Medial temporal lobe atrophy score

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The medial temporal lobe atrophy (MTA) score, also known as Scheltens' scale, is useful in distinguishing patients with mild cognitive impairment and Alzheimer disease from those without impairment is helpful in the assessment of patients with possible dementia (see neurodegenerative MRI brain - an approach).

Classification

It is a visual score performed on MRI of the brain using coronal T1 weighted images in a plane parallel to the brainstem axis and through the hippocampus at the level of the anterior pons. The score is also validated for assessment on CT brain.

It is based on three features :

  • width of the choroid fissure
  • width of the temporal horn of the lateral ventricle
  • height of the hippocampus

    • These result in a score of 0 to 4:

    • 0: no CSF is visible around the hippocampus
    • 1: choroid fissure is slightly widened
    • 2: moderate widening of the choroid fissure, mild enlargement of the temporal horn and mild loss of hippocampal height 
    • 3: marked widening of the choroid fissure, moderate enlargement of the temporal horn, and moderate loss of hippocampal height 
    • 4: marked widening of the choroid fissure, marked enlargement of the temporal horn, and the hippocampus is markedly atrophied and internal structure is lost

    The score is interpreted in relation to age:

    • <75 years: ≥2 is abnormal
    • ≥75 years: ≥3 is abnormal

    Atrophy has been shown to correlate with likelihood of progression from mild cognitive impairment (MCI) to dementia .