To assess interobserver variability in estimation of brain atrophy bas
ed on CT, four neuroradiologists examined CT brain images of 150 conse
cutive patients without focal lesions. An independent neuroradiologist
made the following quantitative measurements: frontal horn index, sub
arachnoid space area and the ratio between subarachnoid space area and
inner skull space area. Level of agreement was fair for the presence
(k = 0.24), slight for the degree (mild, moderate, severe) (k = 0.24)
and moderate for the type (cortical, subcortical, mixed) of atrophy (k
= 0.59). There was a highly significant correlation between the numbe
r of observers agreeing and quantitative measurements. We concluded th
at neuroradiologists' subjective estimation of brain atrophy alone is
not reliable. Quantitative measurements would be needed in cases where
the presence of brain atrophy might determine clinical decisions.