Reliability and interobserver variability of a grading system of ventricular distension in dogs

Adriana Czerwik, Martin Jürgen Schmidt, Agnieszka Olszewska, Steven Hinz, Kathrin Büttner, and Daniela Farke

Background: Internal hydrocephalus is a common malformation of the central nervous system in dogs that can be treated with ventriculoperitoneal shunting (VPS). However, there is no standard classification scheme for grading the degree of ventricular distension in dogs, which may affect the prognosis and outcome of VPS.

Study: The authors proposed a grading system for ventricular distension in dogs based on MRI features and assessed its interobserver variability among three observers with different levels of experience in MRI interpretation and brain anatomy.

Methods: The authors retrospectively reviewed MRI scans of 147 dogs with various diagnoses related to ventricular distension. They graded the lateral cerebral ventricles as normal, minimally, mildly, moderately, severely enlarged or end stage (grade 0 to grade 5) based on morphological characteristics at two defined measuring points. They also measured the ventricle/brain index (VBI) in all dogs. They evaluated the interobserver agreement using the Spearman coefficient and kappa tests, and the correlation between the grading system and VBI using the Spearman coefficient and F-tests.

Results: The authors found a very strong correlation and excellent agreement between the neurologist in training and the board-certified neurologist, and a strong correlation and moderate agreement between the board-certified neurologist and the general practitioner. They also found a high correlation between the grading system and VBI, indicating that a higher VBI was associated with a more advanced grade of ventricular enlargement.

Limitations: The authors acknowledged some limitations of their study, such as the presence of only one observer in each experience group, the lack of correlation between the grading system and clinical symptoms or outcome measures, and the possible inaccuracy of the grading system in the lower grades.

Conclusions: The authors concluded that the grading system they proposed was a reliable and functional method for an objective grading of the ventricular system in dogs, but it required some basic neuroanatomical knowledge. They suggested further validation of the grading system with regard to inter- and intra-observer agreement and clinical relevance.

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