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Published on: July 28, 2013
Qualitative Assessment of Advanced MRI in Post-Treatment High Grade Gliomas Follow Up: Do We Agree?
Nader Zakhari1, Michael Taccone2, Carlos Torres1,3
1Division of Neuroradiology, Department of Radiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, Ottawa, Ontario, Canada.
Purpose:
MRI is commonly used in follow up of high grade glioma. Our purpose is to assess the interrater agreement on the increasingly used visual qualitative assessment of various conventional and advanced MR techniques in the setting of treated high grade glioma in comparison to the well established quantitative measurements.
Methods:
We prospectively enrolled HGG patients who underwent reresection of a new enhancing lesion on post-treatment 3T MR examination including DWI, DCE and DSC sequences. Two neuroradiologists objectively assessed the diffusion and perfusion maps by placing ROI on representative post-processed maps. They subjectively assessed the post-contrast, perfusion and diffusion sequences. Interrater agreement and concordance correlation coefficient were calculated.
Results:
Twenty-eight lesions were included. The interrater agreement on the qualitative assessment was good for k-trans (k = 0.73), moderate for Vp (k = 0.52), fair for AUC and Ve maps (k = 0.37 and 0.21), fair for corrected CBV (k = 0.39) and poor for the enhancement pattern and presence of diffusion restriction (k = 0.02 and 0.07). The concordance between the quantitative measurements was substantial for AUC and Vp (ρc = 0.98 and 0.97), moderate for k-trans and corrected CBV (ρc = 0.94) and poor for Ve and ADC (ρc = 0.86 and 0.24).
Conclusion:
While the quantitative measurements of DSC and DCE perfusion maps show satisfactory inter-rater agreement, the qualitative assessment has lower interobserver agreement and should not be relied upon solely in the interpretation. Similarly, the suboptimal inter-rater agreement on the interpretation of enhancement pattern and diffusion restriction potentially limits their usefulness in differentiating glioma recurrence from treatment related changes.
Insights
Quantitative MRI measurements show good agreement for high-grade glioma follow-up, unlike qualitative assessments. Relying solely on visual interpretation of enhancement patterns and diffusion restriction may hinder accurate diagnosis of glioma recurrence.
Area of Science:
- Radiology
- Neuro-oncology
- Medical Imaging
Background:
- High-grade glioma (HGG) management requires accurate follow-up imaging.
- Magnetic Resonance Imaging (MRI) is crucial for monitoring treatment response and detecting recurrence.
- Advanced MRI techniques, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) perfusion imaging, are increasingly utilized.
Purpose of the Study:
- To evaluate the interrater agreement of qualitative visual assessments for various conventional and advanced MR techniques in treated HGG.
- To compare the reliability of qualitative assessments with established quantitative measurements.
- To determine the utility of these MR techniques in differentiating tumor recurrence from treatment-related changes.
Main Methods:
- Prospective enrollment of HGG patients undergoing resection of new enhancing lesions on post-treatment 3T MRI.
- Inclusion of DWI, DCE, and DSC sequences.
- Objective assessment of diffusion and perfusion maps by two neuroradiologists using regions of interest (ROIs).
- Subjective assessment of post-contrast, perfusion, and diffusion sequences.
- Calculation of interrater agreement (kappa statistic) and concordance correlation coefficient (ρc).
Main Results:
- Quantitative measurements demonstrated substantial to moderate interrater agreement for AUC (ρc=0.98) and Vp (ρc=0.97), and moderate agreement for k-trans and corrected CBV (ρc=0.94).
- Qualitative assessments showed variable interrater agreement, ranging from good for k-trans (k=0.73) to poor for enhancement pattern (k=0.02) and diffusion restriction (k=0.07).
- Quantitative measurements for Ve and ADC showed poor concordance (ρc=0.86 and 0.24, respectively).
Conclusions:
- Quantitative measurements of DSC and DCE perfusion maps exhibit satisfactory interrater agreement, supporting their use in HGG follow-up.
- Qualitative assessments, particularly for enhancement patterns and diffusion restriction, have lower interobserver agreement and should not be solely relied upon.
- Suboptimal inter-rater agreement in qualitative interpretation may limit the ability to reliably differentiate glioma recurrence from treatment effects.
