Standardizing Imaging Certainty Reporting for MRI-Negative Cushing Disease

Neuroradiologists showed only fair interrater agreement (mean κ=0.22) when interpreting MRIs from 14 operatively confirmed Cushing disease patients with indeterminate findings. All agreed that a system to convey imaging certainty in reports would be helpful.

• Two readers had moderate agreement (κ=0.48), but agreement with the third was slight (κ=0.06-0.11), revealing poor concordance even among experienced neuroradiologists.
• The authors propose that communicating diagnostic confidence in reports could alert clinicians to the need for broader exploration or additional imaging.

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