Intra-reader Agreement Research Articles

Differentiate adrenal lipid-poor adenoma from nodular hyperplasia with CT quantitative parameters: a feasibility study.

To explore the potential of CT quantitative parameters in differentiating adrenal lipid-poor adenoma (LPA) from nodular hyperplasia and evaluate diagnostic performance. Patients with LPA or nodular hyperplasia who underwent contrast-enhanced CT before adrenalectomy were analyzed retrospectively. The study included 128 patients (83 with LPA and 45 with nodular hyperplasia). Each lesion's unenhanced attenuation, portal-venous phase attenuation (CTp), and the portal-venous phase attenuation of the abdominal aorta were evaluated. We subsequently calculated absolute enhancement [a lesion's portal-venous phase attenuation minus unenhanced attenuation (in HUs)], relative enhancement (absolute enhancement divided by unenhanced attenuation), and the relative enhancement ratio [(absolute enhancement divided by abdominal aorta's portal-venous phase attenuation) ×100%]. Lesion number and size were recorded. Volume was assessed by ITK-snap software and the ratio of lesion volume to ipsilateral adrenal volume (volume ratio) was determined. Intergroup differences were analyzed using Student's t-test and chi-squared test. Logistic regression models were developed, and receiver operating characteristic (ROC) curves were constructed to determine the area under the ROC curve (AUC), sensitivity, and specificity. The model's performance was then compared against radiologists' subjective assessments, and the inter- and intra-reader agreement values among radiologists were calculated. Portal-venous phase attenuation, volume ratio, and lesion number were independent predictors of LPA. The logistic regression model incorporating CTp, volume ratio, and lesion number achieved an AUC of 0.835, with a sensitivity of 73.5% and a specificity of 80.0%. The radiologists' diagnostic specificity and accuracy appeared to be inferior to the model. The inter-reader agreement among radiologists ranged from 0.082 to 0.535, and the intra-reader agreement of two radiologists were 0.734 and 0.583. The portal-venous phase CT demonstrated potential in distinguishing LPA from nodular hyperplasia. The diagnostic performance of the model integrating CTp, volume ratio, and lesion number outperformed radiologists in terms of variability and reproducibility.

Assessment of the supraspinatus muscle fiber architecture with diffusion tensor imaging in healthy volunteers

ObjectivesThis study presents a framework for the calculation of supraspinatus (SSP) muscle pennation angles (PAs) from diffusion tensor imaging (DTI).Materials and methodsTen healthy individuals (five females and five males; age 32.0 ± 4.7 years) underwent three sessions of 3-T MRI, including a stimulated echo acquisition mode DTI sequence. The imaging plane of the DTI sequence was angled along the intramuscular part of the SSP tendon. A custom-built software was developed and implemented to compute DTI-based PAs of the anterior and posterior SSP in relation to the orientation of the tendon. Subsequently, three readers measured PAs from the post-processed images. Test-retest reliability, inter-reader agreement, and intra-reader agreement of PA measurements were evaluated with intraclass correlation coefficients (ICCs).ResultsThe mean PA in the anterior SSP was 15.6 ± 2.1° and 10.7 ± 0.9° in the posterior SSP. MRI-derived PAs showed good to excellent test-retest reliability (ICC: 0.856–0.945), inter-reader agreement (ICC: 0.863–0.955), and intra-reader agreement (ICC: 0.804–0.955).ConclusionPAs derived from DTI demonstrated good to excellent test-retest reliability, inter-reader agreement, and intra-reader agreement. We successfully implemented a highly standardized technique for evaluating PAs of the SSP muscle.Critical relevance statementThis proposed low-complex method might facilitate the increased use of the PA as a biomarker for pathological conditions of the rotator cuff.Key PointsA low-complex method for measuring PAs of the SSP might help identify pathology early.The mean PA was 15.6 ± 2.1° and 10.7 ± 0.9° in the anterior and posterior SSP, respectively.ICCs were ≥ 0.856 for test-retest reliability, ≥ 0.863 for inter-reader agreement, and ≥ 0.804 for intra-reader agreement.Graphical

Deep Learning-Enhanced Accelerated 2D TSE and 3D Superresolution Dixon TSE for Rapid Comprehensive Knee Joint Assessment.

