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Pediatr Res. 2015 Sep;78(3):304-9. doi: 10.1038/pr.2015.99. Epub 2015 May 21.

Scoring system for periventricular leukomalacia in infants with congenital heart disease.

Author information

1
Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
2
1] Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania [2] Departments of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania.
3
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
4
Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania.
5
Departments of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania.
6
Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
7
The Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.
8
Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Abstract

BACKGROUND:

Currently two magnetic resonance imaging (MRI) methods have been used to assess periventricular leukomalacia (PVL) severity in infants with congenital heart disease: manual volumetric lesion segmentation and an observational categorical scale. Volumetric classification is labor intensive and the categorical scale is quick but unreliable. We propose the quartered point system (QPS) as a novel, intuitive, time-efficient metric with high interrater agreement.

METHODS:

QPS is an observational scale that asks the rater to score MRIs on the basis of lesion size, number, and distribution. Pre- and postoperative brain MRIs were obtained on term congenital heart disease infants. Three independent observers scored PVL severity using all three methods: volumetric segmentation, categorical scale, and QPS.

RESULTS:

One-hundred and thirty-five MRIs were obtained from 72 infants; PVL was seen in 48 MRIs. Volumetric measurements among the three raters were highly concordant (ρc = 0.94-0.96). Categorical scale severity scores were in poor agreement between observers (κ = 0.17) and fair agreement with volumetrically determined severity (κ = 0.26). QPS scores were in very good agreement between observers (κ = 0.82) and with volumetric severity (κ = 0.81).

CONCLUSION:

QPS minimizes training and sophisticated radiologic analysis and increases interrater reliability. QPS offers greater sensitivity to stratify PVL severity and has the potential to more accurately correlate with neurodevelopmental outcomes.

PMID:
25996891
PMCID:
PMC4775272
DOI:
10.1038/pr.2015.99
[Indexed for MEDLINE]
Free PMC Article

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