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Frequency and cause of disagreements in diagnoses for fetuses referred for ventriculomegaly.

Abstract：

PURPOSE:To prospectively assess the frequency and cause of disagreements in diagnoses at ultrasonography (US) and magnetic resonance (MR) imaging for fetuses referred for ventriculomegaly (VM). MATERIALS AND METHODS:One hundred ninety-five women, aged 18-44 years, with 200 fetal referrals for VM, were recruited in a prospective IRB-approved, HIPAA-compliant study. Written informed consent was obtained. US scans were prospectively interpreted by three obstetric radiologists and MR examinations were read by one obstetric radiologist and three pediatric neuroradiologists. Final diagnosis was reached by consensus (198 US, 198 MR, and 196 US-MR comparisons). Gestational age, ventricular size, types of disagreements, and reasons for disagreements were recorded. Interreader agreement was assessed with kappa statistics. Ventricular diameter, gestational age, and confidence scores were analyzed by using mixed-model analysis of variance, accounting for correlation within reader and fetus. RESULTS:There was prospective agreement on 118 (60%) of 198 US and 104 (53%) of 198 MR readings. Consensus was more likely when the final diagnosis was isolated VM (83 of 104, 80% at US; 82 of 109, 75% at MR) than when the final diagnosis included other anomalies as well (14 of 63, 22% at US; seven of 68, 10% at MR; P < .001). There was disagreement on 19 (10%) of 196 and 31 (16%) of 196 fetuses about the presence of VM at US and MR, respectively, and on 29 (15%) of 198 and 39 (20%) of 198 fetuses regarding the presence of major findings at US and MR, respectively. Reasons for discrepancies in reporting major findings included errors of observation, lack of real-time US scanning, lack of neuroradiology experience, as well as modality differences in helping depict abnormalities. CONCLUSION:Of radiologists who read high-risk obstetric US and fetal MR images for VM, there is considerable variability in central nervous system diagnosis.

journal_name

Radiology

journal_title

Radiology

authors

Levine D,Feldman HA,Tannus JF,Estroff JA,Magnino M,Robson CD,Poussaint TY,Barnewolt CE,Mehta TS,Robertson RL

doi

10.1148/radiol.2472071067

subject

Has Abstract

pub_date

2008-05-01 00:00:00

pages

516-27

issue

eissn

0033-8419

issn

1527-1315

pii

2472071067

journal_volume

247

pub_type

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Frequency and cause of disagreements in diagnoses for fetuses referred for ventriculomegaly.