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Chhabra A, Duarte Silva F, Mogharrabi B, Guirguis M, Ashikyan O, Rasper M, Park E, Walter SS, Umpierrez M, Pezeshk P, Thurlow PC, Jagadale A, Bajaj G, Komarraju A, Wu JS, Aguilera A, Cardoso FN, Souza F, Chaganti S, Antil N, Manzano W, Stebner A, Evers J, Petterson M, Geisbush T, Downing C, Christensen D, Horneber E, Kim JM, Purushothaman R, Mohanan S, Raichandani S, Vilanilam G, Cabrera C, Manov J, Maloney S, Deshmukh SD, Lutz AM, Fritz J, Andreisek G, Chalian M, Wong PK, Pandey T, Subhawong T, Xi Y. MRI-based Neuropathy Score Reporting And Data System (NS-RADS): multi-institutional wider-experience usability study of peripheral neuropathy conditions among 32 radiology readers. Eur Radiol 2024:10.1007/s00330-023-10517-2. [PMID: 38244046 DOI: 10.1007/s00330-023-10517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system. METHODS This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings. RESULTS Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036). CONCLUSION Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system. CLINICAL RELEVANCE STATEMENT The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists. KEY POINTS • The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively).
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Affiliation(s)
- Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA.
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA.
- Johns Hopkins University, Baltimore, MD, USA.
- University of Dallas, Richardson, TX, USA.
- Walton Centre for Neuroscience, Liverpool, UK.
| | - Flavio Duarte Silva
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA
| | - Bayan Mogharrabi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA
- Transition Year Residency, John Peter Smith Hospital, Fort Worth, USA
| | - Mina Guirguis
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA
| | - Oganes Ashikyan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA
| | - Michael Rasper
- Institute of Radiology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Eunhae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York City, NY, USA
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sven S Walter
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York City, NY, USA
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Monica Umpierrez
- Division of Musculoskeletal Radiology, Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Parham Pezeshk
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA
| | - Peter C Thurlow
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Akshaya Jagadale
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aparna Komarraju
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Antonio Aguilera
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fabiano Nassar Cardoso
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Felipe Souza
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Neha Antil
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Wilfred Manzano
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Alexander Stebner
- Institute of Radiology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Jochen Evers
- Institute of Radiology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | | | - Thomas Geisbush
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Chad Downing
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Diana Christensen
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Elizabeth Horneber
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jun Man Kim
- Division of Musculoskeletal Radiology, Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Shilpa Mohanan
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Surbhi Raichandani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - George Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clementina Cabrera
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John Manov
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sean Maloney
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Swati D Deshmukh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amelie M Lutz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York City, NY, USA
- Transition Year Residency, John Peter Smith Hospital, Fort Worth, USA
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York City, NY, USA
| | - Gustav Andreisek
- Institute of Radiology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Majid Chalian
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Philip K Wong
- Division of Musculoskeletal Radiology, Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ty Subhawong
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390-9178, USA
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