title: Delphi definition of the EADC-ADNI Harmonized Protocol for hippocampal segmentation on magnetic resonance.
abstract: BACKGROUND
  This study aimed to have international experts converge on a harmonized definition of whole hippocampus boundaries and segmentation procedures, to define standard operating procedures for magnetic resonance (MR)-based manual hippocampal segmentation.
  
  
  METHODS
  The panel received a questionnaire regarding whole hippocampus boundaries and segmentation procedures. Quantitative information was supplied to allow evidence-based answers. A recursive and anonymous Delphi procedure was used to achieve convergence. Significance of agreement among panelists was assessed by exact probability on Fisher's and binomial tests.
  
  
  RESULTS
  Agreement was significant on the inclusion of alveus/fimbria (P = .021), whole hippocampal tail (P = .013), medial border of the body according to visible morphology (P = .0006), and on this combined set of features (P = .001). This definition captures 100% of hippocampal tissue, 100% of Alzheimer's disease-related atrophy, and demonstrated good reliability on preliminary intrarater (0.98) and inter-rater (0.94) estimates.
  
  
  CONCLUSIONS
  Consensus was achieved among international experts with respect to hippocampal segmentation using MR resulting in a harmonized segmentation protocol.
authors.affiliation: LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy. Electronic address: mboccardifbf@gmail.com.
authors.forename: Marina
authors.initials: M
authors.lastname: Boccardi
authors.affiliation: LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Bocchetta
authors.affiliation: Laboratory of NeuroImaging, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Liana G
authors.initials: LG
authors.lastname: Apostolova
authors.affiliation: Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK.
authors.forename: Josephine
authors.initials: J
authors.lastname: Barnes
authors.affiliation: Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Bartzokis
authors.affiliation: LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Corbetta
authors.affiliation: Department of Neurology, University of California, Davis, Davis, CA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.affiliation: Department of Neurological Sciences, Rush University, Chicago, IL, USA.
authors.forename: Leyla
authors.initials: L
authors.lastname: deToledo-Morrell
authors.affiliation: Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Firbank
authors.affiliation: LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Ganzola
authors.affiliation: Department of Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Psychiatry, VU university Medical Center / GGZ inGeest, Amsterdam, the Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: Gerritsen
authors.affiliation: Department of Radiology and Nuclear Medicine; Image Analysis Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Henneman
authors.affiliation: Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Killiany
authors.affiliation: Department of Biomedical Engineering, Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Malykhin
authors.affiliation: SeSMIT (Service for Medical Statistics and Information Technology) - AFaR (Fatebenefratelli Association for Research), Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; Unit of Clinical and Molecular Epidemiology, IRCCS "San Raffaele Pisana", Rome, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pasqualetti
authors.affiliation: Department of Psychiatry, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada.
authors.forename: Jens C
authors.initials: JC
authors.lastname: Pruessner
authors.affiliation: LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Redolfi
authors.affiliation: Department of Radiology, Université Laval and Centre de Recherche Université Laval - Robert Giffard, Quebec City, Quebec, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Robitaille
authors.affiliation: Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
authors.forename: Hilkka
authors.initials: H
authors.lastname: Soininen
authors.affiliation: LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Tolomeo
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Neurology and the Department of Anatomy & Cell Biology, Wayne State University School of Medicine, D-University Health Center, St. Antoine, Detroit, MI, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Watson
authors.affiliation: Department of Psychiatry Research and Geriatric Psychiatry, Psychiatric University Hospitals, University of Zurich, Zurich, Switzerland; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
authors.forename: Henrike
authors.initials: H
authors.lastname: Wolf
authors.affiliation: Chemin des Relançons, Besançon, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Duvernoy
authors.affiliation: Department of Radiology, Université Laval and Centre de Recherche Université Laval - Robert Giffard, Quebec City, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Duchesne
authors.affiliation: Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA.
authors.forename: Clifford R
authors.initials: CR
authors.lastname: Jack
authors.affiliation: LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy; Memory Clinic and LANVIE (Laboratory of Neuroimaging of Aging), University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Frisoni
mesh_terms: D000544:Alzheimer Disease / Q000473:pathology; D001284:Atrophy; D032921:Consensus; D003697:Delphi Technique; D006624:Hippocampus / Q000033:anatomy & histology / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D038622:Internationality; D008279:Magnetic Resonance Imaging / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*
keywords: Alzheimer's disease; Anatomical landmarks; Atrophy; Delphi procedure; Enrichment; Harmonization; Hippocampal atrophy; Hippocampus; MCI; Magnetic resonance; Manual segmentation; Medial temporal lobe; Neuroimaging; Reliability; Standard operational procedures; Volumetry