The aim of this study was to evaluate the use of a multicontrast deep learning (DL)-reconstructed 4-fold accelerated 2-dimensional (2D) turbo spin echo (TSE) protocol and the feasibility of 3-dimensional (3D) superresolution reconstruction (SRR) of DL-enhanced 6-fold accelerated 2D Dixon TSE magnetic resonance imaging (MRI) for comprehensive knee joint assessment, by comparing image quality and diagnostic performance with a conventional 2-fold accelerated 2D TSE knee MRI protocol. This prospective, ethics-approved study included 19 symptomatic adult subjects who underwent knee MRI on a clinical 3 T scanner. Every subject was scanned with 3 DL-enhanced acquisition protocols in a single session: a clinical standard 2-fold in-plane parallel imaging (PI) accelerated 2D TSE-based protocol (5 sequences, 11 minutes 23 seconds) that served as a reference, a DL-reconstructed 4-fold accelerated 2D TSE protocol combining 2-fold PI and 2-fold simultaneous multislice acceleration (5 sequences, 6 minutes 24 seconds), and a 3D SRR protocol based on DL-enhanced 6-fold accelerated (ie, 3-fold PI and 2-fold simultaneous multislice) 2D Dixon TSE MRI (6 anisotropic 2D Dixon TSE acquisitions rotated around the phase-encoding axis, 6 minutes 24 seconds). This resulted in a total of 228 knee MRI scans comprising 21,204 images. Three readers evaluated all pseudonymized and randomized images in terms of image quality using a 5-point Likert scale. Two of the readers (musculoskeletal radiologists) additionally evaluated anatomical visibility and diagnostic confidence to assess normal and pathological knee structures with a 5-point Likert scale. They recorded the presence and location of internal knee derangements, including cartilage defects, meniscal tears, tears of ligaments, tendons and muscles, and bone injuries. The statistical analysis included nonparametric Friedman tests, and interreader and intrareader agreement assessment using the weighted Fleiss-Cohen kappa (κ) statistic. P values of less than 0.05 were considered statistically significant. The evaluated DL-enhanced 4-fold accelerated 2D TSE protocol provided very similar image quality and anatomical visibility to the standard 2D TSE protocol, whereas the 3D SRR Dixon TSE protocol scored less in terms of overall image quality due to reduced edge sharpness and the presence of artifacts (P < 0.001). Subjective signal-to-noise ratio, contrast resolution, fluid brightness, and fat suppression were good to excellent for all protocols. For 1 reader, the Dixon method of the 3D SRR protocol provided significantly better fat suppression than the spectral fat saturation applied in the standard 2D TSE protocol (P < 0.05). The visualization of knee structures with 3D SRR Dixon TSE was very similar to the standard protocol, except for cartilage, tendons, and bone, which were affected by the presence of reconstruction and aliasing artifacts (P < 0.001). The diagnostic confidence of both readers was high for all protocols and all knee structures, except for cartilage and tendons. The standard 2D TSE protocol showed a significantly higher diagnostic confidence for assessing tendons than 3D SRR Dixon TSE MRI (P < 0.01). The interreader and intrareader agreement for the assessment of internal knee derangements using any of the 3 protocols was substantial to almost perfect (κ = 0.67-1.00). For cartilage, the interreader agreement was substantial for DL-enhanced accelerated 2D TSE (κ = 0.79) and almost perfect for standard 2D TSE (κ = 0.98) and 3D SRR Dixon TSE (κ = 0.87). For menisci, the interreader agreement was substantial for 3D SRR Dixon TSE (κ = 0.70-0.80) and substantial to almost perfect for standard 2D TSE (κ = 0.80-0.99) and DL-enhanced 2D TSE (κ = 0.87-1.00). Moreover, the total acquisition time was reduced by 44% when using the DL-enhanced accelerated 2D TSE or 3D SRR Dixon TSE protocol instead of the conventional 2D TSE protocol. The presented DL-enhanced 4-fold accelerated 2D TSE protocol provides image quality and diagnostic performance similar to the standard 2D protocol. Moreover, the 3D SRR of DL-enhanced 6-fold accelerated 2D Dixon TSE MRI is feasible for multicontrast 3D knee MRI as its diagnostic performance is comparable to standard 2-fold accelerated 2D knee MRI. However, reconstruction and aliasing artifacts need to be further addressed to guarantee a more reliable visualization and assessment of cartilage, tendons, and bone. Both the 2D and 3D SRR DL-enhanced protocols enable a 44% faster examination compared with conventional 2-fold accelerated routine 2D TSE knee MRI and thus open new paths for more efficient clinical 2D and 3D knee MRI.

Inter-visit and inter-reader reproducibility of multi-parametric diffusion-weighted MR imaging in longitudinally imaged patients with metabolic dysfunction-associated fatty liver disease and healthy volunteers.

BackgroundDespite the widespread use of diffusion-weighted imaging (DWI) in metabolic dysfunction-associated fatty liver disease (MAFLD), MRI acquisition and quantification techniques vary in the literature suggesting the need for established and reproducible protocols. The goal of this study was to assess inter-visit and inter-reader reproducibility of DWI- and IVIM-derived parameters in patients with MAFLD and healthy volunteers using extensive sampling of the “fast” compartment, non-rigid registration, and exclusion voxels with poor fit quality. MethodsFrom June 2019 to April 2023, 31 subjects (20 patients with biopsy-proven MAFLD and 11 healthy volunteers) were included in this IRB-approved study. Subjects underwent MRI examinations twice within 40 days. 3.0 T DWI was acquired using a respiratory-triggered spin-echo diffusion-weighted echo-planar imaging sequence (b-values of 0, 10, 20, 30, 40, 50, 100, 200, 400, 800 s/mm2). DWI series were co-registered prior to voxel-wise non-linear regression of the IVIM model and voxels with poor fit quality were excluded (normalized root mean squared error ≥ 0.05). IVIM parameters (perfusion fraction, f; diffusion coefficient, D; and pseudo-diffusion coefficient, D*), and apparent diffusion coefficients (ADC) were computed from manual segmentation of the right liver lobe performed by two analysts on two MRI examinations. ResultsAll results are reported for f, D, D*, and ADC respectively. For inter-reader agreement on the first visit, ICC were of 0.985, 0.994, 0.986, and 0.993 respectively. For intra-reader agreement of analyst 1 assessed on both imaging examinations, ICC between visits were of 0.805, 0.759, 0.511, and 0.850 respectively. For inter-reader agreement on the first visit, mean bias and 95 % limits of agreement were (0.00 ± 0.03), (−0.01 ± 0.03) × 10−3 mm2/s, (0.70 ± 10.40) × 10−3 mm2/s, and (−0.02 ± 0.04) × 10−3 mm2/s respectively. For intra-reader agreement of analyst 1, mean bias and 95 % limits of agreement were (0.01 ± 0.09) × 10−3 mm2/s, (−0.01 ± 0.21) × 10−3 mm2/s, (−13.37 ± 56.19) × 10−3 mm2/s, and (−0.01 ± 0.16) × 10−3 mm2/s respectively. Except for parameter D* that was associated with between-subjects parameter variability (P = 0.009), there was no significant variability between subjects, examinations, or readers. ConclusionWith our approach, IVIM parameters f, D, D*, and ADC provided excellent inter-reader agreement and good to very good inter-visit or intra-reader agreement, thus showing the reproducibility of IVIM-DWI of the liver in MAFLD patients and volunteers.

