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Can we improve accuracy and reliability of MRI interpretation in children with optic pathway glioma? Proposal for a reproducible imaging classification

  • Paediatric Neuroradiology
  • Published:
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Abstract

Introduction

Magnetic resonance (MR) images from children with optic pathway glioma (OPG) are complex. We initiated this study to evaluate the accuracy of MR imaging (MRI) interpretation and to propose a simple and reproducible imaging classification for MRI.

Methods

We randomly selected 140 MRIs from among 510 MRIs performed on 104 children diagnosed with OPG in France from 1990 to 2004. These images were reviewed independently by three radiologists (F.T., 15 years of experience in neuroradiology; D.L., 25 years of experience in pediatric radiology; and J.L., 3 years of experience in radiology) using a classification derived from the Dodge and modified Dodge classifications. Intra- and interobserver reliabilities were assessed using the Bland–Altman method and the kappa coefficient. These reviews allowed the definition of reliable criteria for MRI interpretation.

Results

The reviews showed intraobserver variability and large discrepancies among the three radiologists (kappa coefficient varying from 0.11 to 1). These variabilities were too large for the interpretation to be considered reproducible over time or among observers. A consensual analysis, taking into account all observed variabilities, allowed the development of a definitive interpretation protocol. Using this revised protocol, we observed consistent intra- and interobserver results (kappa coefficient varying from 0.56 to 1). The mean interobserver difference for the solid portion of the tumor with contrast enhancement was 0.8 cm3 (limits of agreement = −16 to 17).

Conclusion

We propose simple and precise rules for improving the accuracy and reliability of MRI interpretation for children with OPG. Further studies will be necessary to investigate the possible prognostic value of this approach.

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Abbreviations

MRI:

Magnetic resonance imaging

OPG:

Optic pathway glioma

BB-SFOP:

Baby Brain–Société Française d’Oncologie Pédiatrique

DC:

Dodge classification

MDC:

Modified Dodge classification

C+:

Solid portion of the tumor with contrast enhancement

C-:

Solid portion of the tumor without contrast enhancement

RANO:

Response Assessment in Neuro-Oncology

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Acknowledgments

We are grateful to the following investigators of Société Française des Cancers de l’Enfant (SFCE) for providing the patients’ MRIs: J Grill, Gustave-Roussy Institute Villejuif; C Dufour, Gustave-Roussy Institute Villejuif; F Doz, Curie Institute and University Paris Descartes Paris; P Leblond, Oscar Lambret Center Lille; A Bertozzi, University Hospital Toulouse; D Frappaz, Pediatric Hematology-Oncology Institute Lyon; V Laithier, University Hospital Besançon; D Plantaz, University Hospital Grenoble; Y Perel, University Hospital Bordeaux; P Chastagner, University Hospital Nancy; C Chappé, University Hospital Rennes; N Sirvent, University Hospital Montpellier; JC Gentet, University Hospital La Timone Marseille; P Schneider, University Hospital Rouen; C Berger, University Hospital St. Etienne; P Lutz, University Hospital Strasbourg; P Blouin, University Hospital Tours; C Piguet, University Hospital Limoges; P Lemoine, University Hospital Brest; F Millot, University Hospital Poitiers; O Minckes, University Hospital Caen; and F Demeocq, University Hospital Clermont-Ferrand. We are grateful to E Berardi and S Chalal, University Hospital Angers, for collecting the data. We are also grateful to C Alberti, INSERM CIE5, Robert Debré Hospital, Paris, for reviewing the study’s design.

This work was supported by Ligue Nationale Contre le Cancer and the Pfizer Foundation.

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Author notes

    Authors and Affiliations

    1. Department of Radiology, University Hospital, 1 Place Alexis-Ricordeau, 44093, Nantes Cedex 1, France

      Julien Lambron, Eric Frampas & Frédérique Toulgoat

    2. Department of Pediatric Oncology, University Hospital, Angers, France

      Josué Rakotonjanahary, Emilie De Carli & Xavier Rialland

    3. INSERM CIE5 Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris Diderot, Paris, France

      Josué Rakotonjanahary

    4. Department of Radiology, University Hospital, Angers, France

      Didier Loisel

    5. Department of Neurosurgery, University Hospital, Angers, France

      Matthieu Delion

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    1. Julien Lambron
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    Correspondence to Julien Lambron.

    Ethics declarations

    We declare that all human studies have been approved by the Comité de Protection des Personnes - Ouest 3, Poitiers, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

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    We declare that we have no conflict of interest.

    Additional information

    JL and JR contributed equally to this work.

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    Lambron, J., Rakotonjanahary, J., Loisel, D. et al. Can we improve accuracy and reliability of MRI interpretation in children with optic pathway glioma? Proposal for a reproducible imaging classification. Neuroradiology 58, 197–208 (2016). https://doi.org/10.1007/s00234-015-1612-7

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