Analysis of the Consistency of MRI Signs and Associated Neuroimaging Rating Scales for Patients with Idiopathic Normal Pressure Hydrocephalus
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摘要:
目的：探究特发性正常压力脑积水（iNPH）患者MRI征象及相关神经影像评分量表的一致性。方法：回顾性收集2018年1月至2021年12月行分流术的80例iNPH患者的影像学资料。首先使用iNPH Radscale评分量表和不成比例增大的蛛网膜下腔脑积水（DESH）评分量表的标准对患者图像进行评分，在初次评分一个月后，使用“简易典型快速学习iNPH Radscale评分量表及DESH评分量表标准图”再次对患者图像进行了评分。最后，对不同时间段的评分进行分析，以评估不同观察者同一时间和同一观察者不同时间得到的各个参数的一致性。结果：定量指标（如EI）在两种评分量表中的一致性普遍较高，Kappa系数分别为0.784（DESH评分量表）、0.806（iNPH评分量表），具有显著统计学意义。定性指标（如侧裂池、大脑高凸面挤压、局部脑沟扩张、脑室周围高信号等）的一致性则普遍相对较低，除胼胝体角在DESH评分表中Kappa系数为0.625外，DESH评分量表中其余Kappa系数分别为0.442、0.220和0.333，具有显著统计学意义；iNPH Radscale评分量表中Kappa系数分别为0.441、0.550、0.201、0.301、0.470和0.504，具有显著统计学意义。在统一接受“简易典型快速学习iNPH Radscale评分量表标准图以及DESH评分量表标准图”快速学习后，各项指标的一致性普遍提高。DESH评分量表中各项指标Kappa系数分别为0.812、0.848、0.809、0.732和0.668，具有显著统计学意义；iNPH Radscale评分量表各项指标Kappa系数分别为0.822、0.610、0.848、0.710、0.781、0.616和0.831，具有显著统计学意义。结论：iNPH Radscale评分量表以及DESH评分量表的一致性不佳。“简易典型快速学习iNPH Radscale评分量表及DESH评分量表标准图”作为一种新的测量方法，提高了评分的一致性，减少主观因素的影响，为iNPH患者的临床诊断和治疗提供了更加准确和可靠的依据。
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关键词:
- 特发性正常压力脑积水 /
- 简易典型快速学习 /
- DESH评分量表 /
- iNPH Radscale评分量表 /
- 一致性
Abstract:Objective: To investigate the consistency of MRI signs and associated neuroimaging rating scales for patients with idiopathic normal pressure hydrocephalus (iNPH). Methods: Imaging data were retrospectively collected from 80 patients with iNPH who underwent shunt surgery at our hospital from 2018 to 2021. The patient images were first scored using the criteria of the iNPH Radscale score and disproportionately enlarged subarachnoid hydrocephalus (DESH) score. Then, one month after the initial scoring, the patient images were scored again using the “simple typical rapid-learning standardized images of the iNPH Radscale and DESH scores.” Finally, the scores from different time periods were analyzed to assess the consistency of each parameter obtained from different observers at the same time and from the same observer at different times. Results: The Evans index (a quantitative indicator) showed high consistency in both rating scales, with kappa coefficients of 0.784 (DESH scores) and 0.806 (iNPH Radscale scores), which were statistically significant. By contrast, the consistency of the qualitative indicators was generally relatively low, with the exception of the callosal angle, which had a kappa coefficient of 0.625 in the DESH scores. The rest of the kappa coefficients in the DESH scores were statistically significant at 0.442, 0.220 and 0.333 for Sylvian fissures, tight high convexity, and focal sulcal dilatation, respectively. The kappa coefficients in the iNPH Radscale scores were also statistically significant at 0.441, 0.550, 0.201, 0.301, 0.470 and 0.504 for the callosal angle, Sylvian fissures, tight high convexity, focal sulcal dilatation, temporal horn, and periventricular hyperintensities, respectively. The consistency of the indicators was generally improved after the use of the “simple typical rapid-learning standardized images of the iNPH Radscale and DESH scores.” The kappa coefficients of the Evans index, callosal angle, Sylvian fissures, tight high convexity, and focal sulcal dilatation indicators in the DESH scores were 0.812, 0.848, 0.809, 0.732 and 0.668, respectively, whereas those of the Evans index, callosal angle, Sylvian fissures, tight high convexity, focal sulcal dilatation, temporal horn, and periventricular hyperintensities indicators in the iNPH Radscale scores were 0.822, 0.610, 0.848, 0.710, 0.781, 0.616 and 0.831, respectively. Conclusion: The consistency of the iNPH Radscale and DESH scores was not good. By contrast, the “simple typical rapid-learning standardized images of the iNPH Radscale and DESH scores,” as a new measurement method, improved the consistency of the scores, reduced the influence of subjective factors, and provided a more accurate and reliable basis for the clinical diagnosis and treatment of patients with iNPH.
