The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part III. Reliability of a standardized MRI evaluation of Alzheimer's disease

Abstract

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) has developed procedures for standardized imaging and reporting of magnetic resonance (MR) findings in Alzheimer's disease (AD) for use by neuroradiologists in multiple medical centers using a variety of MR equipment and field strengths. After initial pretesting, we revised the protocol, expanded the summary rating scale to seven points, and added more illustrations. Fourteen participating neuroradiologists evaluated 28 MR scans of elderly patients, giving us the basis for judging interrater agreement. We obtained acceptable intraclass correlations (greater than 0.79) for rating the size of the lateral and third ventricles and the temporal horn. Less satisfactory intraclass correlations occurred when rating other areas, including (1) global atrophy of the brain (0.70); (2) dilatation of the sulci of the temporal lobe (0.66); (3) frequency, location, and severity of white matter lesions (0.77); (4) sylvian fissure enlargement (0.70); and (5) cerebral sulcal dilatation (0.64). We also saw considerable variation in the reporting of cortical and lacunar infarcts. Despite careful design of the rating methodology and readings by experienced neuroradiologists, we did not find satisfactory interrater agreement for interpreting MR findings in elderly subjects. These findings may explain the difficulties encountered in applying similar subjective rating techniques that meet with success at one institution to multicenter studies. More objective and reproducible procedures are needed for interpretation of neuroimaging findings of AD in multicenter studies.

Consortium to Establish a Registry for Alzheimer's Disease (CERAD): The first twenty years

“…Accordingly, while the protocol is available it has not been recommended for use in multicenter studies, although use at any one site may be satisfactory. 18 More sophisticated means of evaluating neuroimages have since been developed, which should produce improved agreement across sites. Nevertheless, use in one study of 20 CERAD patients with neuropathologically ascertained definite AD, found a …”

“…Accordingly, while the protocol is available it has not been recommended for use in multicenter studies, although use at any one site may be satisfactory. 18 More sophisticated means of evaluating neuroimages have since been developed, which should produce improved agreement across sites. Nevertheless, use in one study of 20 CERAD patients with neuropathologically ascertained definite AD, found a significant correlation between neuroimaging evidence of temporal horn enlargement, and autopsy-identified hippocampal atrophy, as well as between severity of cerebral atrophy determined by neuroimaging and MMSE score closest in time to the scan.…”

“…16,17 CERAD also prepared a standardized protocol for neuroimaging in AD, but did not promote it because inter-site agreement on the rating of these neuroimages was considered to be inadequate. 18 Additional evaluated assessments that were developed included a Behavior Rating Scale for Dementia to assess psychopathological behavior in AD, 19,20 a family history assessment for investigators interested in familial aggregation studies and the possible genetics of AD, 21 and since parkinsonism may be manifest with AD, a scale to assess extrapyramidal dysfunction. 22 CERAD also prepared information for ADCs to use to facilitate brain donation; and simply written educational material in English and Spanish, describing the early symptoms of AD, and the appropriate steps to take to handle this condition (see Table 1).…”

A fully automated method for quantifying and localizing white matter hyperintensities on MR images

“…It does not allow accurate information about the location or volume of the WMHs, and thus may ignore some subtle WMH differences across groups. Also different visual rating scales make it difficult to compare or reproduce the findings on WMHs across centers (Davis, et al 1992).…”

Application of Surface-Enhanced Raman Spectroscopy for Detection of Beta Amyloid Using Nanoshells

“…Premortem diagnosis of AD is only probable and is based on in vivo imaging of the brain with magnetic resonance imaging or functional positron emission tomography, along with tests of cognitive and psychological function [20][21][22]. Alzheimer's disease can only be diagnosed definitively by identifying extracellular amyloid plaques composed of amyloid-β (Aβ) and neurofibrillary tangles, which consist of tau proteins, in postmortem central nervous system tissue [5,[23][24][25][26][27][28][29][30].…”