MRI edema patterns in acute neck infections: A multicenter and multidisciplinary interobserver study

Vierula, Jari-Pekka; Aro, Katri; Bode, Michaela; Haapio, Eeva; Hakumäki, Juhana; Happonen, Tatu; Hollmén, Carita; Huhtanen, Heidi; Irjala, Heikki; Jouppila-Mättö, Anna; Jussila, Ville; Kaapu, Kalle; Karhu, Jari O.; Koivunen, Petri; Kolasa, Marcin; Kovalainen, Antti; Kurdo, Goran; Kytö, Eero; Laurikainen, Tiina; Lindén, Riikka; Martikainen, Ilkka; Nyman, Kristofer; Paananen, Timo; Paavilainen, Teemu; Saravo, Jarkko; Tähtinen, Jutta; Tammilehto, Ville; Velhonoja, Jarno; Ånäs, Niklas; Sirén, Aapo; Heikkinen, Jaakko; Nurminen, Janne; Nyman, Mikko; Mattila, Kimmo; Hirvonen, Jussi
MRI edema patterns in acute neck infections: A multicenter and multidisciplinary interobserver study

Vierula, Jari-Pekka
Aro, Katri
Bode, Michaela
Haapio, Eeva
Hakumäki, Juhana
Happonen, Tatu
Hollmén, Carita
Huhtanen, Heidi
Irjala, Heikki
Jouppila-Mättö, Anna
Jussila, Ville
Kaapu, Kalle
Karhu, Jari O.
Koivunen, Petri
Kolasa, Marcin
Kovalainen, Antti
Kurdo, Goran
Kytö, Eero
Laurikainen, Tiina
Lindén, Riikka
Martikainen, Ilkka
Nyman, Kristofer
Paananen, Timo
Paavilainen, Teemu
Saravo, Jarkko
Tähtinen, Jutta
Tammilehto, Ville
Velhonoja, Jarno
Ånäs, Niklas
Sirén, Aapo
Heikkinen, Jaakko
Nurminen, Janne
Nyman, Mikko
Mattila, Kimmo
Hirvonen, Jussi
Katso/Avaa
Lataukset: 

Elsevier
doi:10.1016/j.ejrad.2025.112526
URI
https://doi.org/10.1016/j.ejrad.2025.112526
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe202601216349
Tiivistelmä

Purpose

To assess the diagnostic accuracy and interobserver agreement of radiologists and surgeons in detecting prognostic MRI edema patterns, retropharyngeal (RPE) and mediastinal (ME) edema, in acute neck infections, supporting their clinical integration into emergency imaging workflows. These patterns are known to predict disease severity, yet their reliable identification across specialties remains untested until now.

Methods

In this multicenter observational study, 28 readers (comprising radiology residents, board-certified radiologists, and head and neck surgeons from five academic hospitals) evaluated axial T2-weighted Dixon MRI images from 60 patients with clinically confirmed acute neck infections. Readers, blinded to clinical data such as patient symptoms or laboratory results, assessed images for RPE and ME presence and rated their confidence. Sensitivity, specificity, accuracy, and interobserver agreement (Fleiss’ kappa) were calculated against a consensus standard set by two fellowship-trained neuroradiologists. Intraobserver consistency was tested by repeating 10 randomly selected cases, unbeknownst to readers.

Results

Overall sensitivity, specificity, and accuracy were 0.92, 0.80, and 0.87 for RPE and 0.88, 0.86, and 0.85 for ME, with substantial interobserver agreement (κ = 0.61 for RPE, 0.52 for ME). Radiologists outperformed surgeons in RPE sensitivity (p = 0.007), RPE accuracy (p = 0.04), ME sensitivity (p = 0.01), and ME accuracy (p = 0.02), with intraobserver consistency reaching 90 %. Confidence was high, averaging 4.3 for RPE and 4.1 for ME, and strongly correlated with accuracy (p < 0.001), reinforcing diagnostic reliability.

Conclusion

Physicians reliably detect MRI edema patterns across expertise levels, validating their use for risk stratification in acute neck infections and supporting broader adoption in clinical practice where MRI is available.

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