Single-System Study of Variations in BT-RADS Score Distributions for MRIs of Brain Tumors Based on Patient and Reader Characteristics Open Access
Bian, Evan (Spring 2025)
Abstract
Importance: The radiology report can have significant variation dependent on subjective radiologist preference, leaving the door open for ambiguity and inconsistency. This is problematic for accurately assessing clinical outcomes in brain tumor patients through MRI, where it can already be challenging to differentiate progression from treatment-related changes. A Brain Tumor Reporting and Data System (BT-RADS) was introduced to provide neuroradiologists with a structured reporting method, but its performance in clinical use and variation between different physicians is not completely understood
Objective: To understand how the distribution of BT-RADS scores varies between individual physicians, tumor types, and tumor mutational burden in actual usage at a healthcare system.
Methods: 4246 consecutive MRI scans of brain tumors for 928 unique patients between Jan. 2021 and Sept. 2024 across Emory Healthcare were analyzed. Only faculty members who read over 100 scans were included. Data was collected on tumor type, IDH mutation, and MGMT methylation.
Results: Out of 96 inter-reader comparisons for BT-RADS scoring rates, 80.2% exhibited no significant difference between physicians and the overall score distribution. Significant differences were observed when comparing distributions based on common tumor types as well as between different genetic backgrounds.
Conclusion: BT-RADS demonstrated strong usage similarities by independent radiologists across a single healthcare system. Furthermore, the system encompasses information that can capture how unique tumor characteristics such as type and mutational burden can dictate patient prognosis and outcomes. The reporting system shows promise as an effective standardized system to communicate information on brain tumor MRIs.
Table of Contents
INTRODUCTION 1
MATERIALS AND METHODS 6
Patient Population 6
Clinical Interpretation 6
Demographic and Tumor Data Collection 7
Statistical Methodology 7
RESULTS 9
Overall Study Population Characteristics 9
Overall Population BT-RADS Score Distribution 9
Physician BT-RADS Score Distribution and Deviation 9
Astrocytoma vs. Oligodendroglioma BT-RADS Score Distribution 11
IDH mutant (IDH+) vs. IDH wild-type (IDH–) BT-RADS Score Distribution 11
MGMT methylated (MGMT+) v.s. MGMT unmethylated (MGMT–) BT-RADS Score Distribution 12
DISCUSSION 13
TABLES AND FIGURES 21
REFERENCES 32
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