Delphi definition of the EADC-ADNI Harmonized Protocol for hippocampal segmentation on magnetic resonance

Marina Boccardi¹, Martina Bocchetta², Liana G Apostolova³, Josephine Barnes⁴, George Bartzokis⁵, Gabriele Corbetta⁶, Charles DeCarli⁷, Leyla deToledo-Morrell⁸, Michael Firbank⁹, Rossana Ganzola⁶, Lotte Gerritsen¹⁰, Wouter Henneman¹¹, Ronald J Killiany¹², Nikolai Malykhin¹³, Patrizio Pasqualetti¹⁴, Jens C Pruessner¹⁵, Alberto Redolfi⁶, Nicolas Robitaille¹⁶, Hilkka Soininen¹⁷, Daniele Tolomeo⁶, Lei Wang¹⁸, Craig Watson¹⁹, Henrike Wolf²⁰, Henri Duvernoy²¹, Simon Duchesne¹⁶, Clifford R Jack Jr²², Giovanni B Frisoni²³; EADC-ADNI Working Group on the Harmonized Protocol for Manual Hippocampal Segmentation

Affiliations

¹ LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy. Electronic address: mboccardifbf@gmail.com.
² 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.
³ Laboratory of NeuroImaging, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁴ Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK.
⁵ Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁶ LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy.
⁷ Department of Neurology, University of California, Davis, Davis, CA, USA.
⁸ Department of Neurological Sciences, Rush University, Chicago, IL, USA.
⁹ Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
¹⁰ Department of Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Psychiatry, VU university Medical Center / GGZ inGeest, Amsterdam, the Netherlands.
¹¹ Department of Radiology and Nuclear Medicine; Image Analysis Center, VU University Medical Center, Amsterdam, The Netherlands.
¹² Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
¹³ Department of Biomedical Engineering, Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ 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.
¹⁵ Department of Psychiatry, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada.
¹⁶ Department of Radiology, Université Laval and Centre de Recherche Université Laval - Robert Giffard, Quebec City, Quebec, Canada.
¹⁷ Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
¹⁸ Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁹ 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.
²⁰ Department of Psychiatry Research and Geriatric Psychiatry, Psychiatric University Hospitals, University of Zurich, Zurich, Switzerland; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
²¹ Chemin des Relançons, Besançon, France.
²² Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA.
²³ 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.

PMID: 25130658
PMCID: PMC4419736
DOI: 10.1016/j.jalz.2014.02.009

Delphi definition of the EADC-ADNI Harmonized Protocol for hippocampal segmentation on magnetic resonance

Marina Boccardi et al. Alzheimers Dement. 2015 Feb.

. 2015 Feb;11(2):126-38.

doi: 10.1016/j.jalz.2014.02.009. Epub 2014 Aug 15.

Authors

Affiliations

¹ LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy. Electronic address: mboccardifbf@gmail.com.
² 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.
³ Laboratory of NeuroImaging, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁴ Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK.
⁵ Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁶ LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS - S. Giovanni di Dio - Fatebenefratelli Brescia, Italy.
⁷ Department of Neurology, University of California, Davis, Davis, CA, USA.
⁸ Department of Neurological Sciences, Rush University, Chicago, IL, USA.
⁹ Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
¹⁰ Department of Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Psychiatry, VU university Medical Center / GGZ inGeest, Amsterdam, the Netherlands.
¹¹ Department of Radiology and Nuclear Medicine; Image Analysis Center, VU University Medical Center, Amsterdam, The Netherlands.
¹² Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
¹³ Department of Biomedical Engineering, Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ 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.
¹⁵ Department of Psychiatry, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada.
¹⁶ Department of Radiology, Université Laval and Centre de Recherche Université Laval - Robert Giffard, Quebec City, Quebec, Canada.
¹⁷ Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
¹⁸ Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁹ 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.
²⁰ Department of Psychiatry Research and Geriatric Psychiatry, Psychiatric University Hospitals, University of Zurich, Zurich, Switzerland; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
²¹ Chemin des Relançons, Besançon, France.
²² Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA.
²³ 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.

PMID: 25130658
PMCID: PMC4419736
DOI: 10.1016/j.jalz.2014.02.009

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.

Discussion: Consensus was achieved among international experts with respect to hippocampal segmentation using MR resulting in a harmonized segmentation protocol.

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.

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Figures

**Fig. 1**
Evidence-based Delphi procedure used for defining the Harmonized Protocol for manual hippocampal segmentation.

**Fig. 2**
Example of information provided to panelists in the Delphi rounds for the definition of landmarks. Abbreviation: SUs, segmentation units.

**Fig. 3**
Consensus on landmarks through the Delphi panel voting sessions. Agreement for the inclusion of each SU was expressed through a Likert scale, from 1 (“I fully disagree”) to 9 (“I fully agree”). Subiculum—horizontal line was voted as a “second choice” criterion for those slices where no morphologic details can be detected, that would allow for the adoption of the Subiculum—morphology criterion. The Minimum Hippocampus (red SU) was included a priori since it was the part included by all of the protocols surveyed in [9]. Abbreviation: SU, segmentation unit.

See this image and copyright information in PMC

References

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1. Frisoni GB, Jack CR. Harmonization of magnetic resonance-based manual hippocampal segmentation: a mandatory step for wide clinical use. Alzheimers Dement. 2011;7:171–4. - PubMed

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Delphi definition of the EADC-ADNI Harmonized Protocol for hippocampal segmentation on magnetic resonance

Affiliations

Delphi definition of the EADC-ADNI Harmonized Protocol for hippocampal segmentation on magnetic resonance

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical