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improving interrater agreement about brain microbleeds: development of the Brain Observer MicroBleed Scale (BOMBS)
Charlotte Cordonnier1, Gillian M Potter, Caroline A Jackson
1Division of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK.
Stroke
|November 15, 2008
Summary
A new scale, the Brain Observer MicroBleed Scale (BOMBS), significantly improved agreement among doctors assessing brain microbleeds (BMBs) in stroke patients. This standardized approach is crucial for understanding BMBs
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Brain microbleeds (BMBs) are increasingly recognized in stroke and TIA patients.
- Accurate assessment of BMBs is essential for understanding their diagnostic and prognostic significance.
- Observer variation in BMB detection on MRI can hinder clinical application.
Purpose of the Study:
- To minimize observer variation in the assessment of brain microbleeds (BMBs).
- To develop and validate a standardized rating scale for BMBs.
- To improve interrater reliability in identifying BMBs on gradient echo MRI.
Main Methods:
- Two physicians assessed BMBs in 264 stroke/TIA patients using a pilot rating scale.
- A third observer adjudicated disagreements, informing the development of the Brain Observer MicroBleed Scale (BOMBS).
- The BOMBS scale was tested on a separate cohort of 156 stroke patients.
Main Results:
- Initial assessment showed moderate agreement for BMB presence (kappa=0.44), with lower reliability in lobar locations.
- The standardized BOMBS scale significantly improved agreement for BMB presence in any location (kappa=0.68).
- BOMBS notably enhanced agreement for lobar BMBs (kappa=0.78), addressing a key area of prior disagreement.
Conclusions:
- Interrater reliability for BMB detection was moderate to good.
- The Brain Observer MicroBleed Scale (BOMBS) effectively improves agreement in BMB assessment.
- BOMBS accounts for major sources of disagreement, facilitating more consistent BMB evaluation.
