Frequency and cause of disagreements in diagnoses for fetuses referred for ventriculomegaly.
OBJECTIVE
To prospectively assess the frequency and cause of disagreements in diagnoses at ultrasonography (US) and magnetic resonance (MR) imaging for fetuses referred for ventriculomegaly (VM).


METHODS
One hundred ninety-five women, aged 18-44 years, with 200 fetal referrals for VM, were recruited in a prospective IRB-approved, HIPAA-compliant study. Written informed consent was obtained. US scans were prospectively interpreted by three obstetric radiologists and MR examinations were read by one obstetric radiologist and three pediatric neuroradiologists. Final diagnosis was reached by consensus (198 US, 198 MR, and 196 US-MR comparisons). Gestational age, ventricular size, types of disagreements, and reasons for disagreements were recorded. Interreader agreement was assessed with kappa statistics. Ventricular diameter, gestational age, and confidence scores were analyzed by using mixed-model analysis of variance, accounting for correlation within reader and fetus.


RESULTS
There was prospective agreement on 118 (60%) of 198 US and 104 (53%) of 198 MR readings. Consensus was more likely when the final diagnosis was isolated VM (83 of 104, 80% at US; 82 of 109, 75% at MR) than when the final diagnosis included other anomalies as well (14 of 63, 22% at US; seven of 68, 10% at MR; P < .001). There was disagreement on 19 (10%) of 196 and 31 (16%) of 196 fetuses about the presence of VM at US and MR, respectively, and on 29 (15%) of 198 and 39 (20%) of 198 fetuses regarding the presence of major findings at US and MR, respectively. Reasons for discrepancies in reporting major findings included errors of observation, lack of real-time US scanning, lack of neuroradiology experience, as well as modality differences in helping depict abnormalities.


CONCLUSIONS
Of radiologists who read high-risk obstetric US and fetal MR images for VM, there is considerable variability in central nervous system diagnosis.
Levine
Deborah
D
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. dlevine@caregroup.harvard.edu
Feldman
Henry A
HA
Tannus
João F Kazan
JF
Estroff
Judy A
JA
Magnino
Melissa
M
Robson
Caroline D
CD
Poussaint
Tina Y
TY
Barnewolt
Carol E
CE
Mehta
Tejas S
TS
Robertson
Richard L
RL
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002552:Cerebral Ventricles / Q000002:abnormalities*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005865:Gestational Age; D006801:Humans; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal