Normative brain volume reports may improve differential diagnosis of dementing neurodegenerative diseases in clinical practice
Normative brain volume reports may improve differential diagnosis of dementing neurodegenerative diseases in clinical practice
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DOI：
10.1007/s00330-019-06602-0
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发表时间：
2020-01-30
影响因子：
5.9
通讯作者：
Grimmer, Timo
中科院分区：
文献类型：
--
作者：
Hedderich, Dennis M.;Dieckmeyer, Michael;Grimmer, Timo
目的规范性脑容量报告（NBVR）越来越多地应用于痴呆患者的临床常规检查。然而，目前尚不清楚如何在放射决策过程中使用这些信息。本研究探讨了NBVR对几种痴呆性神经退行性疾病中不同局部脑萎缩的检测和鉴别诊断的诊断价值。方法对81例痴呆性神经退行性疾病患者和13例健康对照者进行NBVR检测。分析了40例阿尔茨海默病（AD; 18例痴呆，22例轻度认知障碍（MCI），11例后皮质萎缩（PCA）），20例额颞叶痴呆（FTD）和10例语义性痴呆（SD）病例，并对萎缩模式的代表性报告进行了定性测试。金标准诊断基于患者的临床病程、FDG-PET成像和/或符合既定诊断标准的脑脊液（CSF）生物标志物。计算模式表征的诊断准确性。结果NBVR改善了基于评级者1的结构MRI对患者与健康对照的正确识别（p < 0.001），而对于评级者2，正确分类的数量相当不变。评定者1（p = 0.001）和评定者2（p = 0.022）对痴呆性神经退行性疾病的正确鉴别诊断显著提高。此外，评估者间的可靠性从中度提高到优秀的神经退行性疾病的检测和鉴别诊断（kappa = 0.556/0.894和kappa = 0.403/0.850，分别）。结论NBVR提供了有价值的、不依赖于神经元的信息，可提高神经退行性疾病的鉴别诊断。
Objectives Normative brain volume reports (NBVRs) are becoming more and more available for the workup of dementia patients in clinical routine. However, it is yet unknown how this information can be used in the radiological decision-making process. The present study investigates the diagnostic value of NBVRs for detection and differential diagnosis of distinct regional brain atrophy in several dementing neurodegenerative disorders. Methods NBVRs were obtained for 81 consecutive patients with distinct dementing neurodegenerative diseases and 13 healthy controls (HC). Forty Alzheimer's disease (AD; 18 with dementia, 22 with mild cognitive impairment (MCI), 11 posterior cortical atrophy (PCA)), 20 frontotemporal dementia (FTD), and ten semantic dementia (SD) cases were analyzed, and reports were tested qualitatively for the representation of atrophy patterns. Gold standard diagnoses were based on the patients' clinical course, FDG-PET imaging, and/or cerebrospinal fluid (CSF) biomarkers following established diagnostic criteria. Diagnostic accuracy of pattern representations was calculated. Results NBVRs improved the correct identification of patients vs. healthy controls based on structural MRI for rater 1 (p < 0.001) whereas the amount of correct classifications was rather unchanged for rater 2. Correct differential diagnosis of dementing neurodegenerative disorders was significantly improved for both rater 1 (p = 0.001) and rater 2 (p = 0.022). Furthermore, interrater reliability was improved from moderate to excellent for both detection and differential diagnosis of neurodegenerative diseases (kappa = 0.556/0.894 and kappa = 0.403/0.850, respectively). Conclusion NBVRs deliver valuable and observer-independent information, which can improve differential diagnosis of neurodegenerative diseases.