# Scheltens MTA — Scheltens medial temporal atrophy visual rating scale

> Per-side 0-4 visual rating of medial temporal atrophy on a correctly oriented coronal T1-weighted image using choroid-fissure width, temporal-horn width and hippocampal height. It describes structural atrophy; it is neither a standalone Alzheimer diagnosis nor a treatment-eligibility rule, and every threshold must name its age, modality, cohort and side-combination protocol.

**Situação:** vigente · **Órgão:** Encéfalo · **Órgão emissor:** Scheltens et al. / neuroradiology practice · **Versão:** Original 1992 coronal MRI scale; interpretation evidence reviewed through 2024 · **Ano:** 1992

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

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI
- Fonte primária: Scheltens P, Leys D, Barkhof F, et al.. Atrophy of medial temporal lobes on MRI in Alzheimer's disease (Scheltens scale) (1992) — https://doi.org/10.1136/jnnp.55.10.967
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Report the original score bilaterally and preserve the protocol boundary. MTA is a structural sign, not a standalone etiologic diagnosis, risk calculator or management engine.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0 | Grade 0 | No visually appreciable medial temporal atrophy on the scored side: the choroid fissure and temporal horn retain normal width and hippocampal height is preserved on an adequately oriented coronal T1-weighted image. Record right and left independently rather than using a single whole-patient zero. | No treatment or diagnostic closure follows from grade 0. If cognitive symptoms are present, continue the indicated clinical, neuropsychological, laboratory and complete imaging assessment and consider disease-specific biomarkers according to the actual question; low MTA does not end evaluation of early, young-onset or hippocampal-sparing disease. | Grade 0 is below proposed abnormal thresholds in published age protocols, but it does not exclude Alzheimer biology, another neurodegenerative process or future decline. The scale is a structural snapshot rather than a negative predictive guarantee, and risk cannot be estimated without age, symptoms, longitudinal change, other imaging findings and biomarker context. | Scheltens et al. 1992, PMID 1431963, original 0-4 bilateral coronal scale; Cotta Ramusino et al. 2019, PMC6690662, coronal rating plane and category 0; Jack et al. 2024, DOI 10.1002/alz.13859, biological AD diagnostic boundary. | ✓ |
| 1 | Grade 1 | Mild widening of the choroid fissure on the scored side, while the temporal horn remains normal in width and hippocampal height remains preserved. If the temporal horn or hippocampal height is already abnormal, reassess the grade-1-versus-2 boundary rather than scoring from the fissure alone. | Interpret grade 1 only after recording age, side, technique and the named cutoff protocol. It does not trigger therapy. In a symptomatic younger patient it may contribute to a pattern-based workup, whereas in an older adult it can fall within expected variation; integrate cognition, function, the full MRI pattern, vascular burden and biomarkers when clinically indicated. | A single grade 1 has no universal meaning. In the Claus 2017 memory-clinic CT protocol using the bilateral mean, at least 1.0 was proposed below age 65 but higher thresholds applied to older bands; other MRI cohorts use different cutoffs. Do not attach that protocol's sensitivity or specificity to one unilateral grade-1 observation. | Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-1 anatomy; Claus et al. 2017, PMC5491609, decade-specific CT bilateral-mean thresholds and performance; Molinder et al. 2021, PMC8305846, distinct MRI cohort thresholds. | ✓ |
| 2 | Grade 2 | Moderate widening of the choroid fissure together with mild widening of the temporal horn and mild loss of hippocampal height on the scored side. The three features are assessed as a pattern on the correct coronal plane; a numerical grade should not be manufactured when plane or coverage makes one axis unreliable. | Report side and asymmetry and interpret grade 2 against an explicitly named age, modality and bilateral-combination protocol. It can support clinically meaningful medial temporal atrophy in context but does not establish etiology or treatment eligibility. Correlate with cognitive phenotype, other regional atrophy, vascular disease and validated biomarkers as appropriate. | Grade 2 exceeds some younger-adult thresholds and meets the Claus CT bilateral-mean threshold for ages 75-84, but normal distributions shift with age and protocols differ. It increases concern for structural medial temporal neurodegeneration in an appropriate syndrome; it is not an individual probability of Alzheimer disease, conversion or treatment response. | Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-2 anatomy; Claus et al. 2017, age-specific CT mean-score thresholds; Molinder et al. 2021, validity across Alzheimer, vascular and mixed dementia; Park et al. 2021, DOI 10.1007/s00330-021-08227-8, heterogeneous group-level performance. | ✓ |
| 3 | Grade 3 | Marked widening of the choroid fissure, moderate enlargement of the temporal horn and moderate reduction of hippocampal height on the scored side. The side-specific score should be accompanied by the visible anatomic pattern and any asymmetry, not reduced to an unlabeled patient-level number. | Grade 3 warrants clinical correlation and usually strengthens the case for a structured cognitive-disorder evaluation when symptoms are present, but it does not specify a drug, prove Alzheimer pathology or independently qualify a patient for disease-modifying therapy. Evaluate alternative and mixed etiologies and the complete MRI rather than acting on the score alone. | This is substantial structural atrophy and exceeds many proposed cohort cutoffs, yet high MTA scores occur in non-Alzheimer conditions and in some very old cognitively healthy adults. A 2021 meta-analysis reported pooled 74 percent sensitivity and 88 percent specificity for Alzheimer disease versus healthy controls across thresholds, not a grade-3 posterior probability. | Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-3 anatomy and age-shifted normative distributions; Park et al. 2021, diagnostic meta-analysis; Jack et al. 2024, biological AD criteria and need to separate syndrome, neurodegeneration and pathology. | ✓ |
| 4 | Grade 4 | Severe or end-stage visual medial temporal atrophy on the scored side, with marked widening of the choroid fissure and temporal horn and severe loss of hippocampal height. Confirm that marked ventricular or sulcal enlargement is anatomically medial temporal and not chiefly distortion, resection, infarction or an oblique plane. | Communicate the severe side-specific structural finding and investigate its clinical and etiologic significance using symptoms, function, onset pattern, full MRI, vascular and structural lesions and relevant biomarkers. Grade 4 alone neither proves Alzheimer disease nor dictates treatment, prognosis, capacity, driving status or level of care. | Grade 4 represents the maximum visual atrophy category, but it is not synonymous with end-stage dementia or confirmed Alzheimer pathology. Normative work found that high scores become more frequent with advanced age, and marked medial temporal atrophy also has non-Alzheimer causes; prognosis requires clinical stage, longitudinal data, comorbidity and etiology. | Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-4 or end-stage visual pattern and normative age distributions; Molinder et al. 2021, heterogeneous etiologies and validity limits; Alzheimer's Association 2024 revised criteria for biological diagnosis. | ✓ |

