title: MRI in the classical MM1 and the atypical MV2 subtypes of sporadic CJD: an inter-observer agreement study.
abstract: OBJECTIVE
  To establish radiological features in the atypical MV2 subtype of sCJD compared with the classical MM1 subtype, as well as region- and sequence-dependent inter-observer correlation.
  
  
  METHODS
  MRI hyperintensity of basal ganglia (BG), cortex and thalamus was evaluated in 31 MM1 and 32 MV2 patients. Each MR scan was analyzed independently by two neuroradiologists blinded to PRNP genotype/prion protein type.
  
  
  RESULTS
  Cumulative T2-sensitivity for BG hyperintensity was higher in the MV2 subtype (84% for both observers versus 61% in observer 1/42% in observer 2 in MM1 patients). Significant inter-observer agreement was found for BG and thalamus on T2, FLAIR, PD and DWI, but for cortex only on DWI. Thalamic changes were significantly more frequent in MV2 than in MM1 patients (cumulative sensitivity 86% vs. 12.5% on DWI).
  
  
  CONCLUSIONS
  The high frequency of thalamic hyperintensity in the MV2 subtype allowed differentiation from MM1 patients. Good inter-observer agreement was found for BG and thalamus in all sequences. DWI showed the highest inter-observer correlation independent of the investigated brain region and was therefore not only highly sensitive but also relatively independent of investigator bias. Since inter-observer correlation for cortical hyperintensity in T2, FLAIR and PD is relatively low, the cortical changes should not be over-interpreted with these sequences.
authors.affiliation: Department of Neurology, Georg-August University Göttingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Krasnianski
authors.forename: K
authors.initials: K
authors.lastname: Kallenberg
authors.forename: D A
authors.initials: DA
authors.lastname: Collie
authors.forename: B
authors.initials: B
authors.lastname: Meissner
authors.forename: W J
authors.initials: WJ
authors.lastname: Schulz-Schaeffer
authors.forename: U
authors.initials: U
authors.lastname: Heinemann
authors.forename: D
authors.initials: D
authors.lastname: Varges
authors.forename: D M
authors.initials: DM
authors.lastname: Summers
authors.forename: H A
authors.initials: HA
authors.lastname: Kretzschmar
authors.forename: T
authors.initials: T
authors.lastname: Talbot
authors.forename: R G
authors.initials: RG
authors.lastname: Will
authors.forename: I
authors.initials: I
authors.lastname: Zerr
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D007562:Creutzfeldt-Jakob Syndrome / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results