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Research ArticleBRAIN

Morphology of the Inner Structure of the Hippocampal Formation in Alzheimer Disease

Michito Adachi, Shinobu Kawakatsu, Takaaki Hosoya, Koichi Otani, Tsuguo Honma, Akiko Shibata and Yukio Sugai
American Journal of Neuroradiology September 2003, 24 (8) 1575-1581;

Article Figures & Data

Figures

  • Fig 1.
    Fig 1.

    Coronal photomicrographs of normal and atrophic hippocampus (Klüver-Barrera stain).

    A, Image in a 56-year-old man with dentatorubro-pallidoluysian atrophy shows no atrophy of the left subiculum or hippocampus proper. Image represents a normal hippocampus. The hippocampus proper consists of the CA1, CA2, CA3, and CA4 fields. Bar indicates 1 mm.

    B, Image in a 78-year-old man with AD (duration of illness, 15 years) shows severe atrophy of the subiculum (arrow). The superficial medullary lamina (arrowheads) is thinner than that of a normal hippocampus. Bar indicates 1 mm.

    C, Magnified (×200) view of the image in A shows numerous nerve fibers running in the anteroposterior direction in the superficial medullary lamina of the hippocampal formation.

  • Fig 2.
    Fig 2.

    Schematic representation of the hippocampal formation shows the measurement points for the subiculum and the hippocampus proper. PHG indicates the parahippocampal gyrus.

  • Fig 3.
    Fig 3.

    Coronal MR images in a 59-year-old man (control subject).

    A, Multishot diffusion-weighted image clearly shows the inner structure of the left hippocampus. The subiculum (left arrowhead), CA1 of the hippocampus proper (right arrowhead), and CA3–4 (top arrow) are demonstrated as hyperintense areas, and the superficial medullary lamina (bottom arrow) is shown as a hypointense area.

    B, T2-weighted image faintly shows the subiculum (arrowhead), the hippocampus proper, and the superficial medullary lamina (arrow).

  • Fig 4.
    Fig 4.

    MR images in a 71-year-old woman with mild AD (MMSE score, 27; duration of illness, 2 years).

    A, Multishot diffusion-weighted coronal image shows atrophic subiculum (left arrowhead) and CA1 (right arrowhead). However, the CA3–4 (arrow) is spared.

    B, T2-weighted image scarcely demonstrates the inner structure of the left hippocampus (arrow).

  • Fig 5.
    Fig 5.

    MR images in a 68-year-old man with mild AD (MMSE score, 25; duration of illness, 3 years).

    A, Multishot diffusion-weighted coronal image shows an atrophic subiculum (left arrowhead) and CA1 (right arrowhead). CA3–4 (arrow) is spared.

    B, T2-weighted image scarcely demonstrates the inner structure of the left hippocampus (arrow).

  • Fig 6.
    Fig 6.

    MR images in a 64-year-old woman with moderate AD (MMSE score, 8; duration of illness, 12 years).

    A, Multishot diffusion-weighted coronal image shows an atrophic subiculum (left arrowhead). CA1 (right arrowhead) is comparatively spared; however, CA3–4 (arrow) is atrophic.

    B, T2-weighted image scarcely demonstrates the inner structure of the left hippocampus (arrow).

  • Fig 7.
    Fig 7.

    MR images in a 71-year-old woman with moderate AD (MMSE score, 6; duration of illness, 11 years).

    A, Multishot diffusion-weighted coronal image shows severe atrophy of the subiculum (left arrowhead) and CA3–4 (small arrow). Atrophy of CA1 (right arrowhead) is mild. Image also shows atrophy of the parahippocampal gyrus (large arrow).

    B, T2-weighted image barely shows the inner structure of the hippocampus (arrow).

  • Fig 8.
    Fig 8.

    MR images in a 45-year-old man (control subject).

    A, Multishot diffusion-weighted coronal image clearly shows the inner structure of the left hippocampus: the subiculum (left arrowhead), CA1 of the hippocampus proper (right arrowhead), CA3–4 (small arrow), and the superficial medullary lamina (large arrow).

    B, T2-weighted coronal image faintly shows the superficial medullary lamina (arrow) as a hypointense area.

