Visual Rating Scale Reference Material
Lorna Harper
Dementia Research Centre
University College London
Background
The reference materials included in this document were compiled and used in relation to
the study:
•  Harper et al: MRI visual rating scales in the diagnosis of dementia: evaluation in 184
post-mortem confirmed cases. Brain. 2016 Apr; 139(4): 1211–1225.
http://dx.doi.org/10.1093/brain/aww005
Please acknowledge this source when publicly presenting any work that benefited from
the use of this material. Such presentations include but are not limited to papers, books,
book chapters, conference posters, and talks.
Slice Selection provides information on selecting the brain slice to rate.
Rating Guide provides information on scoring.
Orbito-FrontalRa.ngProtocol
SliceSelec'on
a)
b)
c)
Corpuscallosumnotyetvisible(prera'ngslice)
Corpuscallosumjustvisible(rate
olfactorysulcusandcingulatesulcus
onthisslice)
Post-ra'ngslice
CC-corpuscallosum,OS-olfactorysulcus,CS-cingulatesulcus
Ra'ngGuide
0:Closedsulcus
1:Smallsulcalslit,justrevealingCSF
2:Openingofthesulcus,CSFclearlyvisible
3:Severewideningofthesulcus
RostralAnteriorCingulateRa.ngProtocol
SliceSelec'on
a)
b)
c)
Corpuscallosumnotyetvisible(prera'ngslice)
Corpuscallosumjustvisible(rate
olfactorysulcusandcingulatesulcus
onthisslice)
Post-ra'ngslice
CC-corpuscallosum,OS-olfactorysulcus,CS-cingulatesulcus
Ra'ngGuide
0:Closedsulcus
1:Sulcalopening(CSFvisible),although
narrowertowardsthepeak
2:Sulcalwideningalongthelengthofthe
sulcus
3:Severewideningofthesulcus
AnteriorTemporalRa.ngProtocol
SliceSelec'on
a)
b)
c)
Connec'onbetweenthefrontaland
temporallobesiss'llvisible(prera'ngslice)
Novisibleconnec'onbetweenthe
frontalandtemporallobes(ratethis
slice)
Post-ra'ngslice
Ra'ngGuide
0:Normalappearances
1:Slightprominenceofanteriortemporal
sulci
2:Temporalsulcidefinitelywidened
3:Gyriseverelyatrophicandribbon-like.
WMandGMcannotbedis'nguished
(normaltemporallobeatthislevelis
lesssubstan'althanthefrontallobe,
ribbon-likegyriofstage3temporallobe
aresimilartostage4frontalgyri)
4:Temporalpolehasasimplelinearprofile
orisnotseenatall
Fronto-InsulaRa.ngProtocol
SliceSelec'on
a)
b)
Anteriorcommissure(AC)notyet
visible(pre-ra'ngslice)
Anteriorcommisurejustvisible(rate
thissliceandthe2posterior)
CIS:Circularinsularsulcus,AC:Anteriorcommissure
Ra'ngGuide
(Averagethescoreoverthe3slices)
0:Closedsulcus
1:Sulcalopening,CSFclearlyvisible
2:Sulcalwideningandtheemergenceof
anarrowheadshapepoin'ngtowards
themidline
3:Severewideningalongthelengthofthe
sulcus
MedialTemporalRa.ngProtocol
SliceSelec'on
•
•
•
•
•
•
Inthemiddleofthehippocampalbody,infrontoftheponsorhalfwaythroughtheponsdependingontheangleofthescan
Scrollthoughthehippocampustogetanimpressionoftheatrophythroughout
Don’tratetooclosetotheamygdala.Ifthehippocampuscurlsup,thesliceistooclosetothehippocampalhead.
Attheoriginofthefornix,thesliceistooclosetothetail.
Ascoreof0cans'llbegivenifthereissomeopeningofthechoroidfissureonafewslicesthroughthehippocampalbodyif
theremainderareclosed.
Ascoreof1isgivenifthechoroidfissureisopenedovertheen'relengthofthehippocampalbody.
Ra'ngGuide
CF
(Referencesimagesfromh@p://www.radiologyassistant.nl/en/p43dbf6d16f98d/demen.a-role-of-mri.html)
CF
Alsotakethesestructuresintoaccount:
CF–choroidfissure
TH-temporalhorn
PHG-parahippocampalgyrus
CoS-collateralsulcus
FS-fusiformsulcus
0:Normal,
1:Widenedchoroidfissure
2:Increasedwideningofthechoroidfissure,wideningofthe
temporalhorn,openingofothersulci(i.e.collateral/fusiformsulcus)
3:Pronouncedvolumelossofthehippocampus,
4:Endstageatrophy
PosteriorAtrophyRa.ngProtocol
0
Ra'ngGuide
1
2
0:Closedsulciofparietallobesandcuneus
1:Mildwideningofposteriorcingulateand
parieto-occipitalsulci
2:Substan'alwideningofthesulci
3:Extremewideningoftheposteriorcingulate
andparieto-occipitalsulci
SliceSelec'on
Nosliceselec'on–justscrollthrough
PAR-parietallobe
PCS-posteriorcingulatesulcus
POS-parieto-occipitalsulcus
PRE-precuneus
3
ImagefromLehmannetal,
NeurobiolAging.2012Mar;33(3):627.e1-627.e12.
References
Frontal Scales were adapted by Fumagalli et al from the following papers (anterior temporal scale from the
same authors):
•
Ambikairajah A et al. A visual MRI atrophy rating scale for the amyotrophic lateral sclerosis-frontotemporal
dementia continuum. Amyotroph Lateral Scler Front. Degener 2014
•
Davies RR et al. Progression in frontotemporal dementia: identifying a benign behavioral variant by magnetic
resonance imaging. Arch Neurol 2006; 63: 1627–1631.
•
Davies RR et al. Development of an MRI rating scale for multiple brain regions: comparison with volumetrics and
with voxel-based morphometry. Neuroradiology 2009; 51: 491–503.
•
Kipps CM et al. Clinical significance of lobar atrophy in frontotemporal dementia: application of an MRI visual
rating scale. Dement Geriatr Cogn Disord 2007; 23: 334–342.
•
Fumagalli GG et al. 9th International Conference on Frontotemporal Dementias P.252 Development of a visual
rating scale for atrophy of the anterior cingulate, insula and frontal lobes. Am J Neurodegener Dis 2014; 3: 1–375.
Medial Temporal Scale:
•
Scheltens P et al. Atrophy of medial temporal lobes on MRI in ‘probable’ Alzheimer’s disease and normal ageing:
diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 1992; 55: 967–972.
Posterior Scale:
•
•
Koedam ELGE et al. Visual assessment of posterior atrophy development of a MRI rating scale. Eur Radiol 2011;
21: 2618–2625.
Lehmann M et al. Posterior cerebral atrophy in the absence of medial temporal lobe atrophy in pathologicallyconfirmed Alzheimer’s disease. Neurobiol Aging 2012; 33: 627.e1–627.e12.