Identifying enthesitis in the sacroiliac joints in patients with axial spondyloarthritis by readers of varying experience: impact of the learning progress

BackgroundThis study aimed to investigate the accuracy of identifying enthesitis along with other inflammatory lesions and structural lesions on the MRI of the sacroiliac joints (SIJ) by readers of varying experience and how training sessions and workshops could help improve the accuracy.MethodsA total of 224 patients with clinical diagnosis of axial spondyloarthritis who underwent SIJ MRI examinations were retrospectively included in this study. Three readers with 5 years, 3 years and 1 year of experience in musculoskeletal imaging were invited to review the SIJ MRI images independently, while the imaging reports of a senior radiologist (> 10 years’ experience) were used as reference. After the first round of image review, a training session and a workshop on the imaging of SIJ in spondyloarthritis were held and the three readers were asked to review the images in the second round. We calculated the accuracy of identifying inflammatory and structural lesions of the three readers as well as the intra-reader agreement.ResultsEnthesitis could be observed in 52.23% of the axial spondyloarthritis patients, while 81.58% of the patients with enthesitis were accompanied with bone marrow edema. All the three readers showed better accuracy at identifying structural lesions than inflammatory lesions. In the first round of image review, the three readers only correctly identified 15.07%, 2.94% and 0.74% of the enthesitis sites. After the training session and workshop, the accuracy rose to 61.03%, 39.34% and 20.22%. The intra-reader agreement of enthesitis calculated as Cohen’s kappa was 0.23, 0.034 and 0.014, respectively.ConclusionReaders with less experience in musculoskeletal imaging showed lower accuracy of identifying inflammatory lesions, notably enthesitis. Training sessions and workshops could help improve the diagnostic accuracy of the junior readers.

Effectiveness of microvascular flow imaging for radiofrequency ablation in recurrent thyroid cancer: comparison with power Doppler imaging.

To compare microvascular flow imaging (MVFI) and power Doppler ultrasonography imaging (PDUS) for detecting intratumoral vascularity in recurrent thyroid cancer both before and after radiofrequency ablation (RFA). This retrospective study included 80 patients (age, 57 ± 12 years; 54 women) with 110 recurrent tumors who underwent RFA between January 2021 and June 2023. A total of 151 PDUS and MVFI image sets were analyzed (85 pre-RFA, 66 post-RFA). Two readers assessed vascularity on the images using a four-point scale with a 2-week interval between PDUS and MVFI to estimate inter-reader agreement. Intra-reader agreement was determined by reinterpreting images in reverse order (MVFI-PDUS) after a 1-month gap. Additionally, diagnostic performance for identifying viable tumors after RFA was assessed in 44 lesions using thyroid-protocol CT as a reference standard. MVFI demonstrated higher vascular grades than PDUS, both before (reader 1: 3.04 ± 1.15 vs. 1.93 ± 1.07, p < 0.001; reader 2: 3.20 ± 0.96 vs. 2.12 ± 1.07, p < 0.001) and after RFA (reader 1: 2.44 ± 1.28 vs. 1.67 ± 1.06, p < 0.001; reader 2: 2.62 ± 1.23 vs. 1.83 ± 0.99, p < 0.001). Inter-reader agreement was substantial (κ = 0.743) and intra-reader agreement was almost perfect (κ = 0.840). MVFI showed higher sensitivity (81.5%-88.9%) and accuracy (84.1%-86.4%) than PDUS (sensitivity: 51.9%, p < 0.01; accuracy: 63.6-70.5%, p < 0.04), without sacrificing specificity. MVFI was superior to PDUS for assessing intratumoral vascularity and showed good inter- and intra-reader agreement, highlighting its clinical value for assessing pre-RFA vascularity and accurately identifying post-RFA viable tumors in recurrent thyroid cancer. Microvascular flow imaging (MVFI) is superior to power-Doppler US for assessing intratumoral vascularity; therefore, MVFI can be a valuable tool for assessing vascularity before radiofrequency ablation (RFA) and for identifying viable tumors after RFA in patients with recurrent thyroid cancer. The value of microvascular flow imaging (MVFI) for evaluating intratumoral vascularity is unexplored. MVFI demonstrated higher vascular grades than power Doppler US before and after ablation. Microvascular flow imaging showed higher sensitivity and accuracy than power Doppler US without sacrificing specificity.

Influence of Gadolinium-based Contrast Media and Inter-reader Variation on the Estimation of Intravoxel Incoherent Motion (IVIM) Parameters in Breast MR Imaging.

