Improving Interrater Agreement About Brain Microbleeds

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Abstract
Background and Purpose— If the diagnostic and prognostic significance of brain microbleeds (BMBs) are to be investigated and used for these purposes in clinical practice, observer variation in BMB assessment must be minimized. Methods— Two doctors used a pilot rating scale to describe the number and distribution of BMBs (round, low-signal lesions, Results— In the pilot study, agreement about the presence of ≥1 BMB in any location was moderate (κ=0.44; 95% CI, 0.32–0.56), but agreement was worse in lobar locations (κ=0.44; 95% CI, 0.30–0.58) than in deep (κ=0.62; 95% CI, 0.48–0.76) or posterior fossa locations (κ=0.66; 95% CI, 0.47–0.84). Using BOMBS, agreement about the presence of ≥1 BMB improved in any location (κ=0.68; 95% CI, 0.49–0.86) and in lobar locations (κ=0.78; 95% CI, 0.60–0.97). Conclusion— Interrater reliability concerning the presence of BMBs was moderate to good, and could be improved with the use of the BOMBS rating scale, which takes into account the main sources of interrater disagreement identified by our pilot scale.