Scoring system for periventricular leukomalacia in infants with congenital heart disease

Ann L. McCarthy, Madeline E. Winters, David R. Busch, Ernesto Gonzalez-Giraldo, Tiffany S. Ko, Jennifer M. Lynch, Peter J. Schwab, Rui Xiao, Erin M. Buckley, Arastoo Vossough, Daniel J. Licht

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background:Currently two magnetic resonance imaging (MRI) methods have been used to assess periventricular leukomalacia (PVL) severity in infants with congenital heart disease: manual volumetric lesion segmentation and an observational categorical scale. Volumetric classification is labor intensive and the categorical scale is quick but unreliable. We propose the quartered point system (QPS) as a novel, intuitive, time-efficient metric with high interrater agreement.Methods:QPS is an observational scale that asks the rater to score MRIs on the basis of lesion size, number, and distribution. Pre- and postoperative brain MRIs were obtained on term congenital heart disease infants. Three independent observers scored PVL severity using all three methods: volumetric segmentation, categorical scale, and QPS.Results:One-hundred and thirty-five MRIs were obtained from 72 infants; PVL was seen in 48 MRIs. Volumetric measurements among the three raters were highly concordant (ρc = 0.94-0.96). Categorical scale severity scores were in poor agreement between observers (κ = 0.17) and fair agreement with volumetrically determined severity (κ = 0.26). QPS scores were in very good agreement between observers (κ = 0.82) and with volumetric severity (κ = 0.81).Conclusion:QPS minimizes training and sophisticated radiologic analysis and increases interrater reliability. QPS offers greater sensitivity to stratify PVL severity and has the potential to more accurately correlate with neurodevelopmental outcomes.

Original languageEnglish (US)
Pages (from-to)304-309
Number of pages6
JournalPediatric Research
Issue number3
StatePublished - Sep 19 2015
Externally publishedYes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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