Reader variability in the use of diagnostic terms to describe white matter lesions seen on cranial scans of severely premature infants: the ELGAN study.
OBJECTIVE
To evaluate reader variability of white matter lesions seen on cranial sonographic scans of extreme low gestational age neonates (ELGANs).


METHODS
In 1,452 ELGANs, cranial sonographic scans were obtained in the first and second postnatal weeks, and between the third postnatal week and term. All sets of scans were read independently by two sonologists. We reviewed the use of four diagnostic labels: early periventricular leucomalacia, cystic periventricular leucomalacia, periventricular hemorrhagic infarction (PVHI), and other white matter diagnosis, by 16 sonologists at 14 institutions. We evaluated the association of these labels with location and laterality of hyperechoic and hypoechoic lesions, location of intraventricular hemorrhage, and characteristics of ventricular enlargement.


RESULTS
Experienced sonologists differed substantially in their application of the diagnostic labels. Three readers applied early periventricular leucomalacia to more than one fourth of all the scans they read, whereas eight applied this label to ≤5% of scans. Five applied PVHI to ≥10% of scans, while three applied this label to ≤5% of scans. More than one third of scans labeled cystic periventricular leucomalacia had unilateral hypoechoic lesions. White matter abnormalities in PVHI were more extensive than in periventricular leucomalacia and were more anteriorly located. Hypoechoic lesions on late scans tended to be in the same locations, regardless of the diagnostic label applied.


CONCLUSIONS
Experienced sonologists differ considerably in their tendency to apply diagnostic labels for white matter lesions. This is due to lack of universally agreed-upon definitions. We recommend reducing this variability to improve the validity of large multicenter studies.
Westra
Sjirk
S
Massachusetts General Hospital, Department of Radiology, Boston, Massachusetts, USA.
Adler
Ira
I
Batton
Daniel
D
Betz
Bradford
B
Bezinque
Steven
S
Durfee
Sara
S
Ecklund
Kirsten
K
Feinstein
Kate
K
Fordham
Lynn
L
Junewick
Joseph
J
Lorenzo
Robert
R
McCauley
Roy
R
Miller
Cindy
C
Seibert
Joanna
J
Kuban
Karl
K
Allred
Elizabeth
E
Leviton
Alan
A
D001921:Brain / Q000473:pathology*; D003937:Diagnosis, Differential; D004453:Echoencephalography / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging*; D015588:Observer Variation; D016216:Ultrasonography, Prenatal / Q000592:standards*