Victoroff J, Mack W J, Grafton S T, Schreiber S S, Chui H C
Department of Neurology, University of Southern California School of Medicine, Downey 90242.
Neurology. 1994 Dec;44(12):2267-76. doi: 10.1212/wnl.44.12.2267.
MR scanning is used in the clinical evaluation of patients with dementia but lacks a reliable method of visual inspection. Two neurologists conducted multiple pilot trials of alternate methods for visual inspection of MRIs, including methods that produced at least 75% interrater agreement in repeat trials, and selected a final method for rating ventricular:brain ratio (VBR), cortical atrophy, and white matter changes. Two other neurologists, new to the method, tested interrater reliability for each component of the method after a brief training session. The correlation of VBR measurement was 0.884 (p = 0.0001). The weighted kappa scores were 0.68 for overall frontal lobe atrophy, 0.38 for right temporal lobe atrophy, 0.20 for left temporal lobe atrophy, and 0.54 for parietal lobe atrophy. The weighted kappa scores were 0.77 for overall periventricular white matter hyperintensities and 0.72 for centrum semiovale hyperintensities. The proposed method may provide a rapid and reliable way to assess VBR, frontal lobe atrophy, parietal lobe atrophy, and white matter changes on brain MRIs in the evaluation of dementia, but it was less reliable for the assessment of temporal lobe atrophy.
磁共振成像扫描用于痴呆患者的临床评估，但缺乏可靠的视觉检查方法。两位神经科医生对磁共振成像的替代视觉检查方法进行了多次试点试验，包括在重复试验中产生至少75%观察者间一致性的方法，并选择了一种最终方法来评估脑室与脑比率（VBR）、皮质萎缩和白质变化。另外两位不熟悉该方法的神经科医生在经过简短培训后，测试了该方法各组成部分的观察者间可靠性。VBR测量的相关性为0.884（p = 0.0001）。总体额叶萎缩的加权kappa评分为0.68，右侧颞叶萎缩为0.38，左侧颞叶萎缩为0.20，顶叶萎缩为0.54。脑室周围白质总体高信号的加权kappa评分为0.77，半卵圆中心高信号为0.72。所提出的方法可能为痴呆评估中脑磁共振成像上VBR、额叶萎缩、顶叶萎缩和白质变化的评估提供一种快速可靠的方法，但在评估颞叶萎缩方面可靠性较低。