Gadolinium-based contrast media (GBCM) may affect apparent diffusion coefficient measurements on diffusion-weighted imaging. We aimed at investigating the effect of GBCM and inter-reader variation on intravoxel incoherent motion (IVIM) parameters in breast lesions. A total of 89 patients referred to 3T breast MRI with at least one histologically verified lesion were included. IVIM data were acquired using a single-shot echo planar imaging sequence before and after GBCM administration. D (true diffusion coefficient), D* (pseudo-diffusion coefficient) and f (perfusion fraction) were calculated and measured by two readers (R1, R2). Inter-reader and intra-reader agreements were assessed by intraclass correlation coefficients (ICCs) and Bland-Altman plots. D was comparable before and after GBCM administration and between readers. D* and f decreased after GBCM administration and showed a lower agreement between readers. Intra-reader agreement before and after GBCM administration was almost perfect for D for both R1 and R2 (ICC 0.955 and 0.887). The intra-reader agreement was substantial to moderate for D* (ICC R1 0.708, R2 0.583) and moderate for f (ICC R1 0.529 and R2 0.425). Inter-reader agreement before GBCM administration was almost perfect for D (ICC 0.905), substantial for D* (ICC 0.733), and moderate for f (ICC 0.404); after contrast media administration, it was almost perfect for D (ICC 0.876) and substantial for D* (ICC 0.654) and f (ICC 0.606). Bland-Altman plots revealed no significant bias. Administration of GBCM seems to have a stronger effect on D* and f values than on D values. This should be considered when applying IVIM in clinical practice.

Comparison of the Size Measurement of Gallbladder Polyps by Three Different Radiologists in Abdominal Ultrasonography.

There is little information regarding the size measurement differences in gallbladder (GB) polyps performed by different radiologists on abdominal ultrasonography (US). To reveal the differences in GB polyp size measurements performed by different radiologists on abdominal US. From June to September 2022, the maximum diameter of 228 GB polyps was measured twice on abdominal US by one of three radiologists (a third-year radiology resident [reader A], a radiologist with 7 years of experience in abdominal US [reader B], and an abdominal radiologist with 8 years of experience in abdominal US [reader C]). Intra-reader agreements for polyp size measurements were assessed by intraclass correlation coefficient (ICC). A Bland-Altman plot was used to visualize the differences between the first and second size measurements in each reader. Reader A, reader B, and reader C evaluated 65, 77, and 86 polyps, respectively. The mean size of measured 228 GB polyps was 5.0 ± 1.9 mm. Except for the case where reader A showed moderate intra-reader agreement (0.726) for polyps with size ≤ 5 mm, all readers showed an overall high intra-reader reliability (reader A, ICC = 0.859; reader B, ICC = 0.947, reader C, ICC = 0.948), indicative of good and excellent intra-reader agreements. The 95% limit of agreement of reader A, B, and C was 1.9 mm of the mean in all three readers. GB polyp size measurement on abdominal US showed good or excellent intra-reader agreements. However, size changes of approximately less than 1.9 mm should be interpreted carefully because these may be within the measurement error.

Comparison of intra- and inter-reader agreement of abbreviated versus comprehensive MRCP for pancreatic cyst surveillance.

To retrospectively compare inter- and intra-reader agreement of abbreviated MRCP (aMRCP) with comprehensive MRI (cMRCP) protocol for detection of worrisome features, high-risk stigmata, and concomitant pancreatic cancer in pancreatic cyst surveillance. 151 patients (104 women, mean age: 69[10] years) with baseline and follow-up contrast-enhanced MRIs were included. This comprised 138 patients under cyst surveillance with 5-year follow-up showing no pancreatic ductal adenocarcinoma (PDAC), 6 with pancreatic cystic lesion-derived malignancy, and 7 with concomitant PDAC. The aMRCP protocol used four sequences (axial and coronal Half-Fourier Single-shot Turbo-spin-Echo, axial T1 fat-saturated pre-contrast, and 3D-MRCP), while cMRCP included all standard sequences, including post-contrast. Three blinded abdominal radiologists assessed baseline cyst characteristics, worrisome features, high-risk stigmata, and PDAC signs using both aMRCP and cMRCP, with a 2-week washout period. Intra- and inter-reader agreement were calculated using Fleiss' multi-rater kappa and Intra-class Correlation Coefficient (ICC). 95% confidence intervals (CI) were calculated. Cyst size, growth, and abrupt main pancreatic duct transition had strong intra- and inter-reader agreement. Intra-reader agreement was ICC = 0.93-0.99 for cyst size, ICC = 0.71-1.00 for cyst growth, and kappa = 0.83-1.00 for abrupt duct transition. Inter-reader agreement for cyst size was ICC = 0.86 (aMRCP) and ICC = 0.83 (cMRCP), and for abrupt duct transition was kappa = 0.84 (aMRCP) and kappa = 0.69 (cMRCP). Thickened cyst wall, mural nodule and cyst-duct communication demonstrated varying intra-reader agreements and poor inter-reader agreements. aMRCP showed high intra- and inter-reader agreement for most pancreatic cyst parameters that highly rely on T2-weighted sequences.

Interreader and Intrareader Reproducibility of 18F-Flotufolastat Image Interpretation in Patients with Newly Diagnosed or Recurrent Prostate Cancer: Data from Two Phase 3 Prospective Multicenter Studies.

