Good Interobserver Agreement Research Articles

Interobserver Agreement Rates on Fibroblast Activation Protein Inhibitor-Directed Molecular Imaging and Therapy.

ObjectivesFibroblast activation protein (FAP) has emerged as a novel target for FAP inhibitor (FAPI)–directed molecular imaging and endoradiotherapy (ERT). We aimed to assess the interobserver agreement rates for interpretation of 68Ga-FAPI-4 PET/CT and decision for ERT.Patients and MethodsA random order of 68Ga-FAPI-4 PET/CTs from 49 oncology patients were independently interpreted by 4 blinded readers. Per scan, visual assessment was performed, including overall scan impression, number of organ/lymph node (LN) metastases, and number of affected organs/LN regions. Moreover, a maximum of 3 target lesions, defined as largest in size and/or most intense, per organ compartment were identified, which allowed for an additional quantitative interobserver assessment of LN and organ lesions. To investigate potential reference tissues, quantification also included unaffected liver parenchyma and blood pool. Readers also had to indicate whether FAPI-directed ERT should be considered (based on intensity of uptake and widespread disease). Interobserver agreement rates were evaluated using intraclass correlation coefficients (ICCs) and interpreted according to Cicchetti (with 0.4–0.59 indicating fair, and 0.6–0.74 good, agreement).ResultsOn a visual basis, the agreement rate for an overall scan impression was fair (ICC, 0.42; 95% confidence interval [CI], 0.27–0.57). The concordance rate for number of affected LN areas was also fair (ICC, 0.59; 95% CI, 0.45–0.72), whereas the number of LN metastases, number of affected organs, and number of organ metastases achieved good agreement rates (ICC, ≥0.63). In a quantitative analysis, concordance rates for LN were good (ICC, 0.70; 0.48–0.88), but only fair for organ lesions (ICC, 0.43; 0.26–0.60). In regards to background tissues, ICCs were good for unaffected liver parenchyma (0.68; 0.54–0.79) and fair for blood pool (0.43; 0.29–0.58). When readers should decide on ERT, concordance rates were also fair (ICC, 0.59; 95% CI, 0.46–0.73).ConclusionsFor FAPI-directed molecular imaging and therapy, a fair to good interobserver agreement rate was achieved, supporting the adoption of this radiotracer for clinical routine and multicenter trials.

Interobserver agreement of PD-L1 (SP263) assessment in advanced NSCLC on cytological smears and histological samples

BackgroundThe PD-L1 assessment is mandatory for the selection of patients affected by advanced non-small-cell lung cancer (NSCLC) who can benefit from the PD-1/PD-L1 checkpoint inhibitors therapy. Previous studies tested PD-L1 on cytological smears to evaluate this sample as an alternative to formalin-fixed paraffin-embedded (FFPE) ones, but several critical issues needed to be clarified. AimWe evaluated the cyto-histological agreement (CHA) and the PD-L1 interobserver agreement (IrOA) among three different pathologists (Path1, Path2, Path3) on 160 paired cytological smears and histological samples of advanced NSCLC. ResultsWith the cut-off of < 50%/≥ 50%, CHA resulted good for Path1 (Cohen’s k: 0.702) and Path3 (Cohen’s k: 0.731), moderate for Path2 (Cohen’s k: 0.576) adopting the same cut-off, the IrOA was moderate (ICC 0.72 [95% CI: 0.63–0.78]) for smears and good for histological samples (ICC 0.85 [95% CI: 0.80–0.85]). ConclusionWith a cut-off system of < 50%/≥ 50%, PD-L1 assessment shows moderate to good CHA and exhibited moderate IrOA on smears and good IrOA on FFPE. As result, PD-L1 assessment should be improved on cytological smears as well as could be a suitable alternative for patients without FFPE samples and not eligible for pembrolizumab, adopting a cut-off of < 50%/≥ 50%; presumably, an appropriate pathologist training could further improve the reproducibility.

Interobserver Agreement and Reliability of Intrapartum Nonreassuring Cardiotocography and Prediction of Neonatal Acidemia

