Abstract
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.
Similar content being viewed by others
References
Griffiths GD, Razzaq R, Farrell A et al (2001) Variability in measurement of internal carotid artery stenosis by arch angiography and duplex ultrasonography – time for a reappraisal? Eur J Vasc Endovasc Surg 21:130–136
Ballantyne SA, O’Neill G, Hamilton R et al (2002) Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 15:145–149
Winkfield B, Aube C, Burtin P et al (2003) Inter-observer and intra-observer variability in hepatology. Eur J Gastroenterol Hepatol 15:959–966
Berg WA, Blume JD, Cormack JB et al (2006) Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology 241:355–365
Pinto J, Paneth N, Kazam E et al (1988) Interobserver variability in neonatal cranial ultrasonography. Paediatr Perinat Epidemiol 2:43–58
Pinto-Martin J, Paneth N, Witomski T et al (1992) The central New Jersey neonatal brain haemorrhage study: design of the study and reliability of ultrasound diagnosis. Paediatr Perinat Epidemiol 6:273–284
Harris DL, Teele RL, Bloomfield FH et al (2005) Does variation in interpretation of ultrasonograms account for the variation in incidence of germinal matrix/intraventricular haemorrhage between newborn intensive care units in New Zealand? Arch Dis Child Fetal Neonatal Ed 90:F494–F499
O’Shea TM, Volberg F, Dillard RG (1993) Reliability of interpretation of cranial ultrasound examinations of very low-birthweight neonates. Dev Med Child Neurol 35:97–101
Hintz SR, Slovis T, Bulas D et al (2007) Interobserver reliability and accuracy of cranial ultrasound scanning interpretation in premature infants. J Pediatr 150:592–596
Tooth L, Ware R, Bain C et al (2005) Quality of reporting of observational longitudinal research. Am J Epidemiol 161:280–288
Teele R, Share J (1991) Ultrasonography of infants and children. Saunders, Philadelphia
Leviton A, Paneth N, Reuss ML et al (1999) Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants. Developmental Epidemiology Network Investigators. Pediatr Res 46:566–575
Kuban K, Sanocka U, Leviton A et al (1999) White matter disorders of prematurity: association with intraventricular hemorrhage and ventriculomegaly. The Developmental Epidemiology Network. J Pediatr 134:539–546
Kuban KC, Allred EN, Dammann O et al (2001) Topography of cerebral white-matter disease of prematurity studied prospectively in 1607 very-low-birthweight infants. J Child Neurol 16:401–408
Fleiss JL, Kingman A (1990) Statistical management of data in clinical research. Crit Rev Oral Biol Med 1:55–66
Byrt T, Bishop J, Carlin JB (1993) Bias, prevalence and kappa. J Clin Epidemiol 46:423–429
Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363
Harris DL, Bloomfield FH, Teele RL et al (2006) Variable interpretation of ultrasonograms may contribute to variation in the reported incidence of white matter damage between newborn intensive care units in New Zealand. Arch Dis Child Fetal Neonatal Ed 91:F11–F16
Redline RW, Faye-Petersen O, Heller D et al (2003) Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol 6:435–448
Beam CA, Layde PM, Sullivan DC (1996) Variability in the interpretation of screening mammograms by US radiologists. Findings from a national sample. Arch Intern Med 156:209–213
Elmore JG, Wells CK, Lee CH et al (1994) Variability in radiologists’ interpretations of mammograms. N Engl J Med 331:1493–1499
Svensson E, Starmark JE, Ekholm S et al (1996) Analysis of interobserver disagreement in the assessment of subarachnoid blood and acute hydrocephalus on CT scans. Neurol Res 18:487–494
Cloft HJ, Kaufmann T, Kallmes DF (2007) Observer agreement in the assessment of endovascular aneurysm therapy and aneurysm recurrence. AJNR 28:497–500
Grotta JC, Chiu D, Lu M et al (1999) Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy. Stroke 30:1528–1533
Kapeller P, Barber R, Vermeulen RJ et al (2003) Visual rating of age-related white matter changes on magnetic resonance imaging: scale comparison, interrater agreement, and correlations with quantitative measurements. Stroke 34:441–445
de Vet HC, Koudstaal J, Kwee WS et al (1995) Efforts to improve interobserver agreement in histopathological grading. J Clin Epidemiol 48:869–873
Kujan O, Khattab A, Oliver RJ et al (2007) Why oral histopathology suffers inter-observer variability on grading oral epithelial dysplasia: an attempt to understand the sources of variation. Oral Oncol 43:224–231
Breeze AC, Cross JJ, Hackett GA et al (2006) Use of a confidence scale in reporting postmortem fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 28:918–924
Vansteenkiste E, Pizurica A, Philips W (2005) Improved segmentation of ultrasound brain tissue incorporating expert evaluation. Conf Proc IEEE Eng Med Biol Soc 6:6480–6483
Acknowledgements
This work was funded by a cooperative agreement with the National Institute of Neurological Disorders and Stroke (1 U01 NS 40069-01A2) and a program project grant form the National Institute of Child Health and Human Development (NIH-P30-HD-18655). The authors are also grateful for the assistance of all their colleagues, and the cooperation of the families of the infants who are the focus of our attention.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuban, K., Adler, I., Allred, E.N. et al. Observer variability assessing US scans of the preterm brain: the ELGAN study. Pediatr Radiol 37, 1201–1208 (2007). https://doi.org/10.1007/s00247-007-0605-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-007-0605-z