Interrater Agreement of BT-RADS for Evaluation of Follow-up MRI in Patients with Treated Primary Brain Tumor.

BACKGROUND AND PURPOSE: The Brain Tumor Reporting and Data System (BT-RADS) is a structured radiology reporting algorithm that was introduced to provide uniformity in posttreatment primary brain tumor follow-up and reporting, but its interrater reliability (IRR) assessment has not been widely studied. Our goal is to evaluate the IRR among neuroradiologists and radiology residents in the use of BT-RADS. MATERIALS AND METHODS: This retrospective study reviewed 103 consecutive MR studies in 98 adult patients previously diagnosed with and treated for primary brain tumor (January 2019 to February 2019). Six readers with varied experience (4 neuroradiologists and 2 radiology residents) independently evaluated each case and assigned a BT-RADS score. Readers were blinded to the original score reports and the reports from other readers. Cases in which at least 1 neuroradiologist scored differently were subjected to consensus scoring. After the study, a post hoc reference score was also assigned by 2 readers by using future imaging and clinical information previously unavailable to readers. The interrater reliabilities were assessed by using the Gwet AC2 index with ordinal weights and percent agreement. RESULTS: Of the 98 patients evaluated (median age, 53 years; interquartile range, 41-66 years), 53% were men. The most common tumor type was astrocytoma (77%) of which 56% were grade 4 glioblastoma. Gwet index for interrater reliability among all 6 readers was 0.83 (95% CI: 0.78-0.87). The Gwet index for the neuroradiologists' group (0.84 [95% CI: 0.79-0.89]) was not statistically different from that for the residents' group (0.79 [95% CI: 0.72-0.86]) (χ2 = 0.85; P = .36). All 4 neuroradiologists agreed on the same BT-RADS score in 57 of the 103 studies, 3 neuroradiologists agreed in 21 of the 103 studies, and 2 neuroradiologists agreed in 21 of the 103 studies. Percent agreement between neuroradiologist blinded scores and post hoc reference scores ranged from 41%-52%. CONCLUSIONS: A very good interrater agreement was found when tumor reports were interpreted by independent blinded readers by using BT-RADS criteria. Further study is needed to determine if this high overall agreement can translate into greater consistency in clinical care.

Reduced gray-white matter contrast localizes the motor cortex on double inversion recovery (DIR) 3T MRI.

PURPOSE: Reduced gray-white matter contrast along the central sulcus has been described on T1- and T2-weighted magnetic resonance imaging (MRI). The purpose of this study was to assess the gray-white matter contrast of the motor cortex on double inversion recovery (DIR), a sequence with superior gray-white matter differentiation. METHODS: The gray-white matter signal on DIR was retrospectively compared to T1-weighted magnetization-prepared rapid gradient echo (T1-MPRAGE) using normal (n = 25) and abnormal (n = 25) functional MRI (fMRI) exams. Quantitative gray-white matter contrast ratios (CR) of the precentral and adjacent gyri were obtained on normal exams. Two neuroradiologists qualitatively rated reduced gray-white matter contrast of the hemispheres of both normal and abnormal exams. Hand motor functional mapping was used as a reference. RESULTS: In normal hemispheres (n = 50), the mean CR was significantly lower on DIR (0.44) vs T1-MPRAGE (0.63, p < 0.001). Reduced gray-white matter contrast was categorized as "definitely present" more frequently on DIR than T1-MPRAGE by reviewers in both normal (n = 50; reviewer 1 DIR 88% and MPRAGE 68%, p = 0.02; reviewer 2 DIR 86% and T1-MPRAGE 64%; p=0.01) and abnormal hemispheres (n = 50; reviewer 1 DIR 80% and T1-MPRAGE 38%, p < 0.001; reviewer 2 DIR 74% and T1-MPRAGE 46%, p = 0.005). CONCLUSION: Reduced gray-white matter contrast of the motor cortex is more pronounced on DIR compared to T1-MPRAGE on quantitative and qualitative assessments of normal MRI exams. In abnormal cases, reviewers more definitively identified the motor cortex on DIR. In cases with distorted brain anatomy, DIR may be a useful adjunct sequence to localize the motor cortex.

Using a Website to Teach a Structured Reporting System, the Brain Tumor Reporting and Data System.

