Min Jeeyoung, Moon Won-Jin, Jeon Ji Young, Choi Jin Woo, Moon Yeon-Sil, Han Seol-Heui
1 Department of Radiology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea.
2 Department of Radiology, Gachon University, Gil Medical Center, Incheon, Korea.
AJR Am J Roentgenol. 2017 Mar;208(3):617-623. doi: 10.2214/AJR.16.16894. Epub 2017 Jan 11.
The purpose of this study was to compare the diagnostic efficacies of an automated volumetric assessment tool and visual assessment in the evaluation of medial temporal lobar atrophy in mild-to-moderate Alzheimer disease (AD).
This retrospective study included 30 patients with mild-to-moderate AD and 25 age-matched healthy control subjects undergoing MRI with a 3D fast spoiled gradient recalled-echo sequence at 3 T. The images were processed with fully automated volumetric analysis software. To assess medial temporal lobe (MTL) atrophy, two MTL indexes, which took into account the volumes of the hippocampus and the inferior lateral ventricle, were calculated with the automated volumetric assessment software. In addition, two neuroradiologists assessed MTL atrophy visually using the Scheltens scale. ROC curve analysis was used to compare the diagnostic performances of the two methods. The weighted kappa statistic was used to assess the intrarater and interrater reliability of visual inspection.
The automated volumetric assessment tool had moderate sensitivity (63.3%) and high specificity (100%) in differentiating patients with mild-to-moderate AD from control subjects. Visual inspection showed sensitivity of 63.3% and specificity of 92.0%. The diagnostic performance was not significantly different between the two methods (p = 0.536-0.906). Intraobserver reliability for visual inspection was 0.858 and 0.902 for the two reviewers, and interobserver reliability was 0.692-0.780.
Both the automated volumetric assessment tool and visual inspection can be used to evaluate MTL atrophy and differentiate patients with AD from healthy individuals with good diagnostic accuracy. Thus, the automated tool can be a useful and efficient adjunct in clinical practice for evaluating MTL atrophy in the diagnosis of AD.
本研究旨在比较自动容积评估工具和视觉评估在轻至中度阿尔茨海默病（AD）内侧颞叶萎缩评估中的诊断效能。
这项回顾性研究纳入了30例轻至中度AD患者和25例年龄匹配的健康对照者，他们均在3T条件下接受了使用三维快速扰相梯度回波序列的MRI检查。图像使用全自动容积分析软件进行处理。为评估内侧颞叶（MTL）萎缩，利用自动容积评估软件计算了两个MTL指数，这两个指数考虑了海马体和下外侧脑室的容积。此外，两名神经放射科医生使用Scheltens量表对MTL萎缩进行视觉评估。采用ROC曲线分析比较两种方法的诊断性能。加权kappa统计量用于评估视觉检查的观察者内和观察者间可靠性。
自动容积评估工具在区分轻至中度AD患者与对照者时具有中等敏感性（63.3%）和高特异性（100%）。视觉评估显示敏感性为63.3%，特异性为92.0%。两种方法的诊断性能无显著差异（p = 0.536 - 0.906）。两名观察者视觉检查的观察者内可靠性分别为0.858和0.902，观察者间可靠性为0.692 - 0.780。
自动容积评估工具和视觉评估均可用于评估MTL萎缩，并以良好的诊断准确性区分AD患者与健康个体。因此，在临床实践中，自动工具可作为评估AD诊断中MTL萎缩的一种有用且高效的辅助手段。
