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Reader variability in the use of diagnostic terms to describe white matter lesions seen on cranial scans of severely premature infants: The ELGAN study
Author(s) -
Westra Sjirk,
Adler Ira,
Batton Daniel,
Betz Bradford,
Bezinque Steven,
Durfee Sara,
Ecklund Kirsten,
Feinstein Kate,
Fordham Lynn,
Junewick Joseph,
Lorenzo Robert,
McCauley Roy,
Miller Cindy,
Seibert Joanna,
Kuban Karl,
Allred Elizabeth,
Leviton Alan
Publication year - 2010
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.20708
Subject(s) - medicine , white matter , intraventricular hemorrhage , radiology , gestational age , magnetic resonance imaging , pregnancy , genetics , biology
Purpose To evaluate reader variability of white matter lesions seen on cranial sonographic scans of extreme low gestational age neonates (ELGANs). Methods In 1,452 ELGANs, cranial sonographic scans were obtained in the first and second postnatal weeks, and between the third postnatal week and term. All sets of scans were read independently by two sonologists. We reviewed the use of four diagnostic labels: early periventricular leucomalacia, cystic periventricular leucomalacia, periventricular hemorrhagic infarction (PVHI), and other white matter diagnosis, by 16 sonologists at 14 institutions. We evaluated the association of these labels with location and laterality of hyperechoic and hypoechoic lesions, location of intraventricular hemorrhage, and characteristics of ventricular enlargement. Results Experienced sonologists differed substantially in their application of the diagnostic labels. Three readers applied early periventricular leucomalacia to more than one fourth of all the scans they read, whereas eight applied this label to ≤5% of scans. Five applied PVHI to ≥10% of scans, while three applied this label to ≤5% of scans. More than one third of scans labeled cystic periventricular leucomalacia had unilateral hypoechoic lesions. White matter abnormalities in PVHI were more extensive than in periventricular leucomalacia and were more anteriorly located. Hypoechoic lesions on late scans tended to be in the same locations, regardless of the diagnostic label applied. Conclusions Experienced sonologists differ considerably in their tendency to apply diagnostic labels for white matter lesions. This is due to lack of universally agreed‐upon definitions. We recommend reducing this variability to improve the validity of large multicenter studies. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:409–419, 2010