title: Inter- and intra-observer variability in detection and progression assessment with MRI of microadenoma in Cushing's disease patients followed up after bilateral adrenalectomy.
abstract: OBJECTIVE
  To assess the inter- and intra-observer variability in detection and progression assessment with MRI of pituitary microadenomas in cases of Cushing's disease treated by adrenalectomy.
  
  
  METHODS
  Two radiologists independently reviewed initial and follow-up MRI studies of 32 patients with a history of Cushing's disease on two occasions each. Five classical qualitative signs and three quantitative measurements of microadenoma were considered. Intra and inter-observer reproducibility was evaluated with kappa statistics (qualitative signs) and intraclass correlation coefficients and Bland-Altman plots (quantitative measurements).
  
  
  RESULTS
  No sign or measurement could be identified as better than others and none displayed consistently high levels of inter- or even intra-observer reproducibility (kappa or intraclass correlation coefficient > 0.80). Both qualitative and quantitative criteria showed lower reproducibility when used for diagnosing progression than when used for diagnosing the presence of an adenoma. Reproducibility of qualitative signs appeared to be influenced by reader's experience.
  
  
  CONCLUSIONS
  Pituitary MRI study of patients with Cushing disease treated by adrenalectomy remains difficult. In practice, interpretation of MRI studies by a well-experienced reader should be preferred, unless a final decision can be reached by consensus between two and several readers.
authors.affiliation: Department of Radiology A, Cochin Hospital, Faculté René Descartes, Paris 5 University, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Bahurel-Barrera
authors.forename: Guillaume
authors.initials: G
authors.lastname: Assie
authors.forename: Stéphane
authors.initials: S
authors.lastname: Silvera
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertagna
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Paul
authors.initials: P
authors.lastname: Legmann
mesh_terms: D000236:Adenoma / Q000209:etiology / Q000473:pathology*; D000315:Adrenalectomy; D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000209:etiology / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016896:Treatment Outcome