Inter-rater Variability in Assessing Hippocampal Atrophy Using Scheltens Scales

Authors: A. Kadlecová 1,2;  M. Vyhnálek 1,2;  J. Laczó 1,2;  R. Anděl 2,3;  K. Sheardová 4;  B. Urbanová 1;  Z. Nedělská 1,2;  D. Hudeček 2;  I. Gažová 1,2;  J. Lisý 5;  D. Hořínek 2,6;  J. Hort 1,2
Authors‘ workplace: Kognitivní centrum, Neurologická klinika 2. LF UK a FN v Motole, Praha 1;  Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 2;  School of Aging Studies, University of South Florida, Tampa, Florida, USA 3;  Neurologická klinika, Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 4;  Klinika zobrazovacích metod 2. LF UK a FN v Motole, Praha 5;  Neurochirurgická klinika 1. LF UK a ÚVN – Vojenská fakultní nemocnice Praha 6
Published in: Cesk Slov Neurol N 2013; 76/109(5): 603-607
Category: Original Paper

Děkujeme za finanční podporu grantu IGA NT 11225- 4 a projektu FNUSA‑ ICRC (no. CZ.1.05/ 1.1.00/ 02.0123) z Evropského fondu regionálního rozvoje.


Recently, a great emphasis has been placed on early diagnosis of Alzheimer’s disease (AD). The new diagnostic criteria for AD involve new methods such as detection of structural and metabolic changes in the brain. These include examination of hippocampal volume. Scheltens et al. introduced a visual rating scale for hippocampal atrophy assessment. Our aim was to determine inter-rater variability and to test practical application of this scale.

MRI scans of 70 elderly persons with cognitive impairment and persons classified as cognitively normal were assessed by eight investigators. The investigators had a different degree of experience with Scheltens visual rating scale. Following a brief training, the investigators were asked to practice on 20 MRI brain scans in coronal plane. Correct scores were disclosed to all investigators. Subsequently, the investigators evaluated 70 study MRI scans. They were unaware of the participants’ cognitive status. The variability was calculated for all investigators together and after dividing them into “experienced” (n = 4) and “inexperienced” (n = 4) group, where “inexperienced” refered to no previous knowledge of this visual rating scale. Results: Inter-rater agreement (kappa) was very high among all investigators for the right (K = 0.87) and left (K = 0.88) hippocampus. After dividing the raters into experienced and inexperienced, the inter-rater variability continued to be high in both groups for the right and left hippocampus.

Scheltens visual rating scale is a simple and easy to use tool for hippocampal atrophy assessment even for inexperienced investigators. The final assessment variability was relatively low. We can recommend this visual rating scale for routine clinical use.

Key words:
atrophy – hippocampus – visual scale – dementia – Alzheimer disease

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


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