MRI approach to the patient with suspected dementia: artificial intelligence techniques and semi-quantitative rating scales compared

Objectives: To assess the reliability of semi-quantitative and AI-based quantitative brain volume evaluation (Quantib® ND) in predicting clinical diagnosis in patients with suspected neurodegenerative diseases undergoing initial 1.5 T MRI. Additionally, to analyze the frequency of lobar microbleeds (MBs) at diagnosis. Methods: Two neuroradiologists (2 vs. 10 years’ experience), blinded to diagnosis, independently evaluated brain atrophy on 3D-T1 images of 133 subjects using Scheltens, Koedam, and Kipps scales. Automated volumetric analysis was performed using Quantib® ND. SWI images were assessed by one neuroradiologist to classify MBs as cortical, juxtacortical, subcortical, or deep. Inter-observer agreement was measured using intraclass correlation coefficients (ICC); correlation with Quantib® ND was analyzed using Spearman's coefficient. Cohen's Kappa assessed agreement with clinical diagnosis. Results: Good inter-observer agreement was observed for the MTA scale (ICC 0.86 right, 0.82 left) and Kipps scale (ICC 0.76), with moderate concordance for Koedam (ICC 0.66). Frontal and posterior temporal Kipps subregions had good concordance (ICC 0.77, 0.79), while anterior temporal showed poor agreement (ICC 0.59). Diagnostic accuracy was moderate across observers and Quantib® ND. Observer 1 showed 77% sensitivity, 51% specificity; observer 2 had 79% sensitivity, 62% specificity; Quantib® ND reached 56% sensitivity, 74% specificity. Patients exhibited significantly more lobar MBs than non-dementia patients (χ2 p = 0.04). Conclusions: Semi-quantitative visual scales proved effective and sensitive for detecting brain atrophy, showing good concordance with automated volumetric data. While AI-based quantification demonstrated higher specificity, visual assessment remained more sensitive. Lobar MBs were more frequent in neurodegenerative cases.