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  • Multicentre multiobserver study of diffusion-weighted and fluid-attenuated inversion recovery MRI for the diagnosis of sporadic Creutzfeldt–Jakob disease: a reliability and agreement study

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Neurology
Research
Multicentre multiobserver study of diffusion-weighted and fluid-attenuated inversion recovery MRI for the diagnosis of sporadic Creutzfeldt–Jakob disease: a reliability and agreement study
  1. Koji Fujita1,
  2. Masafumi Harada2,
  3. Makoto Sasaki3,
  4. Tatsuhiko Yuasa4,
  5. Kenji Sakai5,
  6. Tsuyoshi Hamaguchi5,
  7. Nobuo Sanjo6,
  8. Yusei Shiga7,
  9. Katsuya Satoh8,
  10. Ryuichiro Atarashi8,
  11. Susumu Shirabe9,
  12. Ken Nagata10,
  13. Tetsuya Maeda10,
  14. Shigeo Murayama11,
  15. Yuishin Izumi1,
  16. Ryuji Kaji1,
  17. Masahito Yamada5,
  18. Hidehiro Mizusawa6
  1. 1Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
  2. 2Department of Radiology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
  3. 3Advanced Medical Science Center, Iwate Medical University, Morioka, Japan
  4. 4Department of Neurology, Kamagaya-Chiba Medical Center for Intractable Neurological Disease, Kamagaya General Hospital, Kamagaya, Japan
  5. 5Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
  6. 6Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
  7. 7Department of Neurology, Aoba Neurosurgical Clinic, Sendai, Japan
  8. 8Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  9. 9Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
  10. 10Department of Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan
  11. 11Department of Neuropathology (Brain Bank for Aging Research), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
  1. Correspondence to Dr Masafumi Harada; masafumi{at}clin.med.tokushima-u.ac.jp

Abstract

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 Creutzfeldt–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.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000649

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    Footnotes

    • To cite: Fujita K, Harada M, Sasaki M, et al. Multicentre, multiobserver study of diffusion-weighted and fluid-attenuated inversion recovery MRI for the diagnosis of sporadic Creutzfeldt–Jakob disease: a reliability and agreement study. BMJ Open 2012;2:e000649. doi:10.1136/bmjopen-2011-000649

    • Funding This study was supported by Grants-in-Aid from the Research Committee of Surveillance and Infection Control of Prion Disease and from the Research Committee of Prion Disease and Slow Virus Infection, the Ministry of Health, Labour and Welfare of Japan.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the Medical Ethics Committee of Kanazawa University and the Ethics Committees of the Tokushima University Hospital and Tokyo Medical and Dental University.

    • Contributors KF, MH, MS, TY, KSak, TH, NS, YS, KSat, SS, MY and HM: design/conceptualisation of the study. MH, KSak, TH, NS, YS, KSat, RA, KN, TM, SM and YI: acquisition of data. KF, MH, MS, RA, RK, MY and HM: analysis/interpretation of the data. MH: statistical analyses. KF, MH, MS, TY, KSak, TH, NS, YS, KSat, RA, SS, KN, TM, SM, YI, RK, MY and HM: drafting/revising the manuscript. All authors contributed to final approval of the version to be published.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional data available.