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Purpose <p>To quantify interobserver variability in Spetzler–Martin (SM) and Spetzler–Ponce (SP) grading of pediatric arteriovenous malformations (AVMs) and to develop a Disagreement Index (DI) capturing case-level grading instability and rater-dependent reclassification.</p> Methods <p>In this single-centre retrospective study, 45 consecutive pediatric AVMs were graded on pretreatment imaging by three raters. SM components/grade, SP class, and compact versus diffuse nidus morphology were recorded. Agreement was assessed using intraclass correlation coefficients (ICC) and κ statistics. A case-level DI (0–1) aggregated between-rater spread in SP class, dispersion of SM scores, and mismatches in SM components.</p> Results <p>SM score agreement was moderate (ICC = 0.72), whereas categorical agreement on SM grades was poor (Fleiss’ κ = 0.04). Collapsing into SP classes improved agreement (κ = 0.49), yet 17/45 AVMs (38%) crossed at least one SP boundary across raters. Eloquence (κ = 0.29) and nidus morphology (κ=−0.15) were least reproducible; nidus size and deep venous drainage showed higher agreement (κ = 0.41 and 0.58). DI ranged from 0.15 to 1.00 (median 0.46); high-DI cases were driven mainly by discordant eloquence and threshold crossings (SM II/III; SP A/B).</p> Conclusions <p>In pediatric AVMs, grading variability clusters around subjective descriptors and clinically meaningful thresholds, allowing the same lesion to be assigned to different risk strata. DI may support trainee feedback, data-quality checks, and prioritisation of cases for multidisciplinary review.</p>

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Interobserver variability of pediatric AVM grading: a disagreement index for training and calibration

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Francesco M.C. Lioi,
  • Alessandro De Benedictis,
  • Davide Ferlito,
  • Franco Randi,
  • Andrea Mattioli,
  • Alberto P. Giraldo,
  • Davide Luglietto,
  • Vittorio Ricciuti,
  • Carlotta Ginevra Nucci,
  • Carlo E. Marras

摘要

Purpose

To quantify interobserver variability in Spetzler–Martin (SM) and Spetzler–Ponce (SP) grading of pediatric arteriovenous malformations (AVMs) and to develop a Disagreement Index (DI) capturing case-level grading instability and rater-dependent reclassification.

Methods

In this single-centre retrospective study, 45 consecutive pediatric AVMs were graded on pretreatment imaging by three raters. SM components/grade, SP class, and compact versus diffuse nidus morphology were recorded. Agreement was assessed using intraclass correlation coefficients (ICC) and κ statistics. A case-level DI (0–1) aggregated between-rater spread in SP class, dispersion of SM scores, and mismatches in SM components.

Results

SM score agreement was moderate (ICC = 0.72), whereas categorical agreement on SM grades was poor (Fleiss’ κ = 0.04). Collapsing into SP classes improved agreement (κ = 0.49), yet 17/45 AVMs (38%) crossed at least one SP boundary across raters. Eloquence (κ = 0.29) and nidus morphology (κ=−0.15) were least reproducible; nidus size and deep venous drainage showed higher agreement (κ = 0.41 and 0.58). DI ranged from 0.15 to 1.00 (median 0.46); high-DI cases were driven mainly by discordant eloquence and threshold crossings (SM II/III; SP A/B).

Conclusions

In pediatric AVMs, grading variability clusters around subjective descriptors and clinically meaningful thresholds, allowing the same lesion to be assigned to different risk strata. DI may support trainee feedback, data-quality checks, and prioritisation of cases for multidisciplinary review.