Cerebral perivascular spaces visible on magnetic resonance imaging: development of a qualitative rating scale and its observer reliability.
Cerebral perivascular spaces visible on magnetic resonance imaging: development of a qualitative rating scale and its observer reliability.
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DOI：
10.1159/000375153
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Wardlaw JM
中科院分区：
文献类型：
--
作者：
Potter GM;Chappell FM;Morris Z;Wardlaw JM
血管周围间隙(PVS)是脑小血管疾病(SVD)、多种炎症性疾病、高血压和血脑屏障破坏的重要组成部分，但难以量化。SVD专家最近的一次国际合作强调了需要一个强大的、易于使用的PVS评定表，以有效地调查PVS的诊断和预后意义。本研究的目的是开发和扩展现有的PVS量表，为测量基底节、半卵圆中心和中脑的PVS提供一个更全面的量表，并测试其评定者内部和评价者之间的一致性，评估差异的原因。我们回顾了以前发表的PVS分级标准，包括PVS评估的部位、分级方法、大小和形态标准。保留关键特征，我们设计了一个更全面的量表，以提高PVS评分的可靠性。两位神经放射学家对来自两项研究(中风、老龄化人口)的60名患者的MRI脑扫描新量表进行了测试，选择这些患者代表全方位的PVS，并显示出SVD的伴随特征，如腔隙和白质高信号。我们评估了基底节、半卵圆中心和中脑PVS。基底节和半卵圆中心PVS评分为0(无)、1(1-10)、2(11-20)、3(21-40)和4(>；40)，中脑PVS评分为0(不可见)或1(可见)。我们计算了评分的kappa统计，评估了PVS类别使用的一致性(Bhapkar检验)，并审查了差异的来源。基底节PVS(范围分别为0.76-0.87和0.8-0.9)高于半卵圆中心PVS(范围分别为0.68-0.75和0.61-0.8)或中脑PVS(范围为0.51-0.52)。与半卵圆中心PVS相比，基底节的评分者间一致性更好(Bhapkar统计量为2.49-3.72，而分别为6.79-21.08)。大多数评价者之间的分歧是由于非常微弱的PVS、共存的广泛的白质高信号(WMH)或腔隙的存在。我们开发了一种更具包容性和更强大的视觉PVS评定量表，允许在结构脑成像上对PVS的所有级别的严重程度进行评级。修订后的PVS评定量表对基底节和半卵圆中心PVS具有良好的观察可靠性，对基底节PVS最好，对中脑PVS的可靠性中等。一致性受PVS严重程度和SVD背景特征的存在的影响。目前的量表可用于进一步的研究，以评估PVS的临床意义。
Perivascular spaces (PVS) are an important component of cerebral small vessel disease (SVD), several inflammatory disorders, hypertension and blood-brain barrier breakdown, but are difficult to quantify. A recent international collaboration of SVD experts has highlighted the need for a robust, easy-to-use PVS rating scale for the effective investigation of the diagnostic and prognostic significance of PVS. The purpose of the current study was to develop and extend existing PVS scales to provide a more comprehensive scale for the measurement of PVS in the basal ganglia, centrum semiovale and midbrain, and to test its intra- and inter-rater agreement, assessing reasons for discrepancy. We reviewed previously published PVS scales, including site of PVS assessed, rating method, and size and morphological criteria. Retaining key features, we devised a more comprehensive scale in order to improve the reliability of PVS rating. Two neuroradiologists tested the new scale in MRI brain scans of 60 patients from two studies (stroke, ageing population), chosen to represent a full range of PVS, and demonstrating concomitant features of SVD such as lacunes and white matter hyperintensities. We rated basal ganglia, centrum semiovale, and midbrain PVS. Basal ganglia and centrum semiovale PVS were rated 0 (none), 1 (1–10), 2 (11–20), 3 (21–40) and 4 (>40), and midbrain PVS were rated 0 (none visible) or 1 (visible). We calculated kappa statistics for rating, assessed consistency in use of PVS categories (Bhapkar test) and reviewed sources of discrepancy. Intra- and inter-rater kappa statistics were highest for basal ganglia PVS (range 0.76–0.87 and 0.8–0.9, respectively) than for centrum semiovale PVS (range 0.68–0.75 and 0.61–0.8, respectively) or midbrain PVS (inter-rater range 0.51–0.52). Inter-rater consistency was better for basal ganglia compared to centrum semiovale PVS (Bhapkar statistic 2.49–3.72, compared to 6.79–21.08, respectively). Most inter-rater disagreements were due to very faint PVS, coexisting extensive white matter hyperintensities (WMH) or the presence of lacunes. We developed a more inclusive and robust visual PVS rating scale allowing rating of all grades of PVS severity on structural brain imaging. The revised PVS rating scale has good observer reliability for basal ganglia and centrum semiovale PVS, best for basal ganglia PVS, and moderate reliability for midbrain PVS. Agreement is influenced by PVS severity and the presence of background features of SVD. The current scale can be used in further studies to assess the clinical implications of PVS.
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影响因子：
4
作者：
Satizabal, Claudia L.;Zhu, Yi-Cheng;Tzourio, Christophe
通讯作者：
Tzourio, Christophe
DOI：
10.1136/jnnp-2013-305815
发表时间：
2014-05
期刊：
Journal of neurology, neurosurgery, and psychiatry
影响因子：
--
作者：
Hurford R;Charidimou A;Fox Z;Cipolotti L;Jager R;Werring DJ
通讯作者：
Werring DJ
影响因子：
3.7
作者：
BHAPKAR, VP
通讯作者：
BHAPKAR, VP
影响因子：
8.3
作者：
Jeerakathil, T;Wolf, PA;DeCarli, C
通讯作者：
DeCarli, C
影响因子：
5.1
作者：
Cumurciuc, R;Guichard, JP;Chabriat, H
通讯作者：
Chabriat, H