Observer Variability of Reference Tissue Selection for Relative Cerebral Blood Volume Measurements in Glioma Patients

M.T.H. Oei, F.J.A. Meijer, J.-J. Mordang, E.J. Smit, A.J. Idema, B.M. Goraj, H.O.A. Laue, M. Prokop and R. Manniesing

European Radiology 2018;28:3902-3911



Objectives: To assess observer variability of different reference tissues used for relative CBV (rCBV) measurements in DSC-MRI of glioma patients.

Methods: In this retrospective study, three observers measured rCBVin DSC-MRimages of 44 glioma patients on two occasions. rCBVis calculated by the CBVin the tumour hotspot/the CBVof a reference tissue at the contralateral side for normalization. One observer annotated the tumour hotspot that was kept constant for all measurements. All observers annotated eight reference tissues of normal white and grey matter. Observer variability was evaluated using the intraclass correlation coefficient (ICC), coefficient of variation (CV) and Bland-Altman analyses.

Results: For intra-observer, the ICC ranged from 0.50–0.97 (fair–excellent) for all reference tissues. The CV ranged from 5.1–22.1 % for all reference tissues and observers. For inter-observer, the ICC for all pairwise observer combinations ranged from 0.44–0.92 (poor–excellent). The CV ranged from 8.1–31.1 %. Centrum semiovale was the only reference tissue that showed excellent intra- and inter-observer agreement (ICC>0.85) and lowest CVs (<12.5 %). Bland-Altman analyses showed that mean differences for centrum semiovale were close to zero.

Conclusion: Selecting contralateral centrum semiovale as reference tissue for rCBV provides the lowest observer variability.

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