BACKGROUND: The Brain Tumor Reporting and Data System (BT-RADS) is a proposed standardized radiology reporting scheme for magnetic resonance imagings in brain tumor patients. A website was created to introduce the classification system and to promote its use during daily radiology readouts with trainees. OBJECTIVES: To demonstrate how a website can help implement a structured reporting at a tertiary academic facility. METHODS: A website, www.btrads.com, including visual aids and an interactive scoring tool was developed to educate trainees about a structured reporting system for brain tumor magnetic resonance imagings. Number of website visitors, resource downloads, and scoring tool users was gathered during the study period of May 1, 2018 to April 30, 2019. Authors surveyed a group of 71 radiology trainees and 34 faculty physicians who care for brain tumor patients to assess the perceived educational and clinical value of BT-RADS. RESULTS: The website was visited by 10,058 unique users in 1 year. The most commonly downloaded support material was the full guide (382 downloads). The interactive scoring tool was used 267 times. The use of BT-RADS at a single institution over 12 months reached over 70%. While survey results from trainees did not reach statistical significance, faculty oncologists, neurosurgeons, and radiologists felt that BT-RADS was a valuable clinical tool that improved interdisciplinary communication, facilitated educational discussions, and helped make treatment decisions. CONCLUSIONS: A website designed to implement a novel structured radiology report facilitated template acceptance across a large neuroradiology section. Groups seeking to modify reporting practices should consider using a website.

A Scalable Natural Language Processing for Inferring BT-RADS Categorization from Unstructured Brain Magnetic Resonance Reports.

The aim of this study is to develop an automated classification method for Brain Tumor Reporting and Data System (BT-RADS) categories from unstructured and structured brain magnetic resonance imaging (MR) reports. This retrospective study included 1410 BT-RADS structured reports dated from January 2014 to December 2017 and a test set of 109 unstructured brain MR reports dated from January 2010 to December 2014. Text vector representations and semantic word embeddings were generated from individual report sections (i.e., "History," "Findings," etc.) using Tf-idf statistics and a fine-tuned word2vec model, respectively. Section-wise ensemble models were trained using gradient boosting (XGBoost), elastic net regularization, and random forests, and classification accuracy was evaluated on an independent test set of unstructured brain MR reports and a validation set of BT-RADS structured reports. Section-wise ensemble models using XGBoost and word2vec semantic word embeddings were more accurate than those using Tf-idf statistics when classifying unstructured reports, with an f1 score of 0.72. In contrast, models using traditional Tf-idf statistics outperformed the word2vec semantic approach for categorization from structured reports, with an f1 score of 0.98. Proposed natural language processing pipeline is capable of inferring BT-RADS report scores from unstructured reports after training on structured report data. Our study provides a detailed experimentation process and may provide guidance for the development of RADS-focused information extraction (IE) applications from structured and unstructured radiology reports.

Ballistic and Penetrating Injuries of the Chest.

Ballistic injuries are a major cause of morbidity and mortality in the United States. Unstable patients have high mortality, and only a small subset arrive at the hospital alive. Many patients undergo emergent surgery upon arrival, but a small subset undergo imaging with plain film, computed tomography, and echocardiography. We present a pictorial essay of ballistic and penetrating injuries and their complications with a focus on lung, cardiac, and vascular injury.

Combined task activation display as an effective method to teach introductory fMRI users.

RATIONALE AND OBJECTIVES: Interpreting functional magnetic resonance imaging (fMRI) can be an overwhelming and challenging task for trainees, particularly when post processing, synthesizing and interpreting data from multiple language paradigms. Currently, there is no established best method for teaching fMRI interpretation to new trainees. The purpose of our study is to compare the use of combined task activation display (CTAD) and conventional display of fMRI language paradigms as an effective method to teach fMRI to the introductory learner. MATERIALS AND METHODS: Following IRB approval, 43 unique cases (with 10 repeat cases to assess intra-reader variability) were identified based on the inclusion/exclusion criteria. Eight radiology trainees, without prior exposure to fMRI, were asked to determine language lateralization based on activation of Wernicke's area, Broca's area, and the pre-supplementary motor area. Prior to trainee interpretation, a 15-minute training session was conducted to describe the expected anatomic locations of the language centers. Trainees were asked to determine language dominance using either the CTAD or conventional methods. Following a 6-week washout period, the same eight trainees were asked to interpret the cases using the opposite interpretation approach. RESULTS: Interpreting fMRI with the CTAD method significantly increased trainee accuracy (85.4% vs 70.9% p < 0.001) and trainee confidence (4.3 vs 3.6 p < 0.001), while decreasing time to interpretation (mean difference of 29 min), and intra-reader variability when compared to the conventional approach. CONCLUSION: Combined task activation display is an effective method to teach fMRI to introductory learners.

