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November 23, 2009

The Microbleed Anatomical Rating Scale (MARS)
Reliability of a tool to map brain microbleeds

November 24, 2009 issue
73 (21) 1759-1766

Abstract

Objective: Brain microbleeds on gradient-recalled echo (GRE) T2*-weighted MRI may be a useful biomarker for bleeding-prone small vessel diseases, with potential relevance for diagnosis, prognosis (especially for antithrombotic-related bleeding risk), and understanding mechanisms of symptoms, including cognitive impairment. To address these questions, it is necessary to reliably measure their presence and distribution in the brain. We designed and systematically validated the Microbleed Anatomical Rating Scale (MARS). We measured intrarater and interrater agreement for presence, number, and anatomical distribution of microbleeds using MARS across different MRI sequences and levels of observer experience.
Methods: We studied a population of 301 unselected consecutive patients admitted to our stroke unit using 2 GRE T2*-weighted MRI sequences (echo time [TE] 40 and 26 ms). Two independent raters with different MRI rating expertise identified, counted, and anatomically categorized microbleeds.
Results: At TE = 40 ms, agreement for microbleed presence in any brain location was good to very good (intrarater κ = 0.85 [95% confidence interval (CI) 0.77–0.93]; interrater κ = 0.68 [95% CI 0.58–0.78]). Good to very good agreement was reached for the presence of microbleeds in each anatomical region and in individual cerebral lobes. Intrarater and interrater reliability for the number of microbleeds was excellent (intraclass correlation coefficient [ICC] = 0.98 [95% CI 0.97–0.99] and ICC = 0.93 [0.91–0.94]). Very good interrater reliability was obtained at TE = 26 ms (κ = 0.87 [95% CI 0.61–1]) for definite microbleeds in any location.
Conclusion: The Microbleed Anatomical Rating Scale has good intrarater and interrater reliability for the presence of definite microbleeds in all brain locations when applied to different MRI sequences and levels of observer experience.

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Information & Authors

Information

Published In

Neurology®
Volume 73Number 21November 24, 2009
Pages: 1759-1766
PubMed: 19933977

Publication History

Published online: November 23, 2009
Published in print: November 24, 2009

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Authors

Affiliations & Disclosures

S. M. Gregoire, MD
From the Stroke Research Group (S.M.G., U.J.C., M.M.B., D.J.W.) and Academic Neuroradiological Unit (T.A.Y., R.H.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London; and Medical Statistics Unit (C.K.), London School of Hygiene and Tropical Medicine, UK.
U. J. Chaudhary, MSc
From the Stroke Research Group (S.M.G., U.J.C., M.M.B., D.J.W.) and Academic Neuroradiological Unit (T.A.Y., R.H.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London; and Medical Statistics Unit (C.K.), London School of Hygiene and Tropical Medicine, UK.
M. M. Brown, FRCP
From the Stroke Research Group (S.M.G., U.J.C., M.M.B., D.J.W.) and Academic Neuroradiological Unit (T.A.Y., R.H.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London; and Medical Statistics Unit (C.K.), London School of Hygiene and Tropical Medicine, UK.
T. A. Yousry, FRCR
From the Stroke Research Group (S.M.G., U.J.C., M.M.B., D.J.W.) and Academic Neuroradiological Unit (T.A.Y., R.H.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London; and Medical Statistics Unit (C.K.), London School of Hygiene and Tropical Medicine, UK.
C. Kallis, PhD
From the Stroke Research Group (S.M.G., U.J.C., M.M.B., D.J.W.) and Academic Neuroradiological Unit (T.A.Y., R.H.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London; and Medical Statistics Unit (C.K.), London School of Hygiene and Tropical Medicine, UK.
H. R. Jäger, FRCR
From the Stroke Research Group (S.M.G., U.J.C., M.M.B., D.J.W.) and Academic Neuroradiological Unit (T.A.Y., R.H.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London; and Medical Statistics Unit (C.K.), London School of Hygiene and Tropical Medicine, UK.
D. J. Werring, PhD
From the Stroke Research Group (S.M.G., U.J.C., M.M.B., D.J.W.) and Academic Neuroradiological Unit (T.A.Y., R.H.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London; and Medical Statistics Unit (C.K.), London School of Hygiene and Tropical Medicine, UK.

Notes

Address correspondence and reprint requests to Dr. David J. Werring, Box 6, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK [email protected]

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