Amoako-Tuffour Yaw, MacDonald Ian, Ahmad Tahani, Maianski Irit, Farhat Ziad, Ansari Afshin, Kraus Mareen Sarah, Erker Craig, Romao Rodrigo, Moineddin Rahim, Fortuna Teresa, O'Brien Kathleen, Mata-Mbemba Daddy
Izaak Walton Killam Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada.
Dalhousie University, Halifax, Canada.
Pediatr Radiol. 2025 Feb;55(2):305-311. doi: 10.1007/s00247-024-06138-6. Epub 2025 Jan 2.
Image-defined risk factors (IDRFs) were introduced to provide a consensus approach for pre-treatment risk stratification on computed tomography (CT) and magnetic resonance imaging (MRI) in patients with neuroblastoma.
To assess the intra- and inter-reader agreement of radiologists in identifying IDRFs on CT.
Approval for this retrospective study was granted by our institutional research ethics board with a waiver of consent. CT studies of pediatric patients with neuroblastoma were assessed by seven radiologists in two rounds. Each CT was accompanied by a standard form to indicate presence or absence of IDRFs for each patient. At least a 4-week period between rounds, randomization, and relabeling of the CT studies was required to minimize recall bias. Finally, three of the seven radiologists conducted a subsequent consensus reading to determine true positive IDRFs in the cohort. Fleiss' kappa statistic was used to evaluate readers' agreements and Pearson's correlation assessed the correlation between years of experiences of radiologists and their performance in accurately (intra-reader agreement) detecting IDRFs.
A total of 31 children with a median age of 2.1 years (interquartile range (IQR) 1.1, 3.0; range 0-18; male=21 (67.7%)) were included and 251 total positive IDRFs were identified on their CT scans. The location of the primary tumor was in the neck in 1 patient (3.2%), within the chest in 2 patients (6.5%), within the abdomen in 27 patients (87.1%), and in the pelvis in 1 patient (3.2%). In determining IDRFs, the inter-reader agreement among radiologists was substantial: 0.65 (95% CI 0.60, 0.69) and the intra-reader agreement for each radiologist was substantial to near perfect, ranging from 0.67 (0.60, 0.70) to 0.86 (0.82, 0.90). The correlation between the number of years of experience of radiologists and their performances in accurately detecting IDRFs (their intra-reader agreements) was respectively low (r=45, P=0.30) for abdomino-pelvic IDRFs and high for organs' infiltration IDRFs (r=0.74, P=0.05).
The determination of IDRFs on CT is reproducible with significant agreement among radiologists. The two IDRF items with the lowest overall inter-reader agreements were "diaphragm infiltration" and "mesenteric infiltration."
引入图像定义风险因素（IDRFs）是为了在神经母细胞瘤患者的计算机断层扫描（CT）和磁共振成像（MRI）上提供一种用于治疗前风险分层的共识方法。
评估放射科医生在CT上识别IDRFs的阅片者内和阅片者间一致性。
本回顾性研究经机构研究伦理委员会批准并豁免了知情同意。7名放射科医生分两轮对患有神经母细胞瘤的儿科患者的CT研究进行评估。每份CT都附有一份标准表格，以表明每位患者是否存在IDRFs。两轮评估之间至少间隔4周，对CT研究进行随机化和重新标记，以尽量减少回忆偏倚。最后，7名放射科医生中的3名进行了后续的共识读片，以确定队列中的真阳性IDRFs。使用Fleiss卡方统计量评估阅片者间的一致性，Pearson相关性评估放射科医生的年资与其准确检测IDRFs（阅片者内一致性）表现之间的相关性。
共纳入31例儿童，中位年龄为2.1岁（四分位间距（IQR）1.1，3.0；范围0 - 18岁；男性21例（67.7%）），在他们的CT扫描上共识别出251个阳性IDRFs。原发肿瘤的位置：颈部1例（3.2%），胸部2例（6.5%），腹部27例（87.1%），骨盆1例（3.2%）。在确定IDRFs时，放射科医生之间的阅片者间一致性较高：0.65（95%CI 0.60，0.69），每位放射科医生的阅片者内一致性较高至近乎完美，范围从0.67（0.60，0.70）到0.86（0.82，0.90）。放射科医生的年资与其准确检测IDRFs（阅片者内一致性）表现之间的相关性，对于腹盆腔IDRFs较低（r = 0.45，P = 0.30），对于器官浸润性IDRFs较高（r = 0.74，P = 0.05）。
CT上IDRFs的确定具有可重复性，放射科医生之间有显著的一致性。阅片者间总体一致性最低的两个IDRF项目是“膈肌浸润”和“肠系膜浸润”。
