Intra- and inter-observer agreement of IMPeTUs in multiple myeloma: a blinded repeated-reader study with independent multi-institutional readers
SCIENTIFIC REPORTS, cilt.16, sa.1, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 16 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1038/s41598-026-74515-2
- Dergi Adı: SCIENTIFIC REPORTS
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Chemical Abstracts Core, EMBASE, MEDLINE, Directory of Open Access Journals, Zoological Record, Academic Search Ultimate (EBSCO), Natural Science Collection (ProQuest), Biological Science Database (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Recep Tayyip Erdoğan Üniversitesi Adresli: Evet
Özet
Standardized interpretation of [18F]FDG PET/CT in multiple myeloma remains challenging because reproducibility varies across visual parameters. The Italian Myeloma criteria for PET Use (IMPeTUs) provide a structured framework, but evidence on intra-observer and inter-observer agreement remains limited, particularly across institutions. We prospectively registered patients with histopathologically confirmed multiple myeloma undergoing [18F]FDG PET/CT between March and September 2025. Fifty patients were included according to a prespecified target sample size. After anonymization, three independent nuclear medicine physicians from different institutions evaluated all examinations twice over 10 weeks using a blinded repeated-reader design with software-randomized weekly case allocation and presentation order. Intra-observer agreement was assessed using Cohen's kappa, inter-observer agreement using Krippendorff's alpha and pairwise kappa, and differences between reading rounds using permutation-based methods. An exploratory whole-patient binary metabolic status analysis using a Deauville score 4 threshold was also performed. Inter-observer agreement was highest for Lytic Lesion Group (alpha = 0.683 and 0.784) and Hottest Bone Focal Lesion Deauville score (alpha = 0.657 and 0.641). Bone Marrow Deauville score showed alpha values of 0.560 and 0.626, whereas Focal Lesion Group yielded 0.538 and 0.491. Fracture and Extramedullary Disease Presence showed lower agreement (alpha = 0.280 and 0.235; alpha = 0.412 and 0.262, respectively). Intra-observer agreement was highest for Hottest Bone Focal Lesion Deauville score (kappa = 0.846-0.891), Lytic Lesion Group (kappa = 0.759-0.905), and Focal Lesion Group (kappa = 0.679-0.855). For exploratory patient-level binary metabolic status, inter-observer agreement was moderate to good (alpha = 0.611 and 0.542), while intra-observer agreement was good to excellent (kappa = 0.626-0.822). No parameter showed a statistically significant change between reading rounds. IMPeTUs supports structured [18F]FDG PET/CT interpretation in multiple myeloma, but reproducibility differs across components, underscoring the need for clearer operational definitions and targeted training for less reproducible parameters.