George Ilena C, Sati Pascal, Absinta Martina, Cortese Irene Cm, Sweeney Elizabeth M, Shea Colin D, Reich Daniel S
Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA/Yale University, New Haven, CT, USA.
Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA.
Mult Scler. 2016 Oct;22(12):1578-1586. doi: 10.1177/1352458515624975. Epub 2016 Jan 14.
To evaluate clinical fluid-attenuated inversion recovery (FLAIR)* 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS).
Central veins may be a distinguishing feature of MS lesions. FLAIR*, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS.
Two experienced MS neurologists evaluated 87 scan pairs (T-FLAIR/FLAIR*), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa (κ).
Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T-FLAIR, 0.95 (0.92, 0.98) for FLAIR*; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T-FLAIR (κ = 0.68) and FLAIR* (κ = 0.74), despite low agreement on the 40% rule (κ = 0.47) ([Formula: see text] in all cases).
Joint clinical evaluation of T-FLAIR and FLAIR* images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.
评估对静脉周围炎性脱髓鞘病变敏感的临床液体衰减反转恢复（FLAIR）* 3T磁共振成像（MRI）在诊断多发性硬化症（MS）中的作用。
中央静脉可能是MS病变的一个显著特征。FLAIR*是一种源自临床MRI扫描的联合对比，尚未作为诊断MS的临床工具进行研究。
两名经验丰富的MS神经科医生分别并排评估了来自68例MS患者、8名健康志愿者和11名患有其他神经系统疾病个体的87对扫描图像（T-FLAIR/FLAIR*）。评估者根据经验、已发表的标准以及对“40%规则”的视觉评估来判断病例，如果超过40%的病变显示有中央静脉，则倾向于诊断为MS。通过受试者操作特征曲线下面积（AUC）确定诊断准确性，并用科恩kappa系数（κ）评估评估者间的可靠性。
诊断准确性较高：评估者1，T-FLAIR的AUC为0.94（95%置信区间：0.89，0.97），FLAIR的AUC为0.95（0.92，0.98）；评估者2，分别为0.94（0.90，0.98）和0.90（0.85，0.95）。当一起考虑图像时，AUC有所提高：评估者1为0.99（0.98，1.00）；评估者2为0.98（0.96，0.99）。尽管在40%规则上一致性较低（κ = 0.47）（所有情况下[公式：见原文]），但T-FLAIR（κ = 0.68）和FLAIR（κ = 0.74）的评估者间一致性较高。
对T-FLAIR和FLAIR*图像进行联合临床评估可适度提高MS的诊断准确性，且无需对有中央静脉的病变进行计数。
