Variable interpretation of ultrasonograms may contribute to variation in the reported incidence of white matter damage between newborn intensive care units in New Zealand

Harris, Deborah L; Bloomfield, Frank H.; Teele, Rita L.; Harding, Jane E.

doi:10.1136/adc.2005.079806

Cited by 27 publications

(26 citation statements)

References 20 publications

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“…In another study, in which kappa values for periventricular leukomalacia were found to range from 0.17 to 0.22, the "gold standard" outside reviewers found periventricular leukomalacia to be present five times more often than the initial home-center readers [18]. Unlike two studies that had both local and central readers [9,18], local readers in our study functioned as both outside readers for scans obtained at other institutions as well as local readers for scans obtained at their own institutions. Perhaps that is why the prevalence of findings seen by the second, outside readers did not differ substantially from that of the first.…”

Section: Discussionmentioning

confidence: 97%

Observer variability assessing US scans of the preterm brain: the ELGAN study

et al. 2007

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Section: Discussionmentioning

confidence: 97%

Observer variability assessing US scans of the preterm brain: the ELGAN study

et al. 2007

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“…More unfavourable cUS findings such as cystic periventricular leukomalacia (cPVL) [13,14] or grade 3/4 IVH were more reliably seen by the observers [11,12,14,15]. Intra-observer agreement (к 0.54-0.64) even for cystic WM injury was only moderate [13].…”

Section: Horsch Et Al Compared Paired Cus and Conventional Mri Performentioning

confidence: 95%

“…The authors recommended formal training available to all those performing and interpreting cUS and for research studies review of the cUS images by experts should be sought [10]. Few studies have investigated the inter-and intraobserver agreement of cUS interpretation showing moderate interobserver agreement for mild/ moderate intraventricular haemorrhages (IVH) or WM injury [11][12][13][14]. More unfavourable cUS findings such as cystic periventricular leukomalacia (cPVL) [13,14] or grade 3/4 IVH were more reliably seen by the observers [11,12,14,15].…”

Section: Horsch Et Al Compared Paired Cus and Conventional Mri Performentioning

confidence: 99%

Interobserver variability in assessment of cranial ultrasound in very preterm infants

Hagmann

Halbherr

Koller

et al. 2011

Journal of Neuroradiology

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BACKGROUND: Cranial ultrasound (cUS) findings help doctors in the clinical management of preterm infants and in their discussion with parents regarding prediction of outcome. cUS is often used as outcome measure in clinical research studies. Accurate cUS performance and interpretation is therefore required. AIMS: The aims of this study were (i) to assess the interobserver variability in cUS interpretation, and (ii) to evaluate whether level of cUS expertise influences the interobserver variability. METHODS: Fifty-eight cUS image series of preterm infants born below 32weeks of gestation collected within the Swiss Neonatal Network were sent to 27 observers for reviewing. Observers were grouped into radiologists, experienced neonatologists and less experienced neonatologists. Agreement between observers was calculated using Kappa statistics. RESULTS: When cystic periventricular leukomalacia, intraventricular haemorrhage and periventricular haemorrhagic infarction were combined to one outcome, agreement among all observers was moderate. When divided into subgroups, kappa for the combined outcome was 0.7 for experienced neonatologists, 0.67 for radiologists and 0.53 for inexperienced neonatologists. Marked difference in interobserver agreement between experienced neonatologists and radiologists could be found for haemorrhagic periventricular ifraction (HPI). CONCLUSIONS: Our results suggest that interobserver agreement for interpretation of cUS varies from poor to good varying with the type of abnormality and level of expertise, suggesting that widespread structured training should be made available to improve the performance and interpretation of cUS.

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“…A cerebral ultrasound (cUS) estimate of this reduction in cerebral volume at TEA was similar to the volume reduction shown by MR in an equivalent sample of infants [1,3]. Although white matter (WM) injury associated with preterm birth and the early neonatal period is generally of a diffuse and noncystic nature and assumed to be the main contributor to this reduction in volume [4], there is no consensus about our ability to diagnose such injury reliably using cUS [5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

“…1) lasting for more than a week; this observation is also referred to as non-cystic periventricular leukomalacia (ncPVL) or grade 1 PVL [9]. The diagnosis of ncPVL was said to have potential prognostic relevance by some authors [10,11,12], but others argue against its use based on low prognostic value [12], low interobserver reliability [5] and low correlation with MR findings [7,13]. This disagreement may be partly explained by different definitions, some authors using stricter criteria (i.e.…”

Section: Introductionmentioning

confidence: 99%

Persistent Periventricular Echogenicities in Preterms Are Not Related to Smaller Brains at Term-Equivalent Age

Graça¹,

Cardoso²,

Costa³

et al. 2014

Neonatology

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Background: Periventricular white matter (PWM) is particularly vulnerable in very preterm infants. Non-cystic white matter injury, known as non-cystic periventricular leukomalacia (ncPVL), is the commonest ‘lesion' affecting the preterm brain. There is no consensus about whether ncPVL can be reliably identified from cerebral ultrasound (cUS) or whether there is any reliable correlate of ncPVL on cUS at term-equivalent age (TEA). Objective: To compare brain volumes and linear measures at TEA in infants with and without a diagnosis of ncPVL. Methods: Preterm infants of ≤32 weeks' gestation without major lesions were serially assessed using cUS. ncPVL was defined as PWM echogenicity comparable to the choroid plexus on two scans at least 2 weeks apart after the first postnatal week. At TEA, infants were scanned for the estimation of brain volume and ventricular and tissue dimensions. Head circumference was measured. The data were compared between those with/without ncPVL. Observer agreement was assessed using kappa statistic. Results: Of 63 eligible infants 29% had ncPVL. Significant differences were found between those with/without ncPVL for 5 min Apgar score, CRIB score, invasive ventilation rates and chronic lung disease but not for other relevant clinical data. No significant differences were found for estimated brain volume, ventricular size, corpus callosum length/thickness or central grey matter width. Intra-observer reliability was moderate (kappa = 0.51-0.56); inter-observer reliability was poor (kappa = 0.20-0.32). Conclusions: This study indicates that an ultrasound diagnosis of ncPVL should not be used as a sole predictor of lower brain growth detectable at TEA.

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Variable interpretation of ultrasonograms may contribute to variation in the reported incidence of white matter damage between newborn intensive care units in New Zealand

Cited by 27 publications

References 20 publications

Observer variability assessing US scans of the preterm brain: the ELGAN study

Observer variability assessing US scans of the preterm brain: the ELGAN study

Interobserver variability in assessment of cranial ultrasound in very preterm infants

Persistent Periventricular Echogenicities in Preterms Are Not Related to Smaller Brains at Term-Equivalent Age

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