van Straaten Elisabeth C W, Scheltens Philip, Knol Dirk L, van Buchem Mark A, van Dijk Ewout J, Hofman Paul A M, Karas Giorgos, Kjartansson Olafur, de Leeuw Frank-Erik, Prins Niels D, Schmidt Reinhold, Visser Marieke C, Weinstein Henry C, Barkhof Frederik
Department of Neurology and Alzheimer Center, VU Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, Netherlands.
Stroke. 2003 Aug;34(8):1907-12. doi: 10.1161/01.STR.0000083050.44441.10. Epub 2003 Jul 10.
Vascular dementia (VaD) is thought to be the most common cause of dementia after Alzheimer's disease. The commonly used International Workshop of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) criteria for VaD necessitate evidence of vascular disease on CT or MRI of the brain. The purposes of our study were to operationalize the radiological part of the NINDS-AIREN criteria and to assess the effect of this operationalization on interobserver agreement.
Six experienced and 4 inexperienced observers rated a set of 40 MRI studies of patients with clinically suspected VaD twice using the NINDS-AIREN set of radiological criteria. After the first reading session, operational definitions were conceived, which were subsequently used in the second reading session. Interobserver reproducibility was measured by Cohen's kappa.
Overall agreement at the first reading session was poor (kappa=0.29) and improved slightly after application of the additional definitions (kappa=0.38). Raters in the experienced group improved their agreement from almost moderate (kappa=0.39) to good (0.62). The inexperienced group started out with poor agreement (kappa=0.17) and did not improve (kappa=0.18). The experienced group improved in both the large- and small-vessel categories, whereas the inexperienced group improved generally in the extensive white matter hyperintensities categories.
Considerable interobserver variability exists for the assessment of the radiological part of the NINDS-AIREN criteria. Use of operational definitions improves agreement but only for already experienced observers.
血管性痴呆（VaD）被认为是仅次于阿尔茨海默病的最常见痴呆病因。常用的美国国立神经疾病与中风研究所（NINDS）和国际神经科学研究与教学协会（AIREN）的VaD诊断标准要求在脑部CT或MRI上有血管疾病的证据。我们研究的目的是将NINDS - AIREN标准的放射学部分进行操作化，并评估这种操作化对观察者间一致性的影响。
6名经验丰富的观察者和4名经验不足的观察者使用NINDS - AIREN放射学标准对一组40例临床疑似VaD患者的MRI研究进行了两次评分。在第一次阅读环节后，构思了操作定义，随后在第二次阅读环节中使用。观察者间的可重复性通过科恩kappa系数进行测量。
第一次阅读环节的总体一致性较差（kappa = 0.29），在应用额外定义后略有改善（kappa = 0.38）。经验丰富组的评分者一致性从几乎中等（kappa = 0.39）提高到良好（0.62）。经验不足组一开始一致性较差（kappa = 0.17），且没有改善（kappa = 0.18）。经验丰富组在大血管和小血管类别中均有改善，而经验不足组总体上在广泛白质高信号类别中有改善。
在评估NINDS - AIREN标准的放射学部分时，观察者间存在相当大的变异性。使用操作定义可提高一致性，但仅对已有经验的观察者有效。
