Clinical 3-tesla FLAIR* MRI improves diagnostic accuracy in multiple sclerosis.
Clinical 3-tesla FLAIR* MRI improves diagnostic accuracy in multiple sclerosis.
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DOI：
10.1177/1352458515624975
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发表时间：
2016-10
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影响因子：
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通讯作者：
Reich DS
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作者：
George IC;Sati P;Absinta M;Cortese IC;Sweeney EM;Shea CD;Reich DS
目的评价临床FLAIR*3T MRI对多发性硬化(MS)的诊断价值。中央静脉可能是多发性硬化病变的一个显著特征。FLAIR*是一种源自临床MRI扫描的综合对比，但尚未作为诊断MS的临床工具进行研究。两位经验丰富的MS神经学家分别和并排评估了来自68例MS患者、8名健康志愿者和11名其他神经系统疾病患者的87对扫描对(FLAIR/FLAIR*)。评分员根据经验、公布的标准和对“40%规则”的目测评估来判断病例，根据该规则，如果40%的病变显示为中央静脉，多发性硬化症更受青睐。用area-under-the-receiver-operating-characteristic曲线(AuC)判定诊断的准确性，用Cohen‘s kappa(κ)评定评分者间的信度。诊断准确率高：评分者1对FLAIR的AUC为0.94(95%可信区间：0.89，0.97)，FLAIR*为0.95(0.92，0.98)；评分者2的AUC为0.94(0.90，0.98)和0.90(0.85，0.95)。当综合考虑图像时，AUC有所改善：评分者1，0.99(0.98，1.00)；评分者2，0.98(0.96，0.99)。对于FLAIR(κ=0.68)和FLAIR*(κ=0.74)，评价者之间的协议是实质性的，尽管对40%规则(κ=0.47)的一致性很低(p<；<；0.001在所有情况下)。FLAIR和FLAIR*图像的联合临床评估略微提高了MS的诊断准确性，并且不需要计算有中心静脉的病变。
To evaluate clinical FLAIR* 3T MRI, which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). Central veins may be a distinguishing feature of MS lesions. FLAIR*, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. Two experienced MS neurologists evaluated 87 scan pairs (FLAIR/FLAIR*), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the “40% rule,” whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area-under-the-receiver-operating-characteristic curve (AUC), and inter-rater reliability was assessed with Cohen’s kappa (κ). Diagnostic accuracy was high: rater 1, AUC 0.94(95% confidence interval: 0.89,0.97) for FLAIR, 0.95(0.92,0.98) for FLAIR*; rater 2, 0.94(0.90,0.98) and 0.90(0.85,0.95). AUC improved when images were considered together: rater 1, 0.99(0.98,1.00); rater 2, 0.98(0.96,0.99). Inter-rater agreement was substantial for FLAIR(κ=0.68) and FLAIR*(κ=0.74), despite low agreement on the 40% rule(κ=0.47) (p<<0.001 in all cases). Joint clinical evaluation of FLAIR and FLAIR* images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.