    C, T1-weighted 3D volumetric SPGR image (26/4.3; FOV, 18 cm; matrix, 256 × 256; thickness, 0.8 mm; slab, 64 mm) shows the superficial medullary lamina (arrow) as a hyperintense area and depicts it more faintly than does the T2-weighted image.

Tables

  • TABLE 1:

    Number of Cases in Which Each Part of the Hippocampal Formation Was Measurable

    Measurement Site and GroupNo. of Cases with Measurable Site
    On Multishot Diffusion-Weighted ImagesOn T2-Weighted Images
    Width of subiculum
     Control14 (100)1 (7)
     Mild AD10 (83)0 (0)
     Moderate AD10 (71)0 (0)
    Width of CA1
     Control14 (100)3 (21)
     Mild AD11 (92)0 (0)
     Moderate AD11 (79)2 (14)
    Width of CA3–4
     Control14 (100)1 (7)
     Mild AD11 (92)1 (8)
     Moderate AD12 (86)0 (0)
    Height of CA3–4
     Control14 (100)2 (14)
     Mild AD10 (83)0 (0)
     Moderate AD11 (79)0 (0)

    • Note.—Data are the numbers of cases. Data in parentheses are percentages. The control group included 14 participants; the mild AD group, 12; and the moderate AD group, 14.

  • TABLE 2:

    Intraobserver and Interobserver Variability

    Measurement SiteIntraobserver Variability, %Interobserver Variability %
    Observer 1Observer 1
    Width of subiculum9.70 ± 8.898.95 ± 6.098.34 ± 6.10
    Width of CA16.01 ± 5.006.40 ± 4.277.97 ± 5.31
    Width of CA3–43.91 ± 3.224.58 ± 4.054.60 ± 4.55
    Height of CA3–46.23 ± 5.765.92 ± 5.566.99 ± 4.53

    • Note.—Data are the mean coefficient of variation ± standard deviation.

  • TABLE 3:

    Mean Dimensions of Hippocampal Inner Structures in Each Group

    Measurement SiteControl GroupMild AD GroupModerate AD Group
    Width of subiculum, mm2.60 ± 0.531.28 ± 0.151.14 ± 0.17
    Width of CA1, mm1.90 ± 0.141.46 ± 0.141.39 ± 0.19
    Width of CA3–4, mm7.18 ± 0.726.56 ± 0.855.70 ± 0.70
    Height of CA3–4, mm4.32 ± 0.574.30 ± 0.584.23 ± 0.63

    • Note.—Data represent the mean dimension ± standard deviation.

  • TABLE 4:

    Intergroup Analyses of the Mean Dimensions of the Inner Hippocampal Structures

    Measurement Site and ComparisonDM*SEM†P Value95% CI‡
    Width of subiculum
     Control vs mild AD1.320.15<.0010.95, 1.70
     Control vs moderate AD1.460.15<.0011.09, 1.83
     Mild AD vs moderate AD0.140.16.688−0.27, 0.54
    Width of CA1
     Control vs mild AD0.430.06<.0010.28, 0.59
     Control vs moderate AD0.510.06<.0010.35, 0.67
     Mild AD vs moderate AD0.080.07.501−0.09, 0.24
    Width of CA3–4
     Control vs mild AD0.620.30.117−0.12, 1.37
     Control vs moderate AD1.490.30<.0010.76, 2.21
     Mild AD vs moderate AD0.860.31.0250.09, 1.64
    Height of CA3–4
     Control vs mild AD0.020.24.995−0.58, 0.63
     Control vs moderate AD0.100.24.911−0.49, 0.68
     Mild AD vs moderate AD0.070.26.955−0.56, 0.71

    • Note.—Intergroup analysis was performed by using the Tukey honestly significant difference adjustment.

    • * Difference of the means.

    • † Standard error of the mean.

    • ‡ 95% confidence interval.

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Morphology of the Inner Structure of the Hippocampal Formation in Alzheimer Disease
Michito Adachi, Shinobu Kawakatsu, Takaaki Hosoya, Koichi Otani, Tsuguo Honma, Akiko Shibata, Yukio Sugai
American Journal of Neuroradiology Sep 2003, 24 (8) 1575-1581;
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