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Updated: Mar 17, 2026
Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling
Published on: May 30, 2011
Interobserver variability in the radiological assessment of magnetic resonance imaging (MRI) including perfusion MRI
M Kerkhof1, R E Hagenbeek2, B F W van der Kallen2
1Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands. m.kerkhof@mchaaglanden.nl.
Background And Purpose:
Conventional magnetic resonance imaging (MRI) has limited value for differentiation of true tumor progression and pseudoprogression in treated glioblastoma multiforme (GBM). Perfusion weighted imaging (PWI) may be helpful in the differentiation of these two phenomena. Here interobserver variability in routine radiological evaluation of GBM patients is assessed using MRI, including PWI.
Methods:
Three experienced neuroradiologists evaluated MR scans of 28 GBM patients during temozolomide chemoradiotherapy at three time points: preoperative (MR1) and postoperative (MR2) MR scan and the follow-up MR scan after three cycles of adjuvant temozolomide (MR3). Tumor size was measured both on T1 post-contrast and T2 weighted images according to the Response Assessment in Neuro-Oncology criteria. PW images of MR3 were evaluated by visual inspection of relative cerebral blood volume (rCBV) color maps and by quantitative rCBV measurements of enhancing areas with highest rCBV. Image interpretability of PW images was also scored. Finally, the neuroradiologists gave a conclusion on tumor status, based on the interpretation of both T1 and T2 weighted images (MR1, MR2 and MR3) in combination with PWI (MR3).
Results:
Interobserver agreement on visual interpretation of rCBV maps was good (κ = 0.63) but poor on quantitative rCBV measurements and on interpretability of perfusion images (intraclass correlation coefficient 0.37 and κ = 0.23, respectively). Interobserver agreement on the overall conclusion of tumor status was moderate (κ = 0.48).
Conclusions:
Interobserver agreement on the visual interpretation of PWI color maps was good. However, overall interpretation of MR scans (using both conventional and PW images) showed considerable interobserver variability. Therefore, caution should be applied when interpreting MRI results during chemoradiation therapy.
Insights
Interobserver agreement for visual perfusion weighted imaging (PWI) in glioblastoma multiforme (GBM) was good. However, overall MRI interpretation, including PWI, showed significant variability, requiring caution in clinical decision-making.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- Distinguishing tumor progression from pseudoprogression in glioblastoma multiforme (GBM) post-treatment is challenging with conventional MRI.
- Perfusion weighted imaging (PWI) shows potential for improving this differentiation.
Purpose of the Study:
- To assess interobserver variability in the radiological evaluation of GBM patients using MRI, including PWI.
- To evaluate the reliability of PWI in assessing tumor status during chemoradiotherapy.
Main Methods:
- Three neuroradiologists evaluated MR scans of 28 GBM patients at three time points.
- Tumor size was measured using Response Assessment in Neuro-Oncology criteria.
- Perfusion weighted imaging (PWI) was assessed via visual inspection and quantitative relative cerebral blood volume (rCBV) measurements.
Main Results:
- Good interobserver agreement was found for visual interpretation of rCBV maps (κ = 0.63).
- Poor agreement was observed for quantitative rCBV measurements and image interpretability (ICC = 0.37, κ = 0.23).
- Moderate interobserver agreement was noted for the overall tumor status conclusion (κ = 0.48).
Conclusions:
- Visual interpretation of PWI color maps demonstrated good interobserver agreement.
- Overall interpretation of MRI scans, combining conventional and PWI, exhibited considerable interobserver variability.
- Caution is advised when interpreting MRI results during chemoradiation therapy for GBM.
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