Medial temporal atrophy score (Scheltens’ scale) calculator

Notes

The medial temporal atrophy score

The medial temporal atrophy score aims to help identifying and distinguishing patients with Alzheimer disease from those with cognitive impairment due to other causes.

The score has the following grades:

  • 0 (normal) – choroid fissure is not widened
  • 1 – slight widening of the choroid fissure
  • 2 – moderate widening of the choroid fissure, mild temporal horn enlargement and hippocampal height loss
  • 3 – marked widening of the choroid fissure, moderate temporal horn enlargement and hippocampal height loss
  • 4 – marked widening of the choroid fissure, marked temporal horn enlargement and hippocampal height loss

The age of the patient must be considered while interpreting the score:

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

Recently a more detailed cut-off was proposed for the average(!) MTA score:

  • <65 years: ≥1 is abnormal
  • 65-74: ≥1.5
  • 75-84: ≥2
  • >85: ≥2 (but low – 62.5% – specificity in this age group!)

Note however that according to more recents studies both gender and education are potential confounders of the MTA score. Furthermore, it has been shown that the effect of age considerably slows down on the medial temporal atrophy score after the age of 80. Thus, a more recent study by Claus et. al warns that the MTA cut-off has limited use after the age of 85.

Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, Kuiper M, Steinling M, Wolters EC, Valk J. 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 Oct;55(10):967-72. doi: 10.1136/jnnp.55.10.967. PMID: 1431963; PMCID: PMC1015202.

Velickaite V, Ferreira D, Cavallin L, Lind L, Ahlström H, Kilander L, Westman E, Larsson EM. Medial temporal lobe atrophy ratings in a large 75-year-old population-based cohort: gender-corrected and education-corrected normative data. Eur Radiol. 2018 Apr;28(4):1739-1747. doi: 10.1007/s00330-017-5103-6. Epub 2017 Nov 9. PMID: 29124383; PMCID: PMC5834557.

Claus JJ, Staekenborg SS, Holl DC, Roorda JJ, Schuur J, Koster P, Tielkes CEM, Scheltens P. Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer’s disease: Validation in a large memory clinic population. Eur Radiol. 2017 Aug;27(8):3147-3155. doi: 10.1007/s00330-016-4726-3. Epub 2017 Jan 12. PMID: 28083697; PMCID: PMC5491609.

Technical considerations

Originally the medial temporal atrophy score was described using MRI (coronal, T1-weighted parallel to the axis of the brainstem and hippocampus, at the level of the anterior pons), but is has been validated for use on CT too.

The right and left side is scored separately. Individual scores for each side, the average, or the higher score has all been used by various authors in the peer-reviewed literature. This calculator reports the score for each side separately.

Limitations

Entorhinal cortex atrophy is not included in the medial temporal atrophy score. Thus, the entorhinal cortical atrophy (ERICA) scoring system was developed to address this issue, and help differentiating patients with Alzheimer disease.

Enkirch SJ, Traschütz A, Müller A, Widmann CN, Gielen GH, Heneka MT, Jurcoane A, Schild HH, Hattingen E. The ERICA Score: An MR Imaging-based Visual Scoring System for the Assessment of Entorhinal Cortex Atrophy in Alzheimer Disease. Radiology. 2018 Jul;288(1):226-333. doi: 10.1148/radiol.2018171888. Epub 2018 Mar 7. PMID: 29514015.

Further reading

Radiopaedia.org article (includes examples of the different grades)

For grading of global cortical atrophy consider using the Pasquier scale.

Last updated: 2022-03-18