Reliability of DWI and FLAIR for diagnosis of sporadic CJD
Sasaki, Makoto Iwate Medical University
Yuasa, Tatsuhiko Kamagaya General Hospital
Sakai, Kenji Kanazawa University
Hamaguchi, Tsuyoshi Kanazawa University
Sanjo, Nobuo Tokyo Medical and Dental University
Shiga, Yusei Aoba Neurosurgical Clinic
Satoh, Katsuya Nagasaki University
Atarashi, Ryuichiro Nagasaki University
Shirabe, Susumu Nagasaki University
Nagata, Ken Research Institute for Brain and Blood Vessels
Maeda, Tetsuya Research Institute for Brain and Blood Vessels
Murayama, Shigeo Tokyo Metropolitan Institute of Gerontology
Yamada, Masahito Kanazawa University
Mizusawa, Hidehiro Tokyo Medical and Dental University
Objectives: To assess the utility of the display standardisation of diffusion-weighted MRI (DWI) and to compare the effectiveness of DWI and fluid-attenuated inversion recovery (FLAIR) MRI for the diagnosis of sporadic Creutzfeldte–Jakob disease (sCJD).
Design: A reliability and agreement study.
Setting: Thirteen MRI observers comprising eight neurologists and five radiologists at two universities in Japan.
Participants: Data of 1.5-Tesla DWI and FLAIR were obtained from 29 patients with sCJD and 13 controls.
Outcome measures: Standardisation of DWI display was performed utilising b0 imaging. The observers participated in standardised DWI, variable DWI (the display adjustment was observer dependent) and FLAIR sessions. The observers independently assessed each MRI for CJD-related lesions, that is, hyperintensity in the cerebral cortex or striatum, using a continuous rating scale. Performance was evaluated by the area under the receiver operating characteristics curve (AUC).
Results: The mean AUC values were 0.84 (95% CI 0.81 to 0.87) for standardised DWI, 0.85 (95% CI 0.82 to 0.88) for variable DWI and 0.68 (95% CI 0.63 to 0.72) for FLAIR, demonstrating the superiority of DWI (p<0.05). There was a trend for higher intraclass correlations of standardised DWI (0.74, 95% CI 0.66 to 0.83) and variable DWI (0.72, 95% CI 0.62 to 0.81) than that of FLAIR (0.63, 95% CI 0.53 to 0.74), although the differences were not statistically significant.
Conclusions: Standardised DWI is as reliable as variable DWI, and the two DWI displays are superior to FLAIR for the diagnosis of sCJD. The authors propose that hyperintensity in the cerebral cortex or striatum on 1.5-Tesla DWI but not FLAIR can be a reliable diagnostic marker for sCJD.
BMJ Publishing Group
BMJOpen_2_1_e000649.pdf 312 KB