Korgun Koral MD, Presenter: Nothing to Disclose

Nabila Choudhury MD, Abstract Co-Author: Nothing to Disclose

Lynn Gargan PhD, Abstract Co-Author: Nothing to Disclose

Song Zhang PhD, Abstract Co-Author: Nothing to Disclose

Timothy Nicholas Booth MD, Abstract Co-Author: Nothing to Disclose

To test whether addition of a balanced fast field echo (BFFE) sequence increases confidence of diagnosis and inter-observer agreement in diagnosis of spinal drop metastases in children with brain tumors. 

Institutional review board approval was obtained for this retrospective HIPAA compliant study. Query of the Neuro-Oncology database from 3/2010 through 3/2013 yielded 42 patients (113 examinations) who underwent MRI for evaluation of spinal drop metastasis using a protocol with both gadolinium enhanced (sagittal and axial) T1W spin echo (SE) sequences and sagittal BFFE sequence of the lumbosacral spine. Two pediatric neuroradiologists with 12 and 16 years’ experience independently reviewed the de-identified studies that were presented randomly. Three sessions, at least 15 days apart, were conducted with each reviewer. At each session, only the T1W SE sequences, only the BFFE sequence and combined T1W SE and BFFE sets were reviewed. The reviewers recorded the presence or absence of the drop metastases and their confidence levels (3= highly confident, 2= moderately confident, 1= not confident). The degree of agreement between the reviewers was assessed for each dataset. Whether the addition of BFFE to T1W SE sequence influenced the diagnosis and confidence level was analyzed. 

Kendall’s coefficient of concordance (0.85) was greater for the combined data set than it was for T1W SE and BFFE sequences, 0.73 and 0.80, respectively. Addition of BFFE resulted in a change in diagnosis of drop metastasis from negative to positive in 9.7% and 7.1% of examinations and from positive to negative in 7.1% and 1.7% of examinations for the reviewers, respectively. The diagnoses changed in 13.7% of observations when both reviewers’ evaluations were combined (31/226). 

Addition of high resolution BFFE sequence to gadolinium enhanced T1W SE sequence increases the confidence and agreement among reviewers. A significant percentage of diagnoses changed with inclusion of BFFE sequence in the imaging protocol.

Accurate detection of spinal drop metastases determines the delivery and dose of spinal radiation in children with brain tumors. Demonstration of clinical utility characterized by increased rates of agreement and confidence of an additional sequence is important in justifying the additional scanning time (on the order of 4-5 minutes).

Koral, K, Choudhury, N, Gargan, L, Zhang, S, Booth, T, Addition of High Resolution Balanced Fast Field Echo Sequence of Lumbosacral Spine Increases Reviewer Confidence and Agreement among Reviewers in Evaluation of Spinal Drop Metastases in Children with Brain Tumors.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008893.html