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图 1 本研究从初步筛选到最终分析的流程图
注：iNPH为特发性正常压力脑积水。
Figure 1. Flow chart of the initial screening to the final analysis of this study
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图 2 典型图像快速学习DESH评分标准图
Figure 2. Standardized images of the simple typical rapid-learning DESH scores
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图 3 典型图像快速学习iNPH Radscale评分标准图
Figure 3. Standardized images of the simple typical rapid-learning iNPH Radscale scores
表 1 DESH与iNPH Radscale评分比较
Table 1 Comparison of the DESH and iNPH Radscale scores
DESH评分 iNPH Radscale评分 脑室扩大EI 0，正常（< 0.3） 0，正常（≤ 0.25） 1，轻度扩大（0.3~0.35） 1，轻度扩大（> 0.25~0.3） 2，扩大（＞0.35） 2，扩大（> 0.3） 胼胝体角CA 0，明显的挤压（＞100°） 0，> 90° 1，小钝角（90°~100°） 1，60°~90° 2，锐角（<90°） 2，≤60° 侧裂池 0，正常或者狭窄 0，正常 1，轻度扩张或单侧扩张 1，扩张 2，双侧扩张 脑凸面 0，正常的或比正常宽的 0，正常 1，轻微挤压 1，大脑镰旁脑沟狭窄 2，明显的挤压 2，大脑凸面皮层脑沟狭窄 局部脑沟扩大 0，不出现 0，不存在 1，部分出现 1，存在 2，较多出现 颞角 NA 0，< 4 mm 1，4~6 mm 2，≥6 mm PVH NA 0，不存在 1，存在额角周围（帽状） 2，弥漫分布于侧脑室周围 总分 10 12 注：PVH为脑室周围高信号。 
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表 2 iNPH Radscale评分量表测量值的Kappa系数检验一致性分析
Table 2 Kappa coefficient test of the consistency of the iNPH Radscale scores
独自学习评分量表 学习简易典型评分量表标准图 iNPH Radscale
评分指标结果A、
B组间P 结果A、
C组内P 结果A′、
B′ 组间P 结果A′、
C′ 组内P EI 0.806 < 0.001 0.902 < 0.001 0.822 < 0.001 0.917 < 0.001 CA 0.441 < 0.001 0.796 < 0.001 0.610 < 0.001 0.744 < 0.001 侧裂池 0.550 < 0.001 0.767 < 0.001 0.848 < 0.001 0.873 < 0.001 脑凸面 0.201 < 0.001 0.541 < 0.001 0.710 < 0.001 0.707 < 0.001 局部脑沟 0.301 < 0.001 0.467 < 0.001 0.781 < 0.001 0.803 < 0.001 颞角 0.470 < 0.001 0.536 < 0.001 0.616 < 0.001 0.700 < 0.001 PVH 0.504 < 0.001 0.705 < 0.001 0.831 < 0.001 0.914 < 0.001 注：A组：医师A独自学习评分标准后对所有图像进行初次评分；B组：医师B独自学习评分标准后对所有图像进行初次评分；C组：医师A独自学习评分标准初次评分1个月后再次学习后进行评分；A′组：医师A经过统一对照典型图像快速学习后对所有图像进行初次评分；B′组：医师B经过统一对照典型图像快速学习后对所有图像进行初次评分；C′组：医师A经过统一对照典型图像快速学习后对所有图像进行初次评分1个月后再次学习后进行评分。
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表 3 DESH评分量表测量值的Kappa系数检验一致性分析
Table 3 Kappa coefficient test of the consistency of the DESH scores
独自学习评分量表 学习简易典型评分量表标准图 DESH评分指标 结果A、B组间 P 结果A、C组内 P 结果A′、B′ 组间 P 结果A′、C′ 组内 P EI 0.784 < 0.001 0.905 < 0.001 0.812 < 0.001 0.931 < 0.001 CA 0.625 < 0.001 0.819 < 0.001 0.848 < 0.001 0.886 < 0.001 侧裂池 0.442 < 0.001 0.680 < 0.001 0.809 < 0.001 0.831 < 0.001 脑凸面 0.220 < 0.001 0.589 < 0.001 0.732 < 0.001 0.780 < 0.001 局部脑沟 0.333 < 0.001 0.566 < 0.001 0.668 < 0.001 0.690 < 0.001 注：A组：医师A独自学习评分标准后对所有图像进行初次评分；B组：医师B独自学习评分标准后对所有图像进行初次评分；C组：医师A独自学习评分标准初次评分1个月后再次学习后进行评分；A′组：医师A经过统一对照典型图像快速学习后对所有图像进行初次评分；B′组：医师B经过统一对照典型图像快速学习后对所有图像进行初次评分；C′组：医师A经过统一对照典型图像快速学习后对所有图像进行初次评分1个月后再次学习后进行评分。
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