Interreader and intrareader reproducibility of 18F-flotufolastat PET/CT scans in newly diagnosed and recurrent prostate cancer patients was assessed from masked image evaluations from two phase 3 studies. Methods: 18F-flotufolastat PET/CT images of newly diagnosed (n = 352) or recurrent (n = 389) patients were evaluated by 3 masked readers. Cohen κ was used to assess pairwise patient- and region-level interreader agreement. Agreement among all readers was assessed using Fleiss κ. Intrareader agreement between the first and repeat read (20% of images, ≥4 wk later) was assessed using Cohen κ. Results: Pairwise interreader agreement was 95% or better (newly diagnosed) and 75% or better (recurrent). The κ coefficients were impacted by the high-agreement-low-κ paradox: Cohen κ ranged from not estimable to 0.55, whereas Fleiss κ was 0.50 (newly diagnosed) and 0.41 (recurrent). Agreement was highest in the prostate of newly diagnosed patients (≥95%) and in the pelvic lymph nodes in recurrent patients (≥87%). Intrareader agreement was 86% or better across both populations. Conclusion: 18F-flotufolastat PET/CT images can be reliably interpreted, with a high degree of inter- and intrareader agreement.

Disease severity prognostication in primary sclerosing cholangitis: a validation of the Anali scores and comparison with the potential functional stricture.

Our aim was twofold. First, to validate Anali scores with and without gadolinium (ANALIGd and ANALINoGd) in primary sclerosing cholangitis (PSC) patients. Second, to compare the ANALIs prognostic ability with the recently-proposed potential functional stricture (PFS). This retrospective study included 123 patients with a mean age of 41.5 years, who underwent gadoxetic acid-enahnced MRI (GA-MRI). Five readers independently evaluated all images for calculation of ANALIGd and ANALINoGd scores based upon following criteria: intrahepatic bile duct change severity, hepatic dysmorphia, liver parenchymal heterogeneity, and portal hypertension. In addition, hepatobiliary contrast excretion into first-order bile ducts was evaluated on 20-minute hepatobiliary-phase (HBP) images to assess PFS. Inter- and intrareader agreement were calculated (Fleiss´and Cohen kappas). Kaplan-Meier curves were generated for survival analysis. ANALINoGd, ANALIGd, and PFS were correlated with clinical scores, labs and outcomes (Cox regression analysis). Inter-reader agreement was almost perfect(ϰ = 0.81) for PFS, but only moderate-(ϰ = 0.55) for binary ANALINoGd. For binary ANALIGd, the agreement was slightly better on HBP (ϰ = 0.64) than on arterial-phase (AP) (ϰ = 0.53). Univariate Cox regression showed that outcomes for decompensated cirrhosis, orthotopic liver transplantation or death significantly correlated with PFS (HR (hazard ratio) = 3.15, p < 0.001), ANALINoGd (HR = 6.42, p < 0.001), ANALIGdHBP (HR = 3.66, p < 0.001) and ANALIGdAP (HR = 3.79, p < 0.001). Multivariate analysis identified the PFS, all three ANALI scores, and Revised Mayo Risk Score as independent risk factors for outcomes (HR 3.12, p < 0.001; 6.12, p < 0.001; 3.56, p < 0.001;3.59, p < 0.001; and 4.13, p < 0.001, respectively). ANALINoGd and GA-MRI-derived ANALI scores and PFS could noninvasively predict outcomes in PSC patients. The combined use of Anali scores and the potential functional stricture (PFS), both derived from unenhanced-, and gadoxetic acid enhanced-MRI, could be applied as a diagnostic and prognostic imaging surrogate for counselling and monitoring primary sclerosing cholangitis patients. Primary sclerosing cholangitis patients require radiological monitoring to assess disease stability and for the presence and type of complications. A contrast-enhanced MRI algorithm based on potential functional stricture and ANALI scores risk-stratified these patients. Unenhanced ANALI score had a high negative predictive value, indicating some primary sclerosing cholangitis patients can undergo non-contrast MRI surveillance.

Reproducibility of MRI Diagnosis of Female Genital Anomalies.

Purpose: To assess and compare intrareader and interreader reproducibility of magnetic resonance imaging (MRI) diagnosis of female genital anomalies (FGAs) using the American Society for Reproductive Medicine-Mullerian anomalies classification 2021 (ASRM-MAC 2021) and European Society of Human Reproduction and Embryology-European Society for Gynecological Endoscopy (ESHRE-ESGE) 2016 classification. Methods: In this retrospective study, we searched our electronic MRI database from April 2021 to September 2023, selecting MRI studies with FGAs. Seventy-six consecutive studies were included and reviewed by 4 independent radiologists using both classifications. Studies were re-evaluated after 1 month. Reproducibility was assessed using kappa (κ) scores with 95% confidence intervals (CI). Results: Intrareader agreement for MRI diagnosis of FGAs was substantial to excellent, with κ scores ranging from 0.684 (95% CI, 0.534-0.834) to 0.985 (95% CI, 0.963-1.01) using the ASRM-MAC 2021 and from 0.743 (95% CI, 0.621-0.865) to 0.846 (95% CI, 0.719-0.973) using the ESHRE-ESGE 2016 classification. Pairwise interreader agreement was higher with the ASRM-MAC 2021, ranging from moderate (κ = 0.491; 95% CI, 0.341-0.642) to substantial (κ = 0.709; 95% CI, 0.597-0.821), compared to the ESHRE-ESGE 2016 classification, with weak (κ = 0.080; 95% CI, 0.068-0.228) to moderate (κ = 0.511; 95% CI, 0.344-0.678) agreement. Overall interreader agreement was moderate for both classifications (κ = 0.599; 95% CI, 0.562-0.638 for ASRM-MAC 2021 and κ = 0.429; 95% CI, 0.396-0.463 for ESHRE-ESGE 2016 classification), but with significant differences (non-overlapping CIs). Conclusion: The intrareader reproducibility was high for both classifications, whereas the interreader reproducibility was higher using the ASRM-MAC 2021, highlighting the impact of classification criteria on the reproducibility of MRI diagnosis of FGAs.

