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I'm back with Dr. Ben Laser,

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Neuroradiologist.

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And I'm Dr. Stephen Pomeranz.

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We're talking about neurodegenerative disease

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and medial temporal atrophic grading,

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which we will use in numerous diseases,

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but specifically most relevant to ALZ

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or Alzheimer's disease,

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which is a tauopathy.

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Some other examples of tauopathies

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include TDP-43 proteinopathies

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and neurofilament disease

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or neurofilamentopathies.

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Let's look at the coronal projection where we can

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best assess the status of the

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mesial temporal region.

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And the two temporal lobes are distinctly different,

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Coronal T2 fast spin echo on the left.

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Coronal T1 spin echo on the right.

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On the left, the choroidal fissure, pretty big.

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In fact, very big.

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It's big on the right, too,

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but on the left,

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the temporal horn is clearly dilated,

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

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

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and some of it is admittedly subjective.

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This material was described by Shelton's.

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So, a zero would be no atrophy,

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a one would be the choroidal fissure is big, a two,

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the temporal horn is big,

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a three, there is hippocampal atrophy,

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a four, there is profound hippocampal atrophy.

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So, that's a very basic grading system.

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Let's have a look.

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Again, some subjectivity present.

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On the right,

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there is some choroidal fissure atrophy,

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so we might give the right a one.

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The temporal horn looks fine.

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On the left,

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clearly, the choroidal fissure is big

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and the temporal horn is big.

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

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There is clearly hippocampal volume loss.

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Look at the hippocampus on the right.

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The dentate gyrus, the amygdala,

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the gyrus dentatus,

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all of these are nice and full and juicy.

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Pressing up on the temporal horn.

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On the other side, not so much.

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It looks like a little knuckle.

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So this would be closer to an MTA 3,

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on the left and an MTA 1 on the right.

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Mesial temporal assessment in tauopathies,

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specifically relevant in Alzheimer's disease

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and also in various forms of cognitive decline,

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like Mild Cognitive Impairment syndrome

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or MCI syndrome.

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Let's move on, shall we?

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Laser and Pomeranz out.