Hentschel F, Kreis M, Damian M, Diepers M, Disqué C, Dzialowski I, Kitzler H, Rodewald A, Struffert T, Trittmacher S, Wille P R, Krumm B
Abteilung Neuroradiologie, ZI, Fakultät für klinische Medizin Mannheim der Universität Heidelberg.
Rofo. 2005 Jan;177(1):105-13. doi: 10.1055/s-2004-813858.
Microangiopathic lesions of the brain tissue correlate with the clinical diagnosis of vascular subcortical dementia. The "experience-based" evaluation is insufficient. Rating scales may contribute to reproducible quantification.
In MRI studies of 10 patients, 9 neuroradiologists quantified vascular white matter lesions (WMLs) at two different points in time for 12 anatomically defined regions with respect to number, size and localization (score). For 9 observers and 10 studies, 90 intra-observer differences were obtained for each of the 12 WML scores. To calculate the inter-observer reliability, rating pairs were formed. Furthermore, 360 differences were computed for each score and rating for 12 anatomically defined WML scores, and the intraclass correlation (ICC) was calculated as a measure of agreement (reliability).
As to the intra-observer reliability, the median of the differences was 1.5 for the entire brain as opposed to 0 for defined brain regions. The corresponding values for the inter-observer reliability were 3 and 1, respectively. The mean intra-class correlation coefficient for the 10 studies was 0.88, whereas the mean interclass correlation concerning the inter-observer reliability was 0.70, with the first and second rating being averaged. The rating of each study took about 6 minutes.
The rating scale with high intra- and inter-observer reliability can dependably quantify WMLs and correlates with the clinical diagnosis of vascular dementia. Using a reliable rating scale, the diagnostic distinction of age-associated physiological vs. pathological size of the WML can make a contribution to the reproducible quantifiable diagnostic evaluation of vascular brain tissue lesions within the framework of dementia diagnostics.
脑组织的微血管病变与血管性皮质下痴呆的临床诊断相关。基于经验的评估并不充分。评分量表有助于实现可重复的量化。
在对10例患者的MRI研究中，9名神经放射科医生在两个不同时间点，针对12个解剖学定义区域的血管性白质病变（WMLs）的数量、大小和定位（评分）进行了量化。对于9名观察者和10项研究，12个WML评分中的每一个都获得了90个观察者内差异。为计算观察者间的可靠性，形成了评分对。此外，针对12个解剖学定义的WML评分中的每个评分和评级计算了360个差异，并计算组内相关系数（ICC）作为一致性（可靠性）的度量。
关于观察者内可靠性，整个大脑差异的中位数为1.5，而特定脑区为0。观察者间可靠性的相应值分别为3和1。10项研究的平均组内相关系数为0.88，而关于观察者间可靠性的平均组间相关系数为0.70，第一次和第二次评级取平均值。每项研究的评级大约需要6分钟。
具有高观察者内和观察者间可靠性的评分量表能够可靠地量化WMLs，并与血管性痴呆的临床诊断相关。使用可靠的评分量表，区分与年龄相关的WML生理大小与病理大小，有助于在痴呆诊断框架内对血管性脑组织病变进行可重复的量化诊断评估。
