An Expanded Role for Neuroimaging in the Evaluation of Memory Impairment

Brain MR imaging evaluation of a patient with amnestic MCI by use of a volumetric technique (NeuroQuant, http://www.cortechslabs.com). The top panel illustrates subcortical regions, such as the hippocampus (dark yellow), automatically classified on axial, coronal, and sagittal T1-weighted MR images. The middle and bottom panel demonstrate volumes and normative percentiles for the hippocampus and ventricles. Analyses of the baseline MR imaging scan demonstrated hippocampal volumes that were at the < 1 normative percentile, lending objective support to an impression of medial temporal lobe atrophy. At the time of volumetric assessment, the patient's Mini-Mental Status Examination score was 29 of 30, yet memory impairment was suggested by more detailed neuropsychological testing. Three years later, his Mini-Mental Status Examination score was 22 of 30, and he had clinically progressed to dementia with high biomarker probability of AD, as supported by evidence of neuronal injury on structural MR imaging and elevated amyloid levels on a florbetapir scan (Fig 3).