Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Neuroimaging. 2021 Mar;31(2):324-333. doi: 10.1111/jon.12820. Epub 2020 Dec 17.
Leptomeningeal metastases (LMs) carry a poor prognosis. Existing LM scoring systems show limited reproducibility. We assessed the contribution of education level on the reproducibility of LM scoring using structured planning and implementation of new experiments (SPINE), a novel web-based platform.
Stringent radiological definitions of LM and a customized interactive scoring system were implemented in SPINE. Five patients with brain LM and 3 patients with spine, but no brain LM, were selected. Each patient's baseline post-contrast T1-weighted brain MRI was analyzed by three attending neuroradiologists, two neuroradiology fellows, and two radiology residents. Raters identified and characterized all LMs based on: (1) location (cerebrum, cerebellum, brainstem, ventricle, and/or cranial nerves); (2) shape (nodular and/or linear/curvilinear); (3) size (≥ or <5mm in two orthogonal diameters); (4) spatial extension (focal or diffuse). Inter-rater agreement and association of LM with patient survival were investigated.
On average, 6.5 LMs per case were detected. Forty-nine percent of LMs were cerebral, 77.7% were nodular, 86.6% were focal, and 66% were <5 × 5 mm. Agreement on the total number of LMs and the above-mentioned common LM characteristics was higher between attendings (intra-class correlation [ICC] = 0.8-0.94) than fellows (ICC = 0.6-0.82) or residents (ICC = 0.43-0.73). Agreement on ventricular, cranial nerve, and nodular + linear LM was low even between attendings. The number of brainstem LMs showed significant correlation with survival.
Structured education using SPINE may improve consistency in LM reporting. Future work should address the impact of the presented approach on the reproducibility of longitudinal analyses directly relevant to the assessment of treatment-response.
软脑膜转移（LM）预后不良。现有的 LM 评分系统显示出有限的可重复性。我们评估了教育水平对使用结构化规划和实施新实验（SPINE）的 LM 评分可重复性的影响，这是一个新的基于网络的平台。
在 SPINE 中实施了严格的 LM 放射学定义和定制的交互式评分系统。选择了 5 例脑 LM 患者和 3 例无脑 LM 的脊柱 LM 患者。每位患者的基线增强后 T1 加权脑 MRI 由三位主治神经放射科医师、两位神经放射科住院医师和两位放射科住院医师进行分析。评分者根据以下内容识别和描述所有 LM：（1）位置（大脑、小脑、脑干、脑室和/或颅神经）；（2）形状（结节状和/或线状/曲线状）；（3）大小（两个正交直径≥或<5mm）；（4）空间扩展（局灶性或弥漫性）。研究了 LM 与患者生存的相关性和评分者之间的一致性。
平均每个病例检测到 6.5 个 LM。49%的 LM 位于大脑，77.7%为结节状，86.6%为局灶性，66%<5×5mm。在总数 LM 和上述常见 LM 特征方面，主治医生之间的一致性较高（组内相关系数 [ICC] = 0.8-0.94），而住院医师（ICC = 0.6-0.82）或住院医师（ICC = 0.43-0.73）之间的一致性较低。即使在主治医生之间，脑室、颅神经和结节+线状 LM 的一致性也较低。脑干部位 LM 的数量与生存有显著相关性。
使用 SPINE 进行结构化教育可能会提高 LM 报告的一致性。未来的工作应直接解决所提出方法对评估治疗反应的纵向分析的可重复性的影响。
