Magnetic Resonance Imaging Hyperintensities in Alzheimer's Disease-Reply

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In Reply. —The significance of white matter and periventricular hyperintensities and the question whether they differ between patients with Alzheimer's disease and age-matched controls remains to be discussed. We found no difference between patients with Alzheimer's disease and normal subjects.1Fazekas and McDonald point out possible methodological bias we would like to discuss in the following nine points: (1) We agree with them that including magnetic resonance imaging scans of lower quality for calculation of interobserver agreement might have lowered κ values in the evaluation of Fazekas' scoring system.2We have again calculated κ among the 27 high-quality magnetic resonance images and we found very small improvements (periventricular hyperintensity, 0.44 instead of 0.43; white matter hyperintensity, 0.58 instead of 0.50). Kozachuck et al3found higher values of κ than we did but most of their subjects had very low periventricular and white matter hyperintensity scores; we think

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