Performance of an ultra-fast deep-learning accelerated MRI screening protocol for prostate cancer compared to a standard multiparametric protocol

ObjectivesTo establish and evaluate an ultra-fast MRI screening protocol for prostate cancer (PCa) in comparison to the standard multiparametric (mp) protocol, reducing scan time and maintaining adequate diagnostic performance.Materials and methodsThis prospective single-center study included consecutive biopsy-naïve patients with suspected PCa between December 2022 and March 2023. A PI-RADSv2.1 conform mpMRI protocol was acquired in a 3 T scanner (scan time: 25 min 45 sec). In addition, two deep-learning (DL) accelerated sequences (T2- and diffusion-weighted) were acquired, serving as a screening protocol (scan time: 3 min 28 sec). Two readers evaluated image quality and the probability of PCa regarding PI-RADSv2.1 scores in two sessions. The diagnostic performance of the screening protocol with mpMRI serving as the reference standard was derived. Inter- and intra-reader agreements were evaluated using weighted kappa statistics.ResultsWe included 77 patients with 97 lesions (mean age: 66 years; SD: 7.7). Diagnostic performance of the screening protocol was excellent with a sensitivity and specificity of 100%/100% and 89%/98% (cut-off ≥ PI-RADS 4) for reader 1 (R1) and reader 2 (R2), respectively. Mean image quality was 3.96 (R1) and 4.35 (R2) for the standard protocol vs. 4.74 and 4.57 for the screening protocol (p < 0.05). Inter-reader agreement was moderate (κ: 0.55) for the screening protocol and substantial (κ: 0.61) for the multiparametric protocol.ConclusionThe ultra-fast screening protocol showed similar diagnostic performance and better imaging quality compared to the mpMRI in under 15% of scan time, improving efficacy and enabling the implementation of screening protocols in clinical routine.Clinical relevance statementThe ultra-fast protocol enables examinations without contrast administration, drastically reducing scan time to 3.5 min with similar diagnostic performance and better imaging quality. This facilitates patient-friendly, efficient examinations and addresses the conflict of increasing demand for examinations at currently exhausted capacities.Key PointsTime-consuming MRI protocols are in conflict with an expected increase in examinations required for prostate cancer screening.An ultra-fast MRI protocol shows similar performance and better image quality compared to the standard protocol.Deep-learning acceleration facilitates efficient and patient-friendly examinations, thus improving prostate cancer screening capacity.Graphical

Validation of the standardization framework SSTR-RADS 1.0 for neuroendocrine tumors using the novel SSTR‑targeting peptide [18F]SiTATE

ObjectivesSomatostatin receptor positron emission tomography/computed tomography (SSTR-PET/CT) using [68Ga]-labeled tracers is a widely used imaging modality for neuroendocrine tumors (NET). Recently, [18F]SiTATE, a SiFAlin tagged [Tyr3]-octreotate (TATE) PET tracer, has shown great potential due to favorable clinical characteristics. We aimed to evaluate the reproducibility of Somatostatin Receptor-Reporting and Data System 1.0 (SSTR-RADS 1.0) for structured interpretation and treatment planning of NET using [18F]SiTATE.MethodsFour readers assessed [18F]SiTATE-PET/CT of 95 patients according to the SSTR-RADS 1.0 criteria at two different time points. Each reader evaluated up to five target lesions per scan. The overall scan score and the decision on peptide receptor radionuclide therapy (PRRT) were considered. Inter- and intra-reader agreement was determined using the intraclass correlation coefficient (ICC).ResultsThe ICC analysis on the inter-reader agreement using SSTR-RADS 1.0 for identical target lesions (ICC ≥ 85%), overall scan score (ICC ≥ 90%), and the decision to recommend PRRT (ICC ≥ 85%) showed excellent agreement. However, significant differences were observed in recommending PRRT among experienced readers (ER) (p = 0.020) and inexperienced readers (IR) (p = 0.004). Compartment-based analysis demonstrated good to excellent inter-reader agreement for most organs (ICC ≥ 74%), except for lymph nodes (ICC ≥ 53%).ConclusionSSTR-RADS 1.0 represents a highly reproducible and consistent framework system for stratifying SSTR-targeted PET/CT scans, even using the novel SSTR-ligand [18F]SiTATE. Some inter-reader variability was observed regarding the evaluation of uptake intensity prior to PRRT as well as compartment scoring of lymph nodes, indicating that those categories require special attention during further clinical validation and might be refined in a future SSTR-RADS version 1.1.Clinical relevance statementSSTR-RADS 1.0 is a consistent framework for categorizing somatostatin receptor-targeted PET/CT scans when using [18F]SiTATE. The framework serves as a valuable tool for facilitating and improving the management of patients with NET.Key PointsSSTR-RADS 1.0 is a valuable tool for managing patients with NET.SSTR-RADS 1.0 categorizes patients with showing strong agreement across diverse reader expertise.As an alternative to [68Ga]-labeled PET/CT in neuroendocrine tumor imaging, SSTR-RADS 1.0 reliably classifies [18F]SiTATE-PET/CT.

