Entorhinal cortical atrophy score

The Entorhinalentorhinal cortical atrophy (ERICA) score has been developed as an alternative to the medial temporal lobe atrophy (MTA) score to help visually identify patients with Alzheimer disease by evaluating the entorhinal cortex for volume loss ¹.

Usage

An ERICA score of 2 or 3 (see below) has been shown to have higher diagnostic accuracy for distinguishing healthy controls with subjective conginite decline from individuals with Alzhemier disease than the older medial temporal lobe atrophy (MTA) score ¹. 

• diagnostic accuracy = 91%
• sensitivity = 83%
• specificity = 98%

Imaging

The ERICA score should be calculated on thin coronal imaging at right angles to the long axis of the hippocampus (standard hippocampal views) and assessed at the level of the mammillary bodies ¹. 

Scoring system

The ERICA score ranges from 0 to 3, with higher values indicating a higher degree of atrophy and a higher likelihood of Alzheimer disease. 

• score = 0
  • normal volume of the entorhinal cortex and parahippocampal gyrus
• score = 1
  • mild atrophy of the entorhinal cortex and parahippocampal gyrus
  • widening of the collateral sulcus
• score = 2
  • moderate atrophy of the entorhinal cortex and parahippocampal gyrus
  • elevation of the entorhinal cortex away from the adjacent cerebellar tentorium
• score = 3
  • marked atrophy of the entorhinal cortex and parahippocampal gyrus
  • wide cleft between the entorhinal cortex and the adjacent cerebellar tentorium

The presence of CSF between the entorhinal cortex and the tentorium has been termed the “tentorial cleft sign” ¹.