognitive decline,

2:09

like Mild Cognitive Impairment syndrome

2:11

or MCI syndrome.

2:12

Let's move on, shall we?

2:14

Laser and Pomeranz out.