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2015 ; 39
(3-4
): 224-31
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gab.com Text
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Cerebral perivascular spaces visible on magnetic resonance imaging: development
of a qualitative rating scale and its observer reliability
#MMPMID25823458
Potter GM
; Chappell FM
; Morris Z
; Wardlaw JM
Cerebrovasc Dis
2015[]; 39
(3-4
): 224-31
PMID25823458
show ga
BACKGROUND: Perivascular spaces (PVS) are an important component of cerebral
small vessel disease (SVD), several inflammatory disorders, hypertension and
blood-brain barrier breakdown, but are difficult to quantify. A recent
international collaboration of SVD experts has highlighted the need for a robust,
easy-to-use PVS rating scale for the effective investigation of the diagnostic
and prognostic significance of PVS. The purpose of the current study was to
develop and extend existing PVS scales to provide a more comprehensive scale for
the measurement of PVS in the basal ganglia, centrum semiovale and midbrain, and
to test its intra- and inter-rater agreement, assessing reasons for discrepancy.
METHODS: We reviewed previously published PVS scales, including site of PVS
assessed, rating method, and size and morphological criteria. Retaining key
features, we devised a more comprehensive scale in order to improve the
reliability of PVS rating. Two neuroradiologists tested the new scale in MRI
brain scans of 60 patients from two studies (stroke, ageing population), chosen
to represent a full range of PVS, and demonstrating concomitant features of SVD
such as lacunes and white matter hyperintensities. We rated basal ganglia,
centrum semiovale, and midbrain PVS. Basal ganglia and centrum semiovale PVS were
rated 0 (none), 1 (1-10), 2 (11-20), 3 (21-40) and 4 (>40), and midbrain PVS were
rated 0 (none visible) or 1 (visible). We calculated kappa statistics for rating,
assessed consistency in use of PVS categories (Bhapkar test) and reviewed sources
of discrepancy. RESULTS: Intra- and inter-rater kappa statistics were highest for
basal ganglia PVS (range 0.76-0.87 and 0.8-0.9, respectively) than for centrum
semiovale PVS (range 0.68-0.75 and 0.61-0.8, respectively) or midbrain PVS
(inter-rater range 0.51-0.52). Inter-rater consistency was better for basal
ganglia compared to centrum semiovale PVS (Bhapkar statistic 2.49-3.72, compared
to 6.79-21.08, respectively). Most inter-rater disagreements were due to very
faint PVS, coexisting extensive white matter hyperintensities (WMH) or the
presence of lacunes. CONCLUSIONS: We developed a more inclusive and robust visual
PVS rating scale allowing rating of all grades of PVS severity on structural
brain imaging. The revised PVS rating scale has good observer reliability for
basal ganglia and centrum semiovale PVS, best for basal ganglia PVS, and moderate
reliability for midbrain PVS. Agreement is influenced by PVS severity and the
presence of background features of SVD. The current scale can be used in further
studies to assess the clinical implications of PVS.