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Peripheral Nerve Diffusion Tensor Imaging

Interreader and Test-retest Reliability as Quantified by the Standard Error of Measurement

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Abstract

Purpose

Diffusion tensor imaging (DTI) is increasingly being used in magnetic resonance neurography (MRN). The purpose of this study was to determine the interreader and test-retest reliability of peripheral nerve DTI in MRN with focus on the sciatic nerve.

Methods

In this prospective study 27 healthy volunteers each underwent 3 scans of a short DTI protocol on separate days consisting of a T2-weighted turbo spin-echo and single-shot DTI sequence of the sciatic nerve of the dominant leg. The DTI parameters fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were obtained after manual nerve segmentation by two independent readers. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), and Bland-Altman plots were calculated as measures for both interreader and test-retest agreement for all readout parameters.

Results

The mean ± standard deviation was 0.507 ± 0.05 for FA, 1308.5 ± 162.4 × 10−6 mm2/s for MD, 905.6 ± 145.4 ×10−6 mm2/s for RD and 2114.1 ± 219.2 × 10−6 mm2/s for AD. The SEM for FA was 0.02 for interreader and test-retest agreement, the SEM for MD, RD, and AD ranged between 46.2 × 10−6 mm2/s (RD) and 70.1 × 10−6 mm2/s (AD) for interreader reliability and between 45.9 × 10−6 mm2/s (RD) and 70.1 × 10−6 mm2/s (AD) for test-retest reliability. The ICC for interreader reliability of DTI parameters ranged between 0.81 and 0.92 and ICC for test-retest reliability between 0.76 and 0.91.

Conclusion

Peripheral nerve DTI of the sciatic nerve is reliable and reproducible. The measures presented here may serve as first orientation values of measurement accuracy when interpreting parameters of sciatic nerve DTI.

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Abbreviations

AD:

Axial diffusivity

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

ICC:

Intra-class correlation coefficient

MD:

Mean diffusivity

MRN:

Magnetic resonance neurography

RD:

Radial diffusivity

SEM:

Standard error of measurement

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Funding

Supported in part by the German Research Council (SFB 1118, S.H.; SFB 1158, M.B.).

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Authors and Affiliations

  1. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Fabian Preisner, Philipp Bäumer, Sabine Heiland, Martin Bendszus & Moritz Kronlage

  2. Center for Radiology Dia.log, Vinzenz-von-Paul Str. 8, 84503, Altötting, Germany

    Philipp Bäumer

  3. Department of Sports Medicine (Internal Medicine VII), Medical Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Michaela Wehrstein & Birgit Friedmann-Bette

  4. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Matthes Hackbusch

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  1. Fabian Preisner
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Correspondence to Moritz Kronlage.

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Conflict of interest

F. Preisner, P. Bäumer, M. Wehrstein, B. Friedmann-Bette, M. Hackbusch, S. Heiland, M. Bendszus and M. Kronlage declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Caption Electronic Supplementary Material

Supplementary Fig. 1

Descriptive statistics for both readers visualized as scattered dot plots to show the full distribution of values. Median and quartiles are presented by lines.

Supplementary Fig. 2–4

Bland-Altman plots for assessment of test-retest reliability of mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) values for both observers and all three scans, respectively. Plots as typically illustrated with single values for bias (grey line) as well as for upper and lower limits of agreement (dotted lines)

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Preisner, F., Bäumer, P., Wehrstein, M. et al. Peripheral Nerve Diffusion Tensor Imaging. Clin Neuroradiol 30, 679–689 (2020). https://doi.org/10.1007/s00062-019-00859-0

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