Related Experiment Videos
Variation in the diagnosis of vesicoureteric reflux using micturating cystourethrography
J C Craig1, L M Irwig, J Christie
1Centre for Kidney Research, New Children's Hospital, Sydney, Australia.
Insights
Experienced pediatric radiologists show high agreement in interpreting micturating cystourethrograms (MCUs) for diagnosing vesicoureteric reflux in children. This consistency suggests reporting variability does not explain differences in medical care for these patients.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Urology
Background:
- Vesicoureteric reflux (VUR) is a common condition in children, often diagnosed via micturating cystourethrography (MCU).
- Variability in radiological interpretation can impact diagnostic accuracy and subsequent patient management.
- Standardized grading systems aim to reduce inter-observer variability in MCU interpretation.
Purpose of the Study:
- To evaluate the inter-observer agreement among pediatric radiologists in interpreting MCUs for VUR diagnosis.
- To determine if reporting variability contributes to discrepancies in medical care for children with suspected VUR.
Main Methods:
- Retrospective review of 265 MCUs from children aged 0.5-61 months investigated for first-time urinary tract infections.
- Three experienced pediatric radiologists independently interpreted MCUs using the International Reflux Study grading system (grades 0-V).
- Agreement was assessed using percentage agreement and kappa statistics, with weighted measures accounting for grade differences.
Main Results:
- Near-perfect agreement was observed for VUR diagnosis and grading in individual patients (96%-97% agreement, 90%-91% kappa).
- High agreement persisted for individual kidneys (97%-98% agreement, 89%-92% kappa).
- Weighted agreement scores further confirmed robust consistency in interpretations.
Conclusions:
- Experienced pediatric radiologists demonstrate high inter-observer reliability in interpreting MCUs for VUR diagnosis and grading.
- Discrepancies in medical care for children with suspected VUR are unlikely due to variability in MCU reporting.
- Standardized interpretation protocols contribute to consistent diagnostic outcomes in pediatric VUR assessment.
Abstract:
Variability in the interpretation of micturating cystourethrography by paediatric radiologists for the diagnosis of vesicoureteric reflux in children was evaluated. All 265 micturating cystourethrograms (MCUs) that were available from 304 consecutive children aged 0.5-61 months-who were investigated after their first urine infection between 1993 and 1995 as part of a prospective cohort study-were selected for interpretation. Three experienced paediatric radiologists from the same department independently interpreted the MCUs according to the grading system of the International Reflux Study in Children, from grades 0 to V, with the presence of intrarenal reflux also noted. Apart from being informed that urine infection was the indication for the MCU, no other clinical information was given to the radiologists. The indices of variability used were the percentage of agreement and the kappa statistic, expressed as a percentage. Both measures were weighted with integers representing the number of categories from perfect agreement. Disagreement was analysed for children and kidneys. For the diagnosis of vesicoureteric reflux in individual patients, including grade, the percentage of agreement was 96%-97% (kappa 90%-91%) and the weighted percentage of agreement was 96%-98% (weighted kappa 93%-94%). The same high level of agreement was present for individual kidneys, with a percentage of agreement of 97%-98% (kappa 89%-92%) and a weighted percentage of agreement of 98%-99% (kappa 94%-95%). There was near perfect agreement in the interpretation of radiological micturating cystourethrography among three experienced paediatric radiologists for the diagnosis and grade of vesicoureteric reflux. Any variations in the medical care of children suspected of having vesicoureteric reflux are not explained by differences in the reporting of this diagnostic test.