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 Jack22, Giovanni B Frisoni23. 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.
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.
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.
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