### Citações por categoria
- **0**: Scheltens P, Leys D, Barkhof F, et al.. Atrophy of medial temporal lobes on MRI in Alzheimer's disease (Scheltens scale) (1992) — https://doi.org/10.1136/jnnp.55.10.967 · Scheltens et al. 1992, PMID 1431963, original 0-4 bilateral coronal scale; Cotta Ramusino et al. 2019, PMC6690662, coronal rating plane and category 0; Jack et al. 2024, DOI 10.1002/alz.13859, biological AD diagnostic boundary.
- **1**: Scheltens P, Leys D, Barkhof F, et al.. Atrophy of medial temporal lobes on MRI in Alzheimer's disease (Scheltens scale) (1992) — https://doi.org/10.1136/jnnp.55.10.967 · Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-1 anatomy; Claus et al. 2017, PMC5491609, decade-specific CT bilateral-mean thresholds and performance; Molinder et al. 2021, PMC8305846, distinct MRI cohort thresholds.
- **2**: Scheltens P, Leys D, Barkhof F, et al.. Atrophy of medial temporal lobes on MRI in Alzheimer's disease (Scheltens scale) (1992) — https://doi.org/10.1136/jnnp.55.10.967 · Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-2 anatomy; Claus et al. 2017, age-specific CT mean-score thresholds; Molinder et al. 2021, validity across Alzheimer, vascular and mixed dementia; Park et al. 2021, DOI 10.1007/s00330-021-08227-8, heterogeneous group-level performance.
- **3**: Scheltens P, Leys D, Barkhof F, et al.. Atrophy of medial temporal lobes on MRI in Alzheimer's disease (Scheltens scale) (1992) — https://doi.org/10.1136/jnnp.55.10.967 · Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-3 anatomy and age-shifted normative distributions; Park et al. 2021, diagnostic meta-analysis; Jack et al. 2024, biological AD criteria and need to separate syndrome, neurodegeneration and pathology.
- **4**: Scheltens P, Leys D, Barkhof F, et al.. Atrophy of medial temporal lobes on MRI in Alzheimer's disease (Scheltens scale) (1992) — https://doi.org/10.1136/jnnp.55.10.967 · Scheltens et al. 1992 and Cotta Ramusino et al. 2019, grade-4 or end-stage visual pattern and normative age distributions; Molinder et al. 2021, heterogeneous etiologies and validity limits; Alzheimer's Association 2024 revised criteria for biological diagnosis.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-12 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-11 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-10 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-09 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-08 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-07 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-06 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-05 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-04 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-03 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-02 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-01 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-31 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-30 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-29 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-28 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-27 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-26 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 1992-10-01 | published | Scheltens and colleagues published the bilateral 0-4 coronal MRI visual rating scale using choroid-fissure width, temporal-horn width and hippocampal height. | 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/scheltens-mta · JSON da API: https://radcommons.laudos.ai/api/v1/systems/scheltens-mta · Índice para agentes: https://radcommons.laudos.ai/llms.txt