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Background <p>Accurate detection of macroscopic residual disease after neuroblastoma resection is essential for postoperative treatment decisions, including radiotherapy. Standard imaging follow-up is often performed at a time point when postoperative and therapy-related changes may hamper reliable differentiation between residual disease and reactive findings.</p> Objective <p>To assess inter-reader agreement and the diagnostic accuracy of early postoperative magnetic resonance imaging (MRI) for detecting residual disease after neuroblastoma surgery.</p> Methods <p>This retrospective single-center study included patients with histologically confirmed neuroblastic tumors who underwent surgical resection at a reference center and received standardized early postoperative MRI with adequate preoperative imaging. Two independent pediatric radiologists, blinded to all clinical data, assessed all examinations. A hierarchical multimodal reference standard was established based on surgical reports including expert consensus between a senior pediatric radiologist and a pediatric surgeon, and follow-up imaging (median follow-up 33&#xa0;months).</p> Results <p>Thirty-nine patients (median age 46&#xa0;months), predominantly with International Neuroblastoma Staging System (INSS) stage 4 neuroblastoma, were included; all patients had at least one image-defined risk factor. MRI was performed at a mean of 8±5&#xa0;days after surgery. Residual disease was identified in 14 patients and confirmed by the reference standard. Five residual diseases were expected by the surgeons (median volume 8&#xa0;ml), whereas nine were unexpected and small (median volume 1&#xa0;ml). Diagnostic accuracy were 95% and 90% for the two readers, respectively, with substantial inter-reader agreement (Cohen’s<i> κ</i>=0.76). Early postoperative MRI findings led to clinically relevant management adaptations in selected cases.</p> Conclusion <p>Early postoperative MRI demonstrates high diagnostic accuracy and substantial inter-reader agreement in detecting macroscopic residual disease, providing a robust baseline for further assessment.</p> Graphical Abstract <p></p>

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Inter-reader agreement and diagnostic accuracy of early postoperative magnetic resonance imaging for detecting macroscopic residual disease in neuroblastic tumors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • Marianna Chaika,
  • Cristian Urla,
  • Steven W. Warmann,
  • Michael Esser,
  • Jakob Spogis,
  • Patrick Krumm,
  • Andreas Schmidt,
  • Henrike Borkers,
  • Thorsten Simon,
  • Jörg Fuchs,
  • Jürgen F. Schäfer

摘要

Background

Accurate detection of macroscopic residual disease after neuroblastoma resection is essential for postoperative treatment decisions, including radiotherapy. Standard imaging follow-up is often performed at a time point when postoperative and therapy-related changes may hamper reliable differentiation between residual disease and reactive findings.

Objective

To assess inter-reader agreement and the diagnostic accuracy of early postoperative magnetic resonance imaging (MRI) for detecting residual disease after neuroblastoma surgery.

Methods

This retrospective single-center study included patients with histologically confirmed neuroblastic tumors who underwent surgical resection at a reference center and received standardized early postoperative MRI with adequate preoperative imaging. Two independent pediatric radiologists, blinded to all clinical data, assessed all examinations. A hierarchical multimodal reference standard was established based on surgical reports including expert consensus between a senior pediatric radiologist and a pediatric surgeon, and follow-up imaging (median follow-up 33 months).

Results

Thirty-nine patients (median age 46 months), predominantly with International Neuroblastoma Staging System (INSS) stage 4 neuroblastoma, were included; all patients had at least one image-defined risk factor. MRI was performed at a mean of 8±5 days after surgery. Residual disease was identified in 14 patients and confirmed by the reference standard. Five residual diseases were expected by the surgeons (median volume 8 ml), whereas nine were unexpected and small (median volume 1 ml). Diagnostic accuracy were 95% and 90% for the two readers, respectively, with substantial inter-reader agreement (Cohen’s κ=0.76). Early postoperative MRI findings led to clinically relevant management adaptations in selected cases.

Conclusion

Early postoperative MRI demonstrates high diagnostic accuracy and substantial inter-reader agreement in detecting macroscopic residual disease, providing a robust baseline for further assessment.

Graphical Abstract