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).
A reliability and agreement study.
Thirteen MRI observers comprising eight neurologists and five radiologists at two universities in Japan.
Data of 1.5-Tesla DWI and FLAIR were obtained from 29 patients with sCJD and 13 controls.
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).
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.
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.
Evaluation of the reliability of diffusion-weighted imaging (DWI) display standardisation for the diagnosis of sporadic Creutzfeldt–Jakob disease (sCJD).
Comparison between DWI and fluid-attenuated inversion recovery (FLAIR) for the diagnosis of sCJD.
Standardised DWI display is as reliable as observer-dependent DWI display.
DWI is superior to FLAIR for the diagnosis of sCJD.
Hyperintensity in the cerebral cortex or striatum on 1.5-Tesla DWI but not FLAIR can be a reliable diagnostic marker for sCJD.
Strengths and limitations of this study
Strength of this study is the large number of physicians who participated in the observer performance study.
This study was limited by the retrospective nature that may lead to a selection bias.