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

Alzheimers Dement. 2015 Feb;11(2):126-38. doi: 10.1016/j.jalz.2014.02.009. Epub 2014 Aug 15.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alzheimer Disease / pathology
  • Atrophy
  • Consensus
  • Delphi Technique
  • Hippocampus / anatomy & histology
  • Hippocampus / pathology*
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Imaging, Three-Dimensional / methods
  • Internationality
  • Magnetic Resonance Imaging / methods*
  • Neuroimaging / methods*