Frequency and Cause of Disagreements in Diagnoses for Fetuses Referred for Ventriculomegaly

Abstract

Purpose: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). Materials and 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,. Gestational age, ventricular size, types of disagreements, and reasons for disagreements were recorded. Interreader agreement was assessed with 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 Ͻ .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. Conclusion:Of radiologists who read high-risk obstetric US and fetal MR images for VM, there is considerable variability in central nervous system diagnosis.

Prognostic Features and Long-Term Outcome in Patients with Isolated Fetal Ventriculomegaly

“…1). Frequent false-positive results have been previously described in mild IVM [1,2,36,37] and may be a bias for outcome analysis.…”

“…After expert sonography, the additional detection rate of MRI is low [41][42][43]. MRI may give more information on cortex, optic nerve, brainstem, and acquired parenchymal lesions, such as bleeding, ischemia, or inflammation [32,37]. At an early gestational age, cortical malformations are not detected due to immaturity of cortical development.…”

Malformations of Cortical Development: Diagnostic Accuracy of Fetal MR Imaging

“…Furthermore, the images were reviewed by two pediatric neuroradiologists who had over 10 years of experience interpreting such images. Interpretation of fetal MR images has been shown to be influenced by neuroradiology experience (17).…”

The significance of fetal ventriculomegaly: etiology, short‐ and long‐term outcomes

“…Diagnostic accuracy is affected by measurement variability. Recently, Levine et al (2008) addressed the issue of variability of readings in prenatal ultrasonography. They found that in 10% of 200 cases, there was disagreement among four experienced obstetric radiologists about the ultrasound diagnosis of VM; as expected, disagreement regarded fetuses with ventricles of intermediate size (mean, 9.4 mm; range, 7-15 mm).…”