Considerations for mean upper cervical cord area implementation in a longitudinal MRI setting: methods, interrater reliability, and MRI quality control

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Item Type:	Article
Title:	Considerations for mean upper cervical cord area implementation in a longitudinal MRI setting: methods, interrater reliability, and MRI quality control
Creators Name:	Chien, C., Juenger, V., Scheel, M., Brandt, A.U. and Paul, F.
Abstract:	BACKGROUND AND PURPOSE: Spinal cord atrophy is commonly measured from cerebral MRIs, including the upper cervical cord. However, rescan intraparticipant measures have not been investigated in healthy cohorts. This study investigated technical and rescan variability in the mean upper cervical cord area calculated from T1-weighted cerebral MRIs. MATERIALS AND METHODS: In this retrospective study, 8 healthy participants were scanned and rescanned with non-distortion- and distortion-corrected MPRAGE sequences (11-50 sessions in 6-8 months), and 50 participants were scanned once with distortion-corrected MPRAGE sequences in the Day2day daily variability study. From another real-world observational cohort, we collected non-distortion-corrected MPRAGE scans from 27 healthy participants (annually for 2-4 years) and cross-sectionally from 77 participants. Statistical analyses included coefficient of variation, smallest real difference, intraclass correlation coefficient, Bland-Altman limits of agreement, and paired t tests. RESULTS: Distortion- versus non-distortion-corrected MPRAGE-derived mean upper cervical cord areas were similar; however, a paired t test showed incomparability (t = 11.0, P = <.001). Higher variability was found in the mean upper cervical cord areas calculated from an automatic segmentation method. Interrater analysis yielded incomparable measures in the same participant scans (t = 4.5, P = <.001). Non-distortion-corrected mean upper cervical cord area measures were shown to be robust in real-world data (t = -1.04, P = .31). The main sources of variability were found to be artifacts from movement, head/neck positioning, and/or metal implants. CONCLUSIONS: Technical variability in cord measures decreased using non-distortion-corrected MRIs, a semiautomatic segmentation approach, and 1 rater. Rescan variability was within ±4.4% for group mean upper cervical cord area when MR imaging quality criteria were met.
Keywords:	Algorithms, Cervical Cord, Computer-Assisted Image Processing, Magnetic Resonance Imaging, Observer Variation, Quality Control, Reproducibility of Results, Retrospective Studies
Source:	American Journal of Neuroradiology
ISSN:	0195-6108
Publisher:	American Society of Neuroradiology
Volume:	41
Number:	2
Page Range:	343-350
Date:	1 February 2020
Additional Information:	Copyright © 2020 by American Journal of Neuroradiology
Official Publication:	https://doi.org/10.3174/ajnr.A6394
External Fulltext:	View full text on PubMed Central
PubMed:	View item in PubMed

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