Journal
EUROPEAN RADIOLOGY
Volume 31, Issue 7, Pages 5312-5323Publisher
SPRINGER
DOI: 10.1007/s00330-020-07455-8
Keywords
Alzheimer's disease; Frontotemporal dementia; Radiologists; Magnetic resonance imaging; Atrophy
Funding
- Engineering and Physical Science Research Council (EPSRC)
- NIHR Biomedical Research Centre at University College London Hospital
- EPSRC
- Wellcome Trust
- Wolfson Foundation
- NIHR Biomedical Research Centre at Guy's and St Thomas' Trust
- Leonard Wolfson Experimental Neurology Centre at Queen Square
- Alzheimer's Research UK
- Brain Research Trust
- Alzheimer's Association Clinician Scientist fellowship
- UK Dementia Research Institute
- UCL Queen Square Biomedical Research Centre
- EPSRC [EP/M020533/1, 1950257] Funding Source: UKRI
- MRC [UKDRI-1001, MR/M009106/1] Funding Source: UKRI
- Engineering and Physical Sciences Research Council [EP/M020533/1] Funding Source: researchfish
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The study found that providing a quantitative report of regional brain volumes can significantly improve sensitivity for detecting volume loss and AD across all raters, with the consultant group showing the most improvement in accuracy. Agreement with the 'gold standard' was not significantly affected by the QReport overall, but the consultant group did show a significant improvement. In conclusion, referencing single-subject results to normative data alongside visual assessment can improve sensitivity, accuracy, and interrater agreement for detecting volume loss.
Objectives We examined whether providing a quantitative report (QReport) of regional brain volumes improves radiologists' accuracy and confidence in detecting volume loss, and in differentiating Alzheimer's disease (AD) and frontotemporal dementia (FTD), compared with visual assessment alone. Methods Our forced-choice multi-rater clinical accuracy study used MRI from 16 AD patients, 14 FTD patients, and 15 healthy controls; age range 52-81. Our QReport was presented to raters with regional grey matter volumes plotted as percentiles against data from a normative population (n = 461). Nine raters with varying radiological experience (3 each: consultants, registrars, 'non-clinical image analysts') assessed each case twice (with and without the QReport). Raters were blinded to clinical and demographic information; they classified scans as 'normal' or 'abnormal' and if 'abnormal' as 'AD' or 'FTD'. Results The QReport improved sensitivity for detecting volume loss and AD across all raters combined (p = 0.015* and p = 0.002*, respectively). Only the consultant group's accuracy increased significantly when using the QReport (p = 0.02*). Overall, raters' agreement (Cohen's kappa) with the 'gold standard' was not significantly affected by the QReport; only the consultant group improved significantly (kappa(s) 0.41 -> 0.55, p = 0.04*). Cronbach's alpha for interrater agreement improved from 0.886 to 0.925, corresponding to an improvement from 'good' to 'excellent'. Conclusion Our QReport referencing single-subject results to normative data alongside visual assessment improved sensitivity, accuracy, and interrater agreement for detecting volume loss. The QReport was most effective in the consultants, suggesting that experience is needed to fully benefit from the additional information provided by quantitative analyses.
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