Hippocampal Sclerosis Detection with NeuroQuant Compared with Neuroradiologists

S. Louis; M. Morita-Sherman; S. Jones; D. Vegh; W. Bingaman; I. Blumcke; N. Obuchowski; F. Cendes; L. Jehi

doi:10.3174/ajnr.A6454

Abstract

BACKGROUND AND PURPOSE: NeuroQuant is an FDA-approved software that performs automated MR imaging quantitative volumetric analysis. This study aimed to compare the accuracy of NeuroQuant analysis with visual MR imaging analysis by neuroradiologists with expertise in epilepsy in identifying hippocampal sclerosis.

MATERIALS AND METHODS: We reviewed 144 adult patients who underwent presurgical evaluation for temporal lobe epilepsy. The reference standard for hippocampal sclerosis was defined by having hippocampal sclerosis on pathology (n = 61) or not having hippocampal sclerosis on pathology (n = 83). Sensitivities, specificities, positive predictive values, and negative predictive values were compared between NeuroQuant analysis and visual MR imaging analysis by using a McNemar paired test of proportions and the Bayes theorem.

RESULTS: NeuroQuant analysis had a similar specificity to neuroradiologist visual MR imaging analysis (90.4% versus 91.6%; P = .99) but a lower sensitivity (69.0% versus 93.0%, P < .001). The positive predictive value of NeuroQuant analysis was comparable with visual MR imaging analysis (84.0% versus 89.1%), whereas the negative predictive value was not comparable (79.8% versus 95.0%).

CONCLUSIONS: Visual MR imaging analysis by a neuroradiologist with expertise in epilepsy had a higher sensitivity than did NeuroQuant analysis, likely due to the inability of NeuroQuant to evaluate changes in hippocampal T2 signal or architecture. Given that there was no significant difference in specificity between NeuroQuant analysis and visual MR imaging analysis, NeuroQuant can be a valuable tool when the results are positive, particularly in centers that lack neuroradiologists with expertise in epilepsy, to help identify and refer candidates for temporal lobe epilepsy resection. In contrast, a negative test could justify a case referral for further evaluation to ensure that false-negatives are detected.

ABBREVIATIONS:

HS: hippocampal sclerosis
PPV: positive predictive value
NPV: negative predictive value

Footnotes

This research was supported by National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number 1R01NS097719-01A1.
Disclosures: Marcia Morita-Sherman—RELATED: Grant: National Institutes of Health (NIH), Comments: NIH grant 1R01NS097719-01A1*; UNRELATED: Employment: Cleveland Clinic, Comments: Cleveland Clinic pays me as a research fellow; Grants/Grants Pending: NIH, Comments: NIH grant 1R01NS097719-01A1*. Stephen Jones—RELATED: Grant: NIH*; Support for Travel to Meetings for the Study or Other Purposes: NIH, Comments: Travel is part of the NIH grant*; UNRELATED: Consultancy: Monteris International; Expert testimony: Law firm in South Carolina*; Grants/Grants Pending: NIH, Biogen, St Jude, DoD; Payment for Lectures including Service on Speakers Bureaus*: St Jude Hospital; Royalties: Book; Payment for Development of Educational Presentations: Cleveland Clinic Educational Material; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Siemens Ultra High Field meeting, Comments: Covered travel expenses.* Deborah Vegh—RELATED: Grant: Cleveland Clinic, Comments: NIH funded grant activity where I serve as research coordinator and am salaried via the grant*; Support for Travel to Meetings for the Study or Other Purposes: Cleveland Clinic.* Nancy Obuchowski—UNRELATED: Consultancy: IBM, Siemens, QIBA, Comments: Dr Obuchowski provides statistical consulting through a contract with her institution.* Fernando Cendes—RELATED: Grant: São Paulo Research Foundation (FAPESP), Grant 2013/07559-3*; UNRELATED: Consultancy: UCB Pharma; Employment: Universidade Estadual de Campinas-UNICAMP, Brazil; Grants/Grants Pending: CNPq-Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil; Payment for Lectures, Including Service on Speakers Bureaus: UCB Pharma. Lara Jehi—RELATED: Grant: NINDS*; UNRELATED: Grants/Grants Pending: Eisai Inc.* *Money paid to institution.