title: Interobserver variability in the radiological assessment of magnetic resonance imaging (MRI) including perfusion MRI in glioblastoma multiforme.
abstract: Conventional magnetic resonance imaging (MRI) has limited value for differentiation of true tumor progression and pseudoprogression in treated glioblastoma multiforme (GBM). Perfusion weighted imaging (PWI) may be helpful in the differentiation of these two phenomena. Here interobserver variability in routine radiological evaluation of GBM patients is assessed using MRI, including PWI.
  
  
  
  Three experienced neuroradiologists evaluated MR scans of 28 GBM patients during temozolomide chemoradiotherapy at three time points: preoperative (MR1) and postoperative (MR2) MR scan and the follow-up MR scan after three cycles of adjuvant temozolomide (MR3). Tumor size was measured both on T1 post-contrast and T2 weighted images according to the Response Assessment in Neuro-Oncology criteria. PW images of MR3 were evaluated by visual inspection of relative cerebral blood volume (rCBV) color maps and by quantitative rCBV measurements of enhancing areas with highest rCBV. Image interpretability of PW images was also scored. Finally, the neuroradiologists gave a conclusion on tumor status, based on the interpretation of both T1 and T2 weighted images (MR1, MR2 and MR3) in combination with PWI (MR3).
  
  
  
  Interobserver agreement on visual interpretation of rCBV maps was good (κ = 0.63) but poor on quantitative rCBV measurements and on interpretability of perfusion images (intraclass correlation coefficient 0.37 and κ = 0.23, respectively). Interobserver agreement on the overall conclusion of tumor status was moderate (κ = 0.48).
  
  
  
  Interobserver agreement on the visual interpretation of PWI color maps was good. However, overall interpretation of MR scans (using both conventional and PW images) showed considerable interobserver variability. Therefore, caution should be applied when interpreting MRI results during chemoradiation therapy.
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands. m.kerkhof@mchaaglanden.nl.
authors.forename: M
authors.initials: M
authors.lastname: Kerkhof
authors.affiliation: Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: R E
authors.initials: RE
authors.lastname: Hagenbeek
authors.affiliation: Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: B F W
authors.initials: BF
authors.lastname: van der Kallen
authors.affiliation: Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Lycklama À Nijeholt
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Dirven
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.|Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M J B
authors.initials: MJ
authors.lastname: Taphoorn
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Vos
mesh_terms: D005909:Glioblastoma / Q000000981:diagnostic imaging*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies
keywords: MR imaging; glioblastoma; interobserver variability; perfusion MRI