特发性正常压力脑积水患者MRI征象及相关神经影像评分量表的一致性分析  

Analysis of the Consistency of MRI Signs and Associated Neuroimaging Rating Scales for Patients with Idiopathic Normal Pressure Hydrocephalus

作　　者：李锐 何文杰 邹舒玥 袁继春 夏军[2] LI Rui;HE Wenjie;ZOU Shuyue;YUAN Jichun;XIA Jun(Guangxi University of Chinese Medicine,Nanning 530200,China;Department of Radiology,Shenzhen Second People's Hospital,Shenzhen 518035,China;Shenzhen University,Shenzhen 518060,China)

机构地区：[1]广西中医药大学研究生院,南宁530200 [2]深圳大学第一附属医院/深圳市第二人民医院医学影像科,广东深圳518035 [3]深圳大学研究生院,广东深圳518060

出　　处：《CT理论与应用研究(中英文)》2025年第2期263-271,共9页Computerized Tomography Theory and Applications

基　　金：国家自然科学基金(机器学习构建特发性正常压力脑积水分流术预后模型:基于大脑结构与连接的磁共振研究(82171913));深圳市科技计划项目(JCYJ20220818101816036);深圳市第二人民医院临床研究重点项目(20243357010)。

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i NPH 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i NPH 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。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 0.812,0.84

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 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.7[医药卫生—诊断学]