Wattjes Mike P, Henneman Wouter J P, van der Flier Wiesje M, de Vries Oscar, Träber Frank, Geurts Jeroen J G, Scheltens Philip, Vrenken Hugo, Barkhof Frederik
Department of Radiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
Radiology. 2009 Oct;253(1):174-83. doi: 10.1148/radiol.2531082262. Epub 2009 Jul 27.
To investigate the assessment of global cortical atrophy (GCA), medial temporal lobe atrophy (MTA), and white matter changes (WMCs) in patients screened at a memory clinic with a 64-detector row computed tomography (CT) brain protocol, in comparison with the reference standard, magnetic resonance (MR) imaging.
The study protocol was approved by the local institutional review board. Written informed consent was obtained from all participants. Thirty patients (21 men, nine women; median age, 62 years) who presented to a memory clinic underwent 64-detector row CT and multisequence MR imaging of the brain on the same day. Three readers blinded to the clinical diagnosis assessed the resultant images. Images were presented in random order and scored for GCA, MTA, and WMC with published visual rating scales. Intermodality agreement between CT and MR imaging (intrareader agreement across both modalities), expressed by weighted kappa analysis, and interobserver agreement within each modality between readers (Kendall W test) were assessed.
Overall, excellent intraobserver agreement between CT and MR imaging was observed for GCA (mean kappa, 0.83) and MTA (mean kappa, 0.88 and 0.86 on the left and right sides of the brain, respectively). There was substantial overall agreement concerning WMC (mean kappa, 0.79). For all three tested scales, interobserver variability was low and comparable for CT and MR imaging.
Use of 64-detector row brain CT yields reliable information that is comparable with that obtained with MR imaging. Thus, multidetector row CT is a suitable diagnostic imaging tool in a memory clinic setting.
采用64排计算机断层扫描（CT）脑部检查方案，对在记忆门诊接受筛查的患者进行全脑皮质萎缩（GCA）、内侧颞叶萎缩（MTA）和白质改变（WMCs）的评估，并与参考标准磁共振（MR）成像进行比较。
本研究方案经当地机构审查委员会批准。所有参与者均获得书面知情同意。30例（21例男性，9例女性；中位年龄62岁）前往记忆门诊就诊的患者于同一天接受了64排CT脑部检查和多序列MR成像。三名对临床诊断不知情的阅片者对所得图像进行评估。图像以随机顺序呈现，并使用已发表的视觉评分量表对GCA、MTA和WMC进行评分。通过加权kappa分析评估CT和MR成像之间的模态间一致性（两种模态间的阅片者内一致性），并通过Kendall W检验评估各模态内阅片者之间的观察者间一致性。
总体而言，CT和MR成像在GCA方面观察到了极好的阅片者内一致性（平均kappa值为0.83），在MTA方面（大脑左侧和右侧的平均kappa值分别为0.88和0.86）也是如此。在WMC方面存在高度总体一致性（平均kappa值为0.79）。对于所有三个测试量表，CT和MR成像的观察者间变异性均较低且相当。
使用64排脑部CT可获得与MR成像相当的可靠信息。因此，多排探测器CT是记忆门诊环境中一种合适的诊断成像工具。
