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Essential features of Chiari II malformation in MR imaging: an interobserver reliability study--part 1.

Geerdink N, van der Vliet T, Rotteveel JJ, Feuth T, Roeleveld N, Mullaart RA - Childs Nerv Syst (2012)

Bottom Line: Brain MR imaging is essential in the assessment of Chiari II malformation in clinical and research settings concerning spina bifida.The interobserver reliability was assessed using κ statistics.Twenty-three of the features studied turned out to be unreliable, whereas the interobserver agreement was almost perfect (κ value > 0.8) for nine features (eight in the sagittal plane and one in the axial plane, but none in the coronal plane).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Neurology 801, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. n.geerdink@cukz.umcn.nl

ABSTRACT

Purpose: Brain MR imaging is essential in the assessment of Chiari II malformation in clinical and research settings concerning spina bifida. However, the interpretation of morphological features of the malformation on MR images may not always be straightforward. In an attempt to select those features that unambiguously characterize the Chiari II malformation, we investigated the interobserver reliability of all its well-known MR features.

Methods: Brain MR images of 79 children [26 presumed to have Chiari II malformation, 36 presumed to have no cerebral abnormalities, and 17 children in whom some Chiari II malformation features might be present; mean age 10.6 (SD 3.2; range, 6-16) years] were blindly and independently reviewed by three observers. They rated 33 morphological features of the Chiari II malformation as present, absent, or indefinable in three planes (sagittal, axial, and coronal). The interobserver reliability was assessed using κ statistics.

Results: Twenty-three of the features studied turned out to be unreliable, whereas the interobserver agreement was almost perfect (κ value > 0.8) for nine features (eight in the sagittal plane and one in the axial plane, but none in the coronal plane).

Conclusions: This study presents essential features of the Chiari II malformation on MR images by ruling out the unreliable features. Using these features may improve the assessment of Chiari II malformation in clinical and research settings.

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a Coronal T2-weighted brain MR image in 9-year-old child with open spinal dysraphism. The image clearly shows that the tentorium indents the cerebellar hemispheres (white arrows); b coronal T2-weighted brain MR image in 12-year-old child with open spinal dysraphism. In this image, it is questionable whether the tentorium indents the cerebellar hemispheres (white arrows)
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Fig3: a Coronal T2-weighted brain MR image in 9-year-old child with open spinal dysraphism. The image clearly shows that the tentorium indents the cerebellar hemispheres (white arrows); b coronal T2-weighted brain MR image in 12-year-old child with open spinal dysraphism. In this image, it is questionable whether the tentorium indents the cerebellar hemispheres (white arrows)

Mentions: On the other hand, the results for pairwise agreement showed systematic disagreement for some features; i.e., stronger agreement between observers A and B than the agreement for each of them with observer C. Perhaps, reappraisal of some definitions may further improve reliability, for instance, for Cerebellum wrapped around brainstem and Indentation (Figs. 2 and 3).Fig. 2


Essential features of Chiari II malformation in MR imaging: an interobserver reliability study--part 1.

Geerdink N, van der Vliet T, Rotteveel JJ, Feuth T, Roeleveld N, Mullaart RA - Childs Nerv Syst (2012)

a Coronal T2-weighted brain MR image in 9-year-old child with open spinal dysraphism. The image clearly shows that the tentorium indents the cerebellar hemispheres (white arrows); b coronal T2-weighted brain MR image in 12-year-old child with open spinal dysraphism. In this image, it is questionable whether the tentorium indents the cerebellar hemispheres (white arrows)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3376258&req=5

Fig3: a Coronal T2-weighted brain MR image in 9-year-old child with open spinal dysraphism. The image clearly shows that the tentorium indents the cerebellar hemispheres (white arrows); b coronal T2-weighted brain MR image in 12-year-old child with open spinal dysraphism. In this image, it is questionable whether the tentorium indents the cerebellar hemispheres (white arrows)
Mentions: On the other hand, the results for pairwise agreement showed systematic disagreement for some features; i.e., stronger agreement between observers A and B than the agreement for each of them with observer C. Perhaps, reappraisal of some definitions may further improve reliability, for instance, for Cerebellum wrapped around brainstem and Indentation (Figs. 2 and 3).Fig. 2

Bottom Line: Brain MR imaging is essential in the assessment of Chiari II malformation in clinical and research settings concerning spina bifida.The interobserver reliability was assessed using κ statistics.Twenty-three of the features studied turned out to be unreliable, whereas the interobserver agreement was almost perfect (κ value > 0.8) for nine features (eight in the sagittal plane and one in the axial plane, but none in the coronal plane).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Neurology 801, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. n.geerdink@cukz.umcn.nl

ABSTRACT

Purpose: Brain MR imaging is essential in the assessment of Chiari II malformation in clinical and research settings concerning spina bifida. However, the interpretation of morphological features of the malformation on MR images may not always be straightforward. In an attempt to select those features that unambiguously characterize the Chiari II malformation, we investigated the interobserver reliability of all its well-known MR features.

Methods: Brain MR images of 79 children [26 presumed to have Chiari II malformation, 36 presumed to have no cerebral abnormalities, and 17 children in whom some Chiari II malformation features might be present; mean age 10.6 (SD 3.2; range, 6-16) years] were blindly and independently reviewed by three observers. They rated 33 morphological features of the Chiari II malformation as present, absent, or indefinable in three planes (sagittal, axial, and coronal). The interobserver reliability was assessed using κ statistics.

Results: Twenty-three of the features studied turned out to be unreliable, whereas the interobserver agreement was almost perfect (κ value > 0.8) for nine features (eight in the sagittal plane and one in the axial plane, but none in the coronal plane).

Conclusions: This study presents essential features of the Chiari II malformation on MR images by ruling out the unreliable features. Using these features may improve the assessment of Chiari II malformation in clinical and research settings.

Show MeSH
Related in: MedlinePlus