Interreader reproducibility of the Neck Imaging Reporting and Data system (NI-RADS) lexicon for the detection of residual/recurrent disease in treated head and neck squamous cell carcinoma (HNSCC)

Abstract

Background: To evaluate the inter-and intrareader agreement and reproducibility of the NI-RADS scoring system and lexicon with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI). Methods: This retrospective study included 97 CECT and CEMRI scans from 58 treated cases of head and neck squamous cell carcinoma (HNSCC) after the exclusion of head and neck cancers (HNCs) other than SCC and noncontrast and poor quality CT and MRI scans, with a total of 111 primary targets and 124 lymph node (LN) targets. Two experienced readers independently scored the likelihood of residual/recurrence for these targets based on the NI-RADS criteria and filled in report templates for NI-RADS lexicon diagnostic features. Inter-and intraobserver reproducibility was assessed with Cohen's kappa, and the percent agreement was calculated. Results: Almost perfect interreader agreement was found for the final NI-RADS category of the primary lesions and LNs, with K = 0.808 and 0.806, respectively. Better agreement was found for CT than for MRI (K = 0.843 and 0.77, respectively, P value 0.001). There was almost perfect agreement for excluding tissue enhancement (K = 0.826, 95% CI = 0.658-0.993, P value 0.001), with a percent agreement of 96.4%, and substantial agreement for discrete nodular and diffuse mucosal enhancement (K = 0.826, 95% CI = 0.658-0.993, P value 0.001), with a percent agreement of 96.4%. There was fair agreement for focal mucosal nonmass and deep ill-defined enhancement. The intrareader agreement was almost perfect for most of the rated features (K ranging from 0.802 to 1), with the exception of enlarging discrete nodule/mass and focal mucosal nonmass-like enhancement, which had substantial intraobserver agreement (K ranging from 0.768 to 0.786). Conclusion: The individual features of NI-RADS show variable degrees of confidence; however, the overall NI-RADS category was not significantly affected.

Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System

“…We did not attempt to validate NI-RADS but note that the validation efforts of others have been previously reported in the literature. 14,16,17,[21][22][23] Although NI-RADS can also be used to report head and neck cancer surveillance MRI and PET/CT examinations, we focused solely on neck CT for the purposes of initial adoption to narrow the focus on the specific examination performed most commonly at our institution. This report includes survey responses from a diverse group of multidisciplinary head and neck tumor board members as well as attending and fellow neuroradiologists with no previous firsthand experience using NI-RADS; however, our single institution experience necessarily represents the perspectives of a relatively small number of physicians and is therefore is not necessarily generalizable to other institutions or other practice settings (e.g., community practice).…”

“…The discussion within the tumor board centered around 1) reports of NI-RADS from the literature, 2) the potential for NI-RADS to decrease variability in radiologist reporting of head and neck cancer surveillance imaging at our institution, and 3) the receptiveness of the tumor board participants to the prospect of linked management recommendations within the NI-RADS reports. The tumor board was encouraged by the published NI-RADS reports 12,[14][15][16][17] and by the prospect of decreased variability in radiologist reporting. The group was receptive to the linked management recommendations with one exception.…”

Epithelial-Mesenchymal Transition (EMT): The Type-2 EMT in Wound Healing, Tissue Regeneration and Organ Fibrosis

“…As inflammation occurs, macrophages undergo a phenotypic transition to a reparative state that activates keratinocytes, fibroblasts and endothelial cells to induce angiogenesis that restores tissue integrity [ 28 ]. Angiogenesis, growth of new blood vessels, supply essential nutrients and oxygen to the damaged tissues and play a crucial part in wound healing [ 29 , 30 ]. Macrophages positively regulate the transition to the proliferation phase of healing [ 31 , 32 ].…”

Role of DWI in evaluation of HCC after radiofrequency ablation compared to dynamic MRI using MRI (3 T)

“…The standardized reporting technique must be a dynamic process that is subject to clinical and radiological reassessment as well as data validation in order to be evaluated and developed further [22][23][24]. The DWI was regarded as one of the minor characteristics in the LI-RADS v2018 for categorization of the nontreated hepatic focal lesion, while the LI-RADS treatment response is based solely on the enhanced pattern of the treated HCC, and it does not include the DWI and ADC.…”