■肥大性橄榄核变性(HOD)是下橄榄核(ION)的病理,发生在格林-莫拉雷特三角形(GMT)受伤后。缺乏诊断金标准,诊断通常基于T2或FLAIR成像和专家评级。为了便于在未来的研究中准确诊断HOD,我们评估了这种基于评分者的方法的可靠性,并探索了替代方法,定量分析。
■在GMT中遭受中风的患者和匹配的对照组前瞻性地接受了MRI检查,包括T2,FLAIR,和质子密度(PD)。在患者组中额外进行扩散张量成像(DTI)。在FLAIR上评估HOD的存在,T2和PD分别由3名盲人审阅者提供。采用易于复制的分割方法,强度的相对差异,分数各向异性(FA),并计算了两个离子之间的平均扩散系数(MD)。
■总共,本研究包括15名患者。评估者间的可靠性对于FLAIR来说是最好的,其次是T2和PD(Fleissκ=0.87/0.77/0.65)。3名评估者在38-46%(FLAIR)诊断为HOD,40-47%(T2),和53-67%(PD)的患者。对照组的假阳性结果在T2中的发生率低于PD和FLAIR(2.2%/8.9%/6.7%)。在53%的患者中,与对照组相比,两种ION在PD上的强度差异显着增加。这些患者还表现出显著降低的FA和增加的MD。
■虽然基于评分器的方法在T2成像上产生了最佳性能,一个定量的,在PD和DTI成像中基于离子强度的更灵敏的HOD诊断似乎是可能的。
UNASSIGNED: Hypertrophic olivary degeneration (HOD) is a pathology of the inferior olivary nucleus (ION) that occurs after injuries to the Guillain-Mollaret triangle (GMT). Lacking a diagnostic gold standard, diagnosis is usually based on T2 or FLAIR imaging and expert rating. To facilitate precise HOD diagnosis in future studies, we assessed the reliability of this rater-based approach and explored alternative, quantitative analysis.
UNASSIGNED: Patients who had suffered strokes in the GMT and a matched control group prospectively underwent an MRI examination including T2, FLAIR, and proton density (PD). Diffusion tensor imaging (DTI) was additionally performed in the patient group. The presence of HOD was assessed on FLAIR, T2, and PD separately by 3 blinded reviewers. Employing an easily reproducible segmentation approach, relative differences in intensity, fractional anisotropy (FA), and mean diffusivity (MD) between both IONs were calculated.
UNASSIGNED: In total, 15 patients were included in this study. The interrater reliability was best for FLAIR, followed by T2 and PD (Fleiss κ = 0.87 / 0.77 / 0.65). The 3 raters diagnosed HOD in 38-46% (FLAIR), 40-47% (T2), and 53-67% (PD) of patients. False-positive findings in the control group were less frequent in T2 than in PD and FLAIR (2.2% / 8.9% / 6.7%). In 53% of patients, the intensity difference between both IONs on PD was significantly increased in comparison with the control group. These patients also showed significantly decreased FA and increased MD.
UNASSIGNED: While the rater-based approach yielded the best performance on T2 imaging, a quantitative, more sensitive HOD diagnosis based on ION intensities in PD and DTI imaging seems possible.