INTER- AND INTRA- OBSERVER RELIABILITY OF MAGNATIC RESONANCE IMAGING FOR DIAGNOSIS OF LUMBAR FAR LATERAL DISC HERNIATION

Objective: To determine the inter- and intra- observer reliability of MRI for diagnosis of lumbar far lateral disc herniation. Method: 27 patients in whom lumbar far lateral disc herniation was definitely diagnosed by operative findings at our department between May 2018 and December 2022 were included. The magnetic resonance images consisting of T1- and T2-weighted axial and sagittal images, and these were reviewed blindly and independently by three orthopaedic spine surgeons in a random manner. The images were interpreted as positive or negative for far lateral disc herniation on 2 different occasions 3 months apart. Results were analyzed using Cohen's kappa statistic, and strengths of agreements were determined using the Landis and Koch criteria. Result: The kappa values for inter-reader agreement averaged 0.234 (0.282, 0.111, and 0.308 respectively) on the first occasion, and 0.166 (0.249, 0.111, and 0.137 respectively) on the second occasion, with an overall mean value of 0.200. Thus, the strength of agreement was only slight-to-fair according to the Landis and Koch criteria. Kappa values for intra-reader agreement averaged 0.479 (0.488, 0.491, and 0.459 respectively), indicating moderate agreement. Conclusion: The present study indicates that magnetic resonance imaging is not a reliable imaging modality for diagnosing lumbar lateral disc herniation. It is necessary to carefully evaluate the intra-foramina and extra-foramina of lumbar spine region on MRI of these patients and the spine surgeon should pay attention to the correlation between the clinical symptoms and MRI findings of these patients.

Ultra-low-dose vs. standard-of-care-dose CT of the chest in patients with post-COVID-19 conditions-a prospective intra-patient multi-reader study.

To conduct an intrapatient comparison of ultra-low-dose computed tomography (ULDCT) and standard-of-care-dose CT (SDCT) of the chest in terms of the diagnostic accuracy of ULDCT and intrareader agreement in patients with post-COVID conditions. We prospectively included 153 consecutive patients with post-COVID-19 conditions. All participants received an SDCT and an additional ULDCT scan of the chest. SDCTs were performed with standard imaging parameters and ULDCTs at a fixed tube voltage of 100 kVp (with tin filtration), 50 ref. mAs (dose modulation active), and iterative reconstruction algorithm level 5 of 5. All CT scans were separately evaluated by four radiologists for the presence of lung changes and their consistency with post-COVID lung abnormalities. Radiation dose parameters and the sensitivity, specificity, and accuracy of ULDCT were calculated. Of the 153 included patients (mean age 47.4 ± 15.3 years; 48.4% women), 45 (29.4%) showed post-COVID lung abnormalities. In those 45 patients, the most frequently detected CT patterns were ground-glass opacities (100.0%), reticulations (43.5%), and parenchymal bands (37.0%). The accuracy, sensitivity, and specificity of ULDCT compared to SDCT for the detection of post-COVID lung abnormalities were 92.6, 87.2, and 94.9%, respectively. The median total dose length product (DLP) of ULDCTs was less than one-tenth of the radiation dose of our SDCTs (12.6 mGy*cm [9.9; 15.5] vs. 132.1 mGy*cm [103.9; 160.2]; p < 0.001). ULDCT of the chest offers high accuracy in the detection of post-COVID lung abnormalities compared to an SDCT scan at less than one-tenth the radiation dose, corresponding to only twice the dose of a standard chest radiograph in two views. Ultra-low-dose CT of the chest may provide a favorable, radiation-saving alternative to standard-dose CT in the long-term follow-up of the large patient cohort of post-COVID-19 patients.

Early rectal cancer: The diagnostic performance of MRI supplemented with a rectal micro-enema and a modified staging system to identify tumors eligible for local excision.

In staging early rectal cancers (ERC), submucosal tumor depth is one of the most important features determining the possibility of local excision (LE). The micro-enema (Bisacodyl) induces submucosal edema and may hypothetically improve the visualization of tumor depth. To test the diagnostic performance of MRI to identify ERC suitable for LE when adding a pre-procedural micro-enema and concurrent use of a modified classification system. In this prospective study, we consecutively included 73 patients with newly diagnosed rectal tumors. Two experienced radiologists independently interpreted the MRI examinations, and diagnostic performance was calculated for local tumors eligible for LE (Tis-T1sm2, n = 43) and non-local tumors too advanced for LE (T1sm3-T3b, n = 30). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were registered for each reader. Inter- and intra-reader agreements were assessed by kappa statistics. Lymph node status was derived from the clinical MRI reports. Reader1/reader2 achieved sensitivities of 93%/86%, specificities of 90%/83%, PPV of 93%/88%, and NPV of 90%/81%, respectively, for identifying tumors eligible for LE. Rates of overstaging of local tumors were 7% and 14% for the two readers, and kappa values for the inter- and intra-reader agreement were 0.69 and 0.80, respectively. For tumors ≤T2, all metastatic lymph nodes were smaller than 3mm on histopathology. MRI after a rectal micro-enema and concurrent use of a modified staging system achieved good diagnostic performance to identify tumors suitable for LE. The rate of overstaging of local tumors was comparable to results reported in previous endorectal ultrasound (ERUS) studies.

Added Value of [18F]PSMA-1007 PET/CT and PET/MRI in Patients With Biochemically Recurrent Prostate Cancer: Impact on Detection Rates and Clinical Management.

