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P-031 The orbital grading system performance in assessing angiographic outcomes for moyamoya vasculopathy in children: an inter-rater reliability analysis
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P-031 The orbital grading system performance in assessing angiographic outcomes for moyamoya vasculopathy in children: an inter-rater reliability analysis
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P-031 The orbital grading system performance in assessing angiographic outcomes for moyamoya vasculopathy in children: an inter-rater reliability analysis
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Journal Article
P-031 The orbital grading system performance in assessing angiographic outcomes for moyamoya vasculopathy in children: an inter-rater reliability analysis
2025
Overview
BackgroundThe Matsushima grading system is widely used to evaluate revascularization outcomes after Encephalo-Duro-Arterio-Synangiosis (EDAS) for Moyamoya vasculopathy by describing collateral ingrowth from the superficial temporal artery (STA) to the MCA territory. However, its subjective measurement and the potential ingrowth of collaterals to the ACA territory, as well as those from the MMA, are all limitations of the scale. The orbital grading system (OGS) is a new, objective scale initially developed to measure these outcomes in adults. We aim to evaluate this scale in the pediatric population.MethodsRetrospective analysis of patients with Moyamoya disease and syndrome treated with EDAS at a single major pediatric center from 2006–2023. An inter-rater reliability analysis was performed using 5 raters with different levels of training that provided scores for 30 blinded cases, and then a Fleiss’ kappa coefficient (k) was calculated as a measure of agreement beyond chance.Results101 patients with a mean age of 9 years old, mostly females (56.4%) and mostly comprised of Moyamoya disease (71.3%), were included. A total of 158 cerebral hemispheres were treated with EDAS (57 patients had bilateral surgeries). Most patients were categorized as Suzuki grade III or above (82.9%). At a median of 12.4 months, collateral growth graded using the Matsushima scale was A in 57.6%, B in 24%, C in 14.6%, and borderline grades in 3.8%. The OGS reported scores were grade 0 (7.0%), grade 1 (8.9%), grade 2 (43.7%), and grade 3 (40.5%). inter-rater agreement evaluation found that the OGS had a superior Kappa than the Matsushima Grading (0.51 vs. 0.15; p < 0.001).ConclusionThe OGS had higher inter-rater agreement rates compared to the Matsushima scale for identifying postoperative collateral ingrowth in children after EDAS. This scale offers a more objective way to evaluate radiological outcomes after EDAS for the pediatric population.DisclosuresA. Enriquez-Marulanda: None. M. Ruppert-Gomez: None. P. Lazatin: None. S. Staffa: None. S. Rangwala: None. D. Orbach: None. A. See: None. E. Smith: None. C. Ogilvy: None.
Publisher
BMJ Publishing Group LTD
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