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

• Published in: BMJ open Vol. 2; no. 1; p. e000649
• Main Authors: Fujita, Koji, Harada, Masafumi, Sasaki, Makoto, Yuasa, Tatsuhiko, Sakai, Kenji, Hamaguchi, Tsuyoshi, Sanjo, Nobuo, Shiga, Yusei, Satoh, Katsuya, Atarashi, Ryuichiro, Shirabe, Susumu, Nagata, Ken, Maeda, Tetsuya, Murayama, Shigeo, Izumi, Yuishin, Kaji, Ryuji, Yamada, Masahito, Mizusawa, Hidehiro
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2012; BMJ Group
• Subjects: Colleges & universities; Committees; Creutzfeldt-Jakob disease; Diffusion; Digital imaging; Hospitals; Methods; Neurology; Neuropathology; NMR; Nuclear magnetic resonance; Patients; Physicians; Proteins
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2011-000649

ObjectivesTo 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).DesignA reliability and agreement study.SettingThirteen MRI observers comprising eight neurologists and five radiologists at two universities in Japan.ParticipantsData of 1.5-Tesla DWI and FLAIR were obtained from 29 patients with sCJD and 13 controls.Outcome measuresStandardisation 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).ResultsThe 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.ConclusionsStandardised 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.