Rozzelle Curtis J, Madura Casey, Reeder Ron W
1Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's of Alabama, Birmingham.
2Department of Neurosurgery, Michigan State University and Helen DeVos Children's Hospital, Grand Rapids, Michigan; and.
J Neurosurg Pediatr. 2018 Jan;21(1):21-24. doi: 10.3171/2017.7.PEDS17241. Epub 2017 Oct 27.
OBJECTIVE Endoscopic third ventriculostomy with choroid plexus cauterization for the treatment of neonatal and infant hydrocephalus has gained popularity in the past decade. Identifying treatment failure is critically important. Results of a pilot study of 2 novel imaging markers seen on fast-sequence T2-weighted axial MRI showed potential clinical utility. However, the reliability of multiple raters detecting these markers must be established before a multicenter validation study can be performed. METHODS Two sets of de-identified single-shot T2-weighted turbo spin-echo axial images were prepared from scans of patients before and after they underwent endoscopic third ventriculostomy with choroid plexus cauterization between March 2013 and January 2016. The first set showed the lateral and third ventricles for visualization of turbulent CSF dynamics, and the second set showed the lateral ventricular atria for choroid plexus glomus detection. Three raters (Group 1) received written instructions before evaluating each image set once and then again 1 week later. Another 8 raters (Group 2) evaluated both image sets after oral instruction and group training on a pretest image set. Fleiss' kappa coefficients with 95% CIs were calculated for intrarater and interrater reliability in Group 1 and interrater reliability in Group 2. RESULTS Intrarater reliability kappa coefficients for Group 1 were ≥ 0.74 for turbulence and ≥ 0.80 for choroid plexus; their interrater kappa coefficients at the initial assessment were 0.50 (95% CI 0.37-0.62) and 0.56 (95% CI 0.43-0.69), respectively. The Group 2 interrater kappa scores were 0.82 (95% CI 0.78-0.86) for turbulence and 0.62 (95% CI 0.58-0.66) for choroid plexus. CONCLUSIONS With minimal training, intrarater reliability on visualization of turbulence and the choroid plexus was substantial, but interrater reliability was only moderate. After modestly increasing training, interrater reliability improved to near perfect and to substantial reliability for visualization of turbulence and choroid plexus, respectively. Given adequately trained observers, a multicenter investigation into the validity and potential clinical utility of the imaging markers seems feasible.
目的 在过去十年中，内镜下第三脑室造瘘术联合脉络丛烧灼术治疗新生儿和婴儿脑积水越来越受欢迎。识别治疗失败至关重要。一项关于快速序列T2加权轴位MRI上观察到的两种新型影像标志物的初步研究结果显示了潜在的临床应用价值。然而，在进行多中心验证研究之前，必须确定多名评估者检测这些标志物的可靠性。方法 从2013年3月至2016年1月接受内镜下第三脑室造瘘术联合脉络丛烧灼术的患者扫描中，制备了两组去识别化的单次激发T2加权快速自旋回波轴位图像。第一组显示侧脑室和第三脑室，以观察脑脊液的湍流动力学，第二组显示侧脑室房，以检测脉络丛球。三名评估者（第1组）在评估每组图像一次之前和1周后再次评估之前，收到了书面说明。另外8名评估者（第2组）在接受口头指导和对一组预测试图像进行小组培训后，评估了两组图像。计算了第1组评估者内和评估者间可靠性以及第2组评估者间可靠性的Fleiss κ系数及其95%置信区间。结果 第1组评估者内可靠性κ系数，湍流方面≥0.74，脉络丛方面≥0.80；其初始评估时评估者间κ系数分别为0.50（95%置信区间0.37 - 0.62）和0.56（95%置信区间？？？）。第2组评估者间κ评分，湍流方面为0.82（95%置信区间0.78 - 0.86），脉络丛方面为0.62（95%置信区间0.58 - 0.66）。结论 经过最少的培训，评估者在观察湍流和脉络丛方面的评估者内可靠性较高，但评估者间可靠性仅为中等。在适度增加培训后，评估者间可靠性分别提高到接近完美和较高水平，用于观察湍流和脉络丛。有了训练有素的观察者，对这些影像标志物的有效性和潜在临床应用价值进行多中心研究似乎是可行
