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Intra- and interobserver variability of whole-tumour apparent diffusion coefficient measurements in nephroblastoma: a
Annemieke S Littooij1, Paul D Humphries2,3, Øystein E Olsen2
1Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. alittooij@hotmail.com.
Background:
The apparent diffusion coefficient (ADC) is potentially useful for assessing treatment response in nephroblastoma (Wilms tumour). However the precision of ADC measurements in these heterogeneous lesions is unknown.
Objective:
To assess intra- and interobserver variability of whole-tumour ADC measurements in viable parts of nephroblastomas at diagnosis and after preoperative chemotherapy.
Materials And Methods:
We included children with histopathologically proven nephroblastoma who had undergone MRI with diffusion-weighted imaging before and after preoperative chemotherapy. Three independent observers performed whole-tumour ADC measurements of all lesions, excluding non-enhancing areas. One observer evaluated all lesions on two occasions. We performed analyses using Bland-Altman plots and concordance correlation coefficient (CCC) calculations with 95% limits of agreement for median ADC, difference between pre- and post-chemotherapy median ADC (ADC shift) and percentage of pixels with ADC values <1.0 × 10(-3) mm(2)/s.
Results:
In 22 lesions (13 pretreatment and 9 post-treatment) in 10 children the interobserver variability in median ADC and ADC shift were within the interval of approximately ±0.1 × 10(-3) mm(2)/s (limits of agreement for median ADC ranged -0.08-0.11 × 10(-3) mm(2)/s and for ADC-shift -0.11-0.09 × 10(-3) mm(2)/s). The interobserver variability for percentage of low-ADC pixels was larger and also biased. The calculated CCC confirmed good intra- and interobserver agreement (ρ-c ranging from 0.968 to 0.996).
Conclusion:
Measurements of whole-tumour ADC values excluding necrotic areas seem to be sufficiently precise for detection of chemotherapy-related change.
