title: Improved interobserver agreement for visual detection of active T2 lesions on serial MR scans in multiple sclerosis using image registration.
abstract: The aim of this study was to analyse the effect of image registration on interobserver agreement in the visual detection of active multiple sclerosis (MS) lesions from serial magnetic resonance (MR) scans. T2W spin-echo MR scans (3-mm slices) of 16 MS patients participating in a treatment trial were selected. For each patient, two pairs of scans were used: an original (i. e., non-registered) and a registered pair. For the original pair, baseline and month 6 were used, and for the registered pair month 3 and 9. For registration an automatic matching algorithm based on Mutual Information was used. Six observers identified active lesions on both original and registered scans. Kappa values were calculated to assess interobserver agreement. Reslicing caused a slight blurring of the images, but near perfect registration. The kappa value of 0.35 +/- 0.07 for new lesions on original images improved to 0.62 (+/- 0.06) by registration (p = 0.004). For enlarging lesions on original images it was extremely poor (kappa 0.11 +/- 0.05), and did not benefit much by registration (kappa 0.20 +/- 0.11). Thus, image registration improved interobserver agreement for visual detection of new lesions. For enlarging lesions, registration improved agreement but still not to a satisfactory level.
authors.affiliation: MR Centre for MS research, VU Medical Centre, Amsterdam, The Netherlands. il.tan@azvu.nl
authors.forename: I L
authors.initials: IL
authors.lastname: Tan
authors.forename: R A
authors.initials: RA
authors.lastname: van Schijndel
authors.forename: F
authors.initials: F
authors.lastname: Fazekas
authors.forename: M
authors.initials: M
authors.lastname: Filippi
authors.forename: P
authors.initials: P
authors.lastname: Freitag
authors.forename: D H
authors.initials: DH
authors.lastname: Miller
authors.forename: T A
authors.initials: TA
authors.lastname: Yousry
authors.forename: P J
authors.initials: PJ
authors.lastname: Pouwels
authors.forename: H J
authors.initials: HJ
authors.lastname: Adèr
authors.forename: M J
authors.initials: MJ
authors.lastname: Quist
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
mesh_terms: D000328:Adult; D000465:Algorithms; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis*; D015588:Observer Variation; D011897:Random Allocation