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) can change management in a large fraction of patients with biochemically recurrent prostate cancer (BCR). To investigate the added value of PET to MRI and CT for this patient group, and to explore whether the choice of the PET paired modality (PET/MRI vs. PET/CT) impacts detection rates and clinical management. Retrospective. 41 patients with BCR (median age [range]: 68 [55-78]). 3T, including T1-weighted gradient echo (GRE), T2-weighted turbo spin echo (TSE) and dynamic contrast-enhanced GRE sequences, diffusion-weighted echo-planar imaging, and a T1-weighted TSE spine sequence. In addition to MRI, [18F]PSMA-1007 PET and low-dose CT were acquired on the same day. Images were reported using a five-point Likert scale by two teams each consisting of a radiologist and a nuclear medicine physician. The radiologist performed a reading using CT and MRI data and a joint reading between radiologist and nuclear medicine physician was performed using MRI, CT, and PET from either PET/MRI or PET/CT. Findings were presented to an oncologist to create intended treatment plans. Intrareader and interreader agreement analysis was performed. McNemar test, Cohen's κ, and intraclass correlation coefficients. A P-value <0.05 was considered significant. 7 patients had positive findings on MRI and CT, 22 patients on joint reading with PET/CT, and 18 patients joint reading with PET/MRI. For overall positivity, interreader agreement was poor for MR and CT (κ = 0.36) and almost perfect with addition of PET (PET/CT κ = 0.85, PET/MRI κ = 0.85). The addition of PET from PET/CT and PET/MRI changed intended treatment in 20 and 18 patients, respectively. Between joint readings, intended treatment was different for eight patients. The addition of [18F]PSMA-1007 PET/MRI or PET/CT to MRI and CT may increase detection rates, could reduce interreader variability, and may change intended treatment in half of patients with BCR. 3 TECHNICAL EFFICACY: Stage 3.

Clinical utility, reproducibility, and radiologist acceptance of ILD-RADS

PurposeTo investigate the clinical utility, reproducibility, and radiologists’ acceptance of the Interstitial Lung Disease Imaging-Reporting and Data System (ILD-RADS). MethodIn this single-institutional retrospective study, three radiologists independently reviewed the chest high-resolution CT (HRCT) scans of 111 consecutive patients diagnosed with ILDs. They assessed the HRCT pulmonary features using the ILD-RADS template and assigned an ILD-RADS category (1–4) to each scan based on the identified imaging pattern. Patients were classified into idiopathic pulmonary fibrosis (IPF) (n = 14) and non-IPF ILD (n = 97) groups based on clinical diagnoses determined by multidisciplinary discussion. Association between ILD-RADS categories and clinical diagnoses was assessed using the Chi-square test for trend. Reproducibility was evaluated using kappa (k) scores, and radiologists’ acceptance of the ILD-RADS was evaluated with a questionnaire. ResultsWe found a significant association between the ILD-RADS categories and patients’ clinical diagnoses (P ≤ 0.0001) for the three readers, with a trend toward increased assignment of ILD-RADS-1 to IPF patients (50 %-57.1 %), and ILD-RADS-4 to non-IPF patients (46.4 %-49.5 %). The ILD-RADS categories showed excellent intra-reader agreement (k = 0.873) and moderate inter-reader agreement (k = 0.440). ILD-RADS-1 and −4 categories showed the highest inter-reader agreement (k = 0.681 and 0.481, respectively). Radiologists gave a positive response to using the ILD-RADS in daily practice. ConclusionsThe clinical utility of the ILD-RADS was demonstrated by the significant association between the ILD-RADS categories and patients’ clinical diagnoses, particularly the ILD-RADS-1 and −4 categories. Excellent intra-reader and moderate inter-reader reproducibility was observed. ILD-RADS has the potential to be widely accepted for standardized HRCT reporting among radiologists.

Agreement of Gallbladder Reporting and Data System for Gallbladder Wall Thickening at Ultrasonography: A Multireader Validation Study

ObjectiveTo evaluate the intra-reader and inter-reader agreement of ultrasound (US) gallbladder reporting and data system (GB-RADS) and validate the risk of malignancy in each GB-RADS category. Materials and MethodsThis retrospective study comprised consecutive patients with non-acute GWT who underwent US evaluation between January 2019 and December 2022. Three radiologists independently read the static US images and cine-loops for GB-RADS findings and assigned GB-RADS categories. The intra-observer (static images) and inter-observer (static images and cine-loops) agreement was calculated using kappa statistics and Krippendorff’s alpha. Another radiologist assigned a consensus GB-RADS category. The percentage of malignancy in each GB-RADS category was calculated. ResultsStatic US images of 414 patients (median age, 56 years; 288 women, benign=45.6% and malignant=54.4%) and cine-loops of 50 patients were read. There was weak to moderate intra-reader agreement for most GB-RADS findings and moderate intra-reader agreement for the GB-RADS category for all readers. On static images, the inter-reader agreement was acceptable for GB-RADS categories. On cine-loops, the inter-reader agreement for GB-RADS findings and categories was better than static images. The percentage of malignancy was 1.2%, 37%, 71.1%, and 89.1% in GB-RADS 2, 3, 4 and 5 categories. ConclusionGB-RADS has moderate intra-reader for GB-RADS categories. As originally proposed, the risk of malignancy is negligible in GB-RADS 2 category and highest in GB-RADS 5 category. However, the discriminatory performance of GB-RADS 3 and 4 categories is low. Larger multicenter studies with more readers must assess the reader agreement and validate the GB-RADS systems for wider clinical utilization.