Observer variability assessing US scans of the preterm brain: the ELGAN study
Observer variability assessing US scans of the preterm brain: the ELGAN study
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DOI：
10.1007/s00247-007-0605-z
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发表时间：
2007-12-01
影响因子：
2.3
通讯作者：
Leviton, Alan
中科院分区：
文献类型：
--
作者：
Kuban, Karl;Adler, Ira;Leviton, Alan
背景：神经超声可以帮助临床医生，并可以为研究人员提供脑损伤的文件。不幸的是，我们对超声诊断的可靠性知之甚少。目的评价经验丰富的神经科医生的观察变异性。材料和方法我们收集了1450名在月经后第28周之前出生的婴儿的所有协议美国扫描。每组扫描由两名独立的超声医师阅读，以确定是否存在脑室内出血（IVH）和中度/重度脑室肿大，以及脑白质中的高回声和低回声病变。这四种特征中任何一种的扫描结果都不一致，被发送给第三位声纳专家。结果脑室肿大、低回声病变与IVH的阳性符合率（68 ~ 76%）、阴性符合率（92 ~ 97%）和kappa值（0.62 ~ 0.68）相似。然而，高回声病变的阳性一致性值（48%）、阴性一致性值（84%）和kappa值（0.32）明显较低。没有超声医生比他/她的同行更经常或更少地发现所有异常。大约40%的情况下，打破僵局的判读者同意判读者对IVH、脑室肿大或白质低回声病变的判断。只有大约25%的时间，第三方同意读者报告的白质高回声病变。结论获得一致性似乎是一种可接受的方法，以保证临床研究所需的图像的合理质量。
Background Neurosonography can assist clinicians and can provide researchers with documentation of brain lesions. Unfortunately, we know little about the reliability of sonographically derived diagnoses.Objective We sought to evaluate observer variability among experienced neurosonologists.Materials and methods We collected all protocol US scans of 1,450 infants born before the 28th postmenstrual week. Each set of scans was read by two independent sonologists for the presence of intraventricular hemorrhage (IVH) and moderate/severe ventriculomegaly, as well as hyperechoic and hypoechoic lesions in the cerebral white matter. Scans read discordantly for any of these four characteristics were sent to a tie-breaking third sonologist.Results Ventriculomegaly, hypoechoic lesions and IVH had similar rates of positive agreement (68-76%), negative agreement (92-97%), and kappa values (0.62 to 0.68). Hyperechoic lesions, however, had considerably lower values of positive agreement (48%), negative agreement (84%), and kappa (0.32). No sonologist identified all abnormalities more or less often than his/her peers. Approximately 40% of the time, the tie-breaking reader agreed with the reader who identified IVH, ventriculomegaly, or a hypoechoic lesion in the white matter. Only about 25% of the time did the third party agree with the reader who reported a white matter hyperechoic lesion.Conclusion Obtaining concordance seems to be an acceptable way to assure reasonably high-quality of images needed for clinical research.