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. 2025 May 14;15(10):1246.
doi: 10.3390/diagnostics15101246.

Radiological Reporting of Brain Atrophy in MRI: Real-Life Comparison Between Narrative Reports, Semiquantitative Scales and Automated Software-Based Volumetry

Federico Bruno  1   2 , Cristina Fagotti  1 , Gaspare Saltarelli  1 , Giovanni Di Cerbo  1 , Alessandra Sabatelli  1 , Claudia De Felici  1 , Antonio Innocenzi  1 , Ernesto Di Cesare  1 , Alessandra Splendiani  1
Affiliations

Radiological Reporting of Brain Atrophy in MRI: Real-Life Comparison Between Narrative Reports, Semiquantitative Scales and Automated Software-Based Volumetry

Federico Bruno et al. Diagnostics (Basel). .

Abstract

Background: Accurate assessment of brain atrophy is essential in the diagnosis and monitoring of brain aging and neurodegenerative disorders. Radiological methods range from narrative reporting to semi-quantitative visual rating scales (VRSs) and fully automated volumetric software. However, their integration and consistency in clinical practice remain limited. Methods: In this retrospective study, brain MRI images of 43 patients were evaluated. Brain atrophy was assessed by extrapolating findings from narrative radiology reports, three validated VRSs (MTA, Koedam, Pasquier), and Pixyl.Neuro.BV, a commercially available volumetric software platform. Agreement between methods was assessed using intraclass correlation coefficients (ICCs), Cohen's kappa, Spearman's correlation, and McNemar tests. Results: Moderate correlation was found between narrative reports and VRSs (ρ = 0.55-0.69), but categorical agreement was limited (kappa = 0.21-0.30). Visual scales underestimated atrophy relative to software (mean scores: VRSs = 0.196; software = 0.279), while reports tended to overestimate. Agreement between VRSs and software was poor (kappa = 0.14-0.33), though MTA showed a significant correlation with hippocampal volume. Agreement between reports and software was lowest for global atrophy. Conclusions: Narrative reports, while common in practice, show low consistency with structured scales and quantitative software, especially in subtle cases. VRSs improve standardization but remain subjective and less sensitive. Integrating structured scales and volumetric tools into clinical workflows may enhance diagnostic accuracy and consistency in dementia imaging.

Keywords: MRI; automated software; brain atrophy; brain volumetry; dementia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Example of Pixyl report after MRI brain volumetry, illustrating the software’s quantitative volumetric measurements of brain structures. The report includes measures of global brain volume, regional volumes (e.g., hippocampus, ventricles), and comparisons to an age-matched normative database.
Figure 2
Figure 2
Percentage distribution of “normal” vs. “pathological” classifications across radiology reports, visual rating scales, and automated volumetric software.
See this image and copyright information in PMC

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