# GCA — Original Pasquier cerebral atrophy regional scale

> Original MRI protocol rates 13 total regional sulcal and ventricular sites from 0 to 3 and sums them to 0-39. A later simplified global 0-3 impression is an adaptation, not the original total. Preserve protocol, regional pattern, asymmetry and modality; GCA does not diagnose Alzheimer disease or prescribe treatment.

**Situação:** vigente · **Órgão:** Encéfalo · **Órgão emissor:** Pasquier et al. / neuroradiology practice · **Versão:** 1996 original 13-region sum; simplified global 0-3 adaptation must be labeled · **Ano:** 1996

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI, CT
- Fonte primária: Pasquier F, Leys D, Weerts JG, Mounier-Vehier F, Barkhof F, Scheltens P. Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts (1996) — https://pubmed.ncbi.nlm.nih.gov/8864706/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Preserve the protocol identity. The original Pasquier result is thirteen component scores summed to 0-39; a single global 0-3 impression is a labeled later adaptation.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0 | Regional score 0, no atrophy | Regional score 0 means normal gyral volume without sulcal opening for a cortical region, or no enlargement for a ventricular region. In the original protocol this code is assigned independently to each of 13 total regions before summation to 0-39. | No action follows from regional score 0 or a simplified global score 0. Normal-appearing global volume does not exclude early or focal disease; investigate persistent cognitive or neurologic symptoms using the appropriate clinical pathway. | This is the no-visible-atrophy morphology for the rated region, not a probability of normal cognition and not an exclusion of biomarker-defined or focal neurodegenerative disease. | Pasquier et al., Eur Neurol 1996;36:268-272, PMID 8864706 and DOI 10.1159/000117270, original 13-region architecture; Vernooij and van Buchem, Neuroimaging in Dementia, NCBI Bookshelf NBK554327, Fig 11.3 and Table 11.1, score-0 morphology and diagnostic limits. | ✓ |
| 1 | Regional score 1, mild sulcal or ventricular enlargement | Regional score 1 means opening of cortical sulci without definite gyral volume loss, or mild enlargement of the rated ventricular region. The same morphology words may be used in a simplified overall 0-3 adaptation, which must be labeled separately. | Interpret mild atrophy with age, symptoms, side, lobar pattern and comparison imaging. Do not order medication, biomarkers, follow-up or referral from score 1 alone; pursue clinical assessment when symptoms or an atypical focal or asymmetric pattern warrant it. | Mild generalized volume loss can accompany aging and is nonspecific. Score 1 supplies no validated individual probability of dementia, Alzheimer pathology, conversion or functional decline. | Pasquier et al. 1996, PMID 8864706, regional visual assessment framework; Vernooij and van Buchem, NBK554327, Fig 11.3 and Table 11.1, opening-of-sulci and mild-ventricular-enlargement descriptors plus age and pattern context; Jack et al. 2024, DOI 10.1002/alz.13859, Alzheimer biomarker boundary. | ✓ |
| 2 | Regional score 2, moderate gyral loss or ventricular enlargement | Regional score 2 means visible gyral volume loss with further sulcal widening, or moderate enlargement of the rated ventricular region. Preserve side and region; in original mode sum all 13 component ratings rather than reporting 2 as a global total. | When moderate atrophy is unexpected for age or matches cognitive or neurologic symptoms, integrate clinical assessment and the regional pattern with disease-specific testing as appropriate. The grade itself does not diagnose dementia or dictate a biomarker, drug or interval. | Moderate atrophy may be clinically concerning, particularly in a younger patient or a focal or asymmetric pattern, but score 2 has no universal age cutoff and no calibrated individual dementia or progression probability. | Pasquier et al. 1996, DOI 10.1159/000117270, original regional scale and reproducibility; Vernooij and van Buchem, NBK554327, Fig 11.3 and Table 11.1, reduced gyral volume, wider sulci, moderate ventricular enlargement and rule-of-thumb age context; Hobden et al. 2024, PMC10942897, CT-versus-MRI reliability context. | ✓ |
| 3 | Regional score 3, severe knife-blade atrophy or ventricular enlargement | Regional score 3 means severe knife-blade gyral volume loss with markedly widened sulci, or severe enlargement of the rated ventricular region. State the affected region and side and distinguish generalized atrophy from focal destructive change or hydrocephalus. | Severe, focal, asymmetric or clinically concordant atrophy warrants integrated neurologic or cognitive evaluation and etiologic work-up as appropriate to the presentation. Score 3 alone does not establish Alzheimer disease, choose treatment or define treatment eligibility. | This is the greatest visual atrophy burden on the rated region and is treated as abnormal at any age in later dementia-imaging teaching, but it still supplies no individual probability of a specific disease, conversion, disability or survival. | Pasquier et al. 1996, PMID 8864706, original regional rating; Vernooij and van Buchem, NBK554327, Fig 11.3 and Table 11.1, knife-blade and severe-enlargement descriptors and age-context caution; Jack et al. 2024, DOI 10.1002/alz.13859, biologic Alzheimer criteria; Hobden et al. 2024, PMC10942897, modality reliability context. | ✓ |

### Citações por categoria
- **0**: Pasquier F, Leys D, Weerts JG, Mounier-Vehier F, Barkhof F, Scheltens P. Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts (1996) — https://pubmed.ncbi.nlm.nih.gov/8864706/ · Pasquier et al., Eur Neurol 1996;36:268-272, PMID 8864706 and DOI 10.1159/000117270, original 13-region architecture; Vernooij and van Buchem, Neuroimaging in Dementia, NCBI Bookshelf NBK554327, Fig 11.3 and Table 11.1, score-0 morphology and diagnostic limits.
- **1**: Pasquier F, Leys D, Weerts JG, Mounier-Vehier F, Barkhof F, Scheltens P. Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts (1996) — https://pubmed.ncbi.nlm.nih.gov/8864706/ · Pasquier et al. 1996, PMID 8864706, regional visual assessment framework; Vernooij and van Buchem, NBK554327, Fig 11.3 and Table 11.1, opening-of-sulci and mild-ventricular-enlargement descriptors plus age and pattern context; Jack et al. 2024, DOI 10.1002/alz.13859, Alzheimer biomarker boundary.
- **2**: Pasquier F, Leys D, Weerts JG, Mounier-Vehier F, Barkhof F, Scheltens P. Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts (1996) — https://pubmed.ncbi.nlm.nih.gov/8864706/ · Pasquier et al. 1996, DOI 10.1159/000117270, original regional scale and reproducibility; Vernooij and van Buchem, NBK554327, Fig 11.3 and Table 11.1, reduced gyral volume, wider sulci, moderate ventricular enlargement and rule-of-thumb age context; Hobden et al. 2024, PMC10942897, CT-versus-MRI reliability context.
- **3**: Pasquier F, Leys D, Weerts JG, Mounier-Vehier F, Barkhof F, Scheltens P. Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts (1996) — https://pubmed.ncbi.nlm.nih.gov/8864706/ · Pasquier et al. 1996, PMID 8864706, original regional rating; Vernooij and van Buchem, NBK554327, Fig 11.3 and Table 11.1, knife-blade and severe-enlargement descriptors and age-context caution; Jack et al. 2024, DOI 10.1002/alz.13859, biologic Alzheimer criteria; Hobden et al. 2024, PMC10942897, modality reliability context.

## Referências cruzadas
- _fronteira compartilhada_ → [Fazekas — Fazekas visual rating of periventricular and deep white matter hyperintensities](https://radcommons.laudos.ai/systems/fazekas.md) — Part of the standardized dementia MRI read: GCA for atrophy burden, Fazekas for white matter hyperintensity burden.
- _fronteira compartilhada_ → [Scheltens MTA — Scheltens medial temporal atrophy visual rating scale](https://radcommons.laudos.ai/systems/scheltens-mta.md) — GCA grades generalized cortical atrophy while Scheltens MTA grades the medial temporal lobe; both feed the dementia imaging work-up.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-26 | revised | Monitored source changed (version_regex). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2024-04-01 | revised | Hobden and colleagues evaluated reliability when a simplified global cortical atrophy visual rating was applied across CT and MRI. This supports explicit modality labeling and does not replace the original 13-region sum. | confirmed |
| 1996-01-01 | published | Pasquier and colleagues published a reproducibility study of thirteen total regional 0-3 cerebral-atrophy ratings on axial T2 MRI, summed to 0-39. | confirmed |


---
> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Página HTML: https://radcommons.laudos.ai/systems/gca-pasquier · JSON da API: https://radcommons.laudos.ai/api/v1/systems/gca-pasquier · Índice para agentes: https://radcommons.laudos.ai/llms.txt