title: Scoring system for periventricular leukomalacia in infants with congenital heart disease.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Ann L
authors.initials: AL
authors.lastname: McCarthy
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Madeline E
authors.initials: ME
authors.lastname: Winters
authors.affiliation: 1] Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania [2] Departments of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David R
authors.initials: DR
authors.lastname: Busch
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Gonzalez-Giraldo
authors.affiliation: Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Tiffany S
authors.initials: TS
authors.lastname: Ko
authors.affiliation: Departments of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Lynch
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwab
authors.affiliation: Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rui
authors.initials: R
authors.lastname: Xiao
authors.affiliation: The Optics Division, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Buckley
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
mesh_terms: D001921:Brain / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000175:diagnosis / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D011184:Postoperative Period; D057234:Preoperative Period; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index