MRI in the classical MM1 and the atypical MV2 subtypes of sporadic CJD: an inter-observer agreement study
MRI in the classical MM1 and the atypical MV2 subtypes of sporadic CJD: an inter-observer agreement study
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DOI：
10.1111/j.1468-1331.2008.02209.x
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发表时间：
2008-08-01
影响因子：
5.1
通讯作者：
Zerr, I.
中科院分区：
文献类型：
--
作者：
Krasnianski, A.;Kallenberg, K.;Zerr, I.
背景和目的：建立sCJD的非典型MV 2亚型与经典MM 1亚型的放射学特征，以及区域和序列依赖性观察者间的相关性。方法：对31例MM 1和32例MV 2患者的基底节（BG）、皮质和丘脑进行MRI检查。由两名对PRNP基因型/朊病毒蛋白类型不知情的神经放射科医生独立分析每个MR扫描。结果如下：MV 2亚型中BG高信号的累积T2敏感性较高（两名观察者均为84%，MM 1患者中观察者1为61%/观察者2为42%）。在T2、FLAIR、PD和DWI上，BG和丘脑的观察者间存在显著一致性，但在DWI上仅皮质存在显著一致性。MV 2患者的丘脑变化显著高于MM 1患者（DWI上的累积灵敏度为86% vs. 12.5%）。讨论：MV 2亚型中丘脑高信号的高频率允许与MM 1患者区分。在所有序列中，BG和丘脑的观察者间一致性良好。DWI显示了独立于所研究的脑区域的最高观察者间相关性，因此不仅高度敏感，而且相对独立于研究者偏倚。由于T2、FLAIR和PD中皮质高信号的观察者间相关性相对较低，因此不应使用这些序列过度解释皮质变化。
Background and purpose: To establish radiological features in the atypical MV2 subtype of sCJD compared with the classical MM1 subtype, as well as region- and sequence-dependent inter-observer correlation. Methods: MRI hyperintensity of basal ganglia (BG), cortex and thalamus was evaluated in 31 MM1 and 32 MV2 patients. Each MR scan was analyzed independently by two neuroradiologists blinded to PRNP genotype/prion protein type. Results: Cumulative T2-sensitivity for BG hyperintensity was higher in the MV2 subtype (84% for both observers versus 61% in observer 1/42% in observer 2 in MM1 patients). Significant inter-observer agreement was found for BG and thalamus on T2, FLAIR, PD and DWI, but for cortex only on DWI. Thalamic changes were significantly more frequent in MV2 than in MM1 patients (cumulative sensitivity 86% vs. 12.5% on DWI). Discussion: The high frequency of thalamic hyperintensity in the MV2 subtype allowed differentiation from MM1 patients. Good inter-observer agreement was found for BG and thalamus in all sequences. DWI showed the highest inter-observer correlation independent of the investigated brain region and was therefore not only highly sensitive but also relatively independent of investigator bias. Since inter-observer correlation for cortical hyperintensity in T2, FLAIR and PD is relatively low, the cortical changes should not be over-interpreted with these sequences.