Reproducibilidad de la valoración cualitativa de la atrofia del lóbulo temporal por RM / Reproducibility of qualitative assessments of temporal lobe atrophy in MRI studies

Objetivo: Determinar la reproducibilidad de la escala visual de Scheltens para establecer la atrofia del lóbulo temporal medial. Material y métodos: Reunimos 25 pacientes con diagnóstico clínico de enfermedad de Alzheimer leve o deterioro cognitivo leve (DCL) y 25 sujetos sin deterioro cognitivo. Todos fueron estudiados con RM 1,5 Tesla utilizando secuencias de inversión recuperación ponderadas en T1 en el plano coronal. Cinco neurorradiólogos fueron entrenados para aplicar la escala de Scheltens y analizaron las imágenes. Se utilizó el coeficiente de correlación intraclase para valorar el grado de acuerdo inter e intraobservadores. Resultados: El 80% de los pacientes con deterioro cognitivo leve o enfermedad de Alzheimer obtuvieron puntuaciones entre 2 a 4, mientras que 21 de los 25 controles sanos (84%) fueron puntuados entre 0-1. La concordancia entre observadores fue consistentemente mayor de 0,82, con un intervalo de confianza del 95% (0,7-0,9). La concordancia intraobservador varió entre 0,82 y 0,87, con un intervalo de confianza del 95% (0,56-0,93). Conclusión: La clasificación de Scheltens es un método reproducible entre observadores, lo que apoya su uso en la práctica clínica (AU)

Objective: To determine the reproducibility of the Scheltens visual rating scale in establishing atrophy of the medial temporal lobe. Material and methods: We used coronal T1-weighted inversion recovery sequences on a 1.5 Tesla MRI scanner to study 25 patients with clinically diagnosed Alzheimer's disease or mild cognitive decline and 25 subjects without cognitive decline. Five neuroradiologists trained to apply the Scheltens visual rating scale analyzed the images. We used the interclass correlation coefficient to evaluate interrater and intrarater agreement. Results: Raters scored 20 (80%) of the 25 patients with mild cognitive decline or Alzheimer's disease between 2 and 4; by contrast, they scored 21 (84%) of the 25 subjects without cognitive decline between 0 and 1. The interrater agreement was consistently greater than 0.82, with a 95% confidence interval of (0.7-0.9). The intrarater agreement ranged from 0.82 to 0.87, with a 95% confidence interval of (0.56-0.93). Conclusion: The Scheltens visual rating scale is reproducible among observers, and this finding supports its use in clinical practice (AU)

Reproducibility of qualitative assessments of temporal lobe atrophy in MRI studies.

OBJECTIVE: To determine the reproducibility of the Scheltens visual rating scale in establishing atrophy of the medial temporal lobe. MATERIAL AND METHODS: We used coronal T1-weighted inversion recovery sequences on a 1.5 Tesla MRI scanner to study 25 patients with clinically diagnosed Alzheimer's disease or mild cognitive decline and 25 subjects without cognitive decline. Five neuroradiologists trained to apply the Scheltens visual rating scale analyzed the images. We used the interclass correlation coefficient to evaluate interrater and intrarater agreement. RESULTS: Raters scored 20 (80%) of the 25 patients with mild cognitive decline or Alzheimer's disease between 2 and 4; by contrast, they scored 21 (84%) of the 25 subjects without cognitive decline between 0 and 1. The interrater agreement was consistently greater than 0.82, with a 95% confidence interval of (0.7-0.9). The intrarater agreement ranged from 0.82 to 0.87, with a 95% confidence interval of (0.56-0.93). CONCLUSION: The Scheltens visual rating scale is reproducible among observers, and this finding supports its use in clinical practice.

Neuroimaging in status epilepticus secondary to paraneoplastic autoimmune encephalitis.

AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of paraneoplastic autoimmune encephalitis in patients with new-onset status epilepticus. MATERIALS AND METHODS: The neuroimaging and clinical data of five patients with paraneoplastic autoimmune encephalitis debuting as status epilepticus were retrospectively reviewed. All patients met the criteria for definite paraneoplastic syndrome and all underwent brain MRI during the status epilepticus episode or immediately after recovery. RESULTS: All patients showed hyperintense lesions on T2-weighted imaging (WI) involving the limbic structures, specifically the hippocampus. Three of them showed additional extra-limbic areas of signal abnormalities. The areas of T2 hyperintensity were related to the electroclinical onset of the seizures. In three patients, various techniques were used to study cerebral perfusion, such as arterial spin labelling MRI, single photon-emission computed tomography (SPECT) and 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG)-positron-emission tomography (PET). Arterial spin labelling showed hyperperfusion overlapping the inflammatory lesions, whereas PET and SPECT disclosed increased perfusion and increased metabolism. The subtraction SPECT co-registered to MRI (SISCOM) demonstrated hypermetabolism outside the areas of encephalitis. After clinical recovery, follow-up MRI revealed the development of atrophy in the initially affected hippocampus. Two patients who had recurrent paraneoplastic autoimmune encephalitis manifesting as status epilepticus showed new T2 lesions involving different structures. CONCLUSION: The presence of limbic and extra-limbic T2 signal abnormalities in new-onset status epilepticus should suggest the diagnosis of a paraneoplastic syndrome, especially when status epilepticus is refractory to treatment. The lesions are consistently seen as hyperintense on T2WI.