Institutional Implementation of a Structured Reporting System: Our Experience with the Brain Tumor Reporting and Data System.

RATIONALE AND OBJECTIVES: Analyze the impact of implementing a structured reporting system for primary brain tumors, the Brain Tumor Reporting and Data System, on attitudes toward radiology reports at a single institution. MATERIALS AND METHODS: Following Institutional Review Board approval, an initial 22 question, 5 point (1-worst to 5-best), survey was sent to faculty members, house staff members, and nonphysician providers at our institution who participate in the direct care of brain tumor patients. Results were used to develop a structured reporting strategy for brain tumors which was implemented across an entire neuroradiology section in a staged approach. Nine months following structured reporting implementation, a follow-up 27 question survey was sent to the same group of providers. Keyword search of radiology reports was used to assess usage of Brain Tumor Reporting and Data System over time. RESULTS: Fifty-three brain tumor care providers responded to the initial survey and 38 to the follow-up survey. After implementing BT-RADS, respondents reported improved attitudes across multiple areas including: report consistency (4.3 vs. 3.4; p < 0.001), report ambiguity (4.2 vs. 3.2, p < 0.001), radiologist/physician communication (4.5 vs. 3.8; p < 0.001), facilitation of patient management (4.2 vs. 3.6; p = 0.003), and confidence in reports (4.3 vs. 3.5; p < 0.001). Providers were more satisfied with the BT-RADS structured reporting system (4.3 vs. 3.7; p = 0.04). Use of the reporting template progressively increased with 81% of brain tumor reports dictated using the new template by 9 months. CONCLUSION: Implementing a structured template for brain tumor imaging improves perception of radiology reports among radiologists and referring providers involved in the care of brain tumor patients.

Evaluation of Incidental Cardiac Masses on Computed Tomography Imaging: An Algorithmic Approach.

Cardiac masses encountered on imaging may present a diagnostic dilemma when discovered incidentally, or even when they serve as the principal reason for the examination. In this review, we present an algorithmic approach for assessing cardiac masses by integrating clinical information with radiologic findings to reach a specific diagnosis or a narrow differential diagnosis.

Effect of tiotropium on spontaneous expiratory flow-volume curves during exercise in GOLD 1-2 COPD.

This substudy of a large, randomized, controlled trial (NCT01072396) examined tiotropium (18 µg qd) effects on dynamic hyperinflation during constant work rate treadmill exercise. Areas-under-the-spontaneous expiratory flow-volume (SEFV)-curves were compared in 20 COPD patients and 16 age-matched untreated controls, using rectangular area ratio (RAR) between peak intrabreath and end-expiratory flow. Seven patients exhibited SEFV curve concavity with RAR ≤ 0.5 (RARlow) in ≥1 test without tiotropium; (mean ±â€¯SD FEV1: 1.60 ±â€¯0.59 L; 63.4 ±â€¯14.0%predicted). In RARlow patients, tiotropium increased end-exercise inspiratory capacity (IC, 2.10 ±â€¯0.05 vs. 1.89 ±â€¯0.05 L, tiotropium vs. placebo; p = 0.045) and RAR (0.57 ±â€¯0.02 vs. 0.53 ±â€¯0.02; p < 0.001). Patients without SEFV curve concavity with RAR > 0.5 (n = 13; RARhigh), had higher screening FEV1 (2.15 ±â€¯0.47 L; 79.6 ±â€¯10.1%predicted) versus RARlow patients and no difference in end-exercise IC and RAR between tiotropium and placebo (IC: 2.24 ±â€¯0.03 vs. 2.17 ±â€¯0.03 L; RAR: 0.63 ±â€¯0.005 vs. 0.62 ±â€¯0.005). RAR and%predicted IC at peak exercise were positively correlated in RARlow patients (R2 = 0.43, p = 0.0002). Tiotropium increased exercise RAR in GOLD 1-2 patients with SEFV curve concavity.