Abstract Objective: To evaluate the agreement and reliability of intrapartum nonreasurring cardiotocography (CTG) interpretation and prediction of neonatal acidemia by obstetricians working in different centers. Methods: A retrospective cohort study involving two tertiary hospitals (The First Affiliated Hospital of Sun Yat-sen University and Perking University Third Hospital) was conducted between 30th September 2018 and 1st April 2019. Six obstetricians from two hospitals with three levels of experience (junior, medium, and senior) reviewed 100 nonreassuring fetal heart rate (FHR) tracings from 1 hour before the onset of abnormalities until delivery. Each reviewer determined the FHR pattern, the baseline, variability, and presence of acceleration, deceleration, sinusoidal pattern, and predicted whether neonatal acidemia and abnormal umbilical arterial pH &lt; 7.1 would occur. Inter-observer agreement was assessed using the proportions of agreement (Pa) and the proportion of specific agreement (Pa for each category). Reliability was evaluated with the kappa statistic (k-Light's kappa for n raters) and Gwet's AC1 statistic. Results: Good inter-observer agreement was found in evaluation of most variables (Pa &gt; 0.5), with the exception of early deceleration (Pa = 0.39, 95% confidence interval (CI): 0.36,0.43). Reliability was also good among most variables (AC1 &gt; 0.40), except for acceleration, early deceleration, and prediction of neonatal acidemia (AC1 = 0.17, 0.10, and 0.25, respectively). There were no statistically significant differences among the three groups, except in the identification of accelerations (Pa = 0.89, 95% CI: 0.83,0.95; Pa = 0.50, 95% CI: 0.41,0.60, and Pa = 0.35, 95% CI: 0.25,0.43 in junior, medium and senior groups, respectively) and the prediction of neonatal acidemia (Pa = 0.52, 0.52, and 0.62 in junior, medium and senior groups, respectively), where agreement was highest and lowest in the junior-level group, respectively. The accuracy and sensitivity of the prediction for umbilical artery pH &lt; 7.1 were similar among the three groups, but the specificity was higher in the senior groups (93.68% vs. 92.53% vs. 98.85% in junior, medium and senior groups, P = 0.015). Conclusion: Although we found a good inter-observer agreement in the evaluation of the most basic CTG features and FHR category statistically, it was insufficient to meet the clinical requirements for “no objection” interpretation for FHR tracings. Further specialized training is needed for standardized interpretation of intrapartum FHR tracings.

Variabilidad intraobservador e interobservador de las líneas de Gilula en el diagnóstico de las luxaciones carpianas

ObjectiveAlteration of Gilula's lines in the posteroanterior (PA) radiology of the wrist is a sign of perilunate dislocation. Our objective is to evaluate the intraobserver and interobserver variability of the Gilula lines in perilunate dislocations and the agreement between general orthopaedic surgeons, hand surgeons and residents of orthopaedic surgery, who participated in the study. Materials and methodsSix observers evaluated 30 PA carpal X-rays, including 15 with a diagnosis of perilunate dislocation and 15 without carpal lesions. These observers were the residents of orthopaedic surgery; orthopaedic surgeons not specialised in hand pathology and hand surgeons. All had to classify the X-rays as normal or pathological attending only to Gilula's lines. We calculated the intraobserver and interobserver variability using the Kappa coefficient.In this study, we have discussed indistinctively of concordance, agreement and variability as synonyms. ResultsIntraobserver concordance was very good (0.867–1.000) in residents and in hand surgeons, and moderate or good (0.553–0.795) in general orthopaedic surgeons.Interobserver concordance was very good (0.875) among hand surgeons, while it was good among general orthopaedic surgeons (0.679) and residents (0.751).Interobserver concordance was greater among residents and hand surgeons (Kappa 0.875, very good agreement) than among residents and general orthopaedic surgeons (Kappa 0.702, good agreement). ConclusionThe observation of Gilula lines is a good diagnostic method in case of suspicion of perilunate dislocation, with good intraobserver and interobserver agreement both in traumatologists in training and those who are already trained, whether or not they are specialists in hand surgery.

Magnetic Resonance Imaging Assessment of Abdominal Ectopic Fat Deposition in Correlation With Cardiometabolic Risk Factors.

PurposeEctopic fat accumulation and abdominal fat distribution may have different cardiometabolic risk profiles. This study aimed to assess the associations between various magnetic resonance imaging (MRI)-acquired fat depots and cardiometabolic risk factors.MethodsA total of 320 subjects with median age of 59 years, 148 men and 172 women, were enrolled in the study. Visceral adipose tissue (VAT) area and fat fraction (FF), subcutaneous adipose tissue (SAT) area and FF at the L1–L2 levels, preperitoneal adipose tissue (pPAT) area and FF, hepatic FF, pancreatic FF, and intramuscular FF were assessed by MRI FF maps. The associations of various MRI-acquired fat depots with blood pressure, glucose, and lipid were examined using sex-stratified linear regression. Logistic regression stratified by sex was used to analyze the association of various MRI-acquired fat depots with the risk of hypertension, T2DM, and dyslipidemia.ResultsThe intraclass correlation coefficient (ICC) values were >0.9, which suggested good interobserver and intraobserver agreement. VAT area, V/S, hepatic fat, pancreatic fat, and pPAT rather than SAT area were significantly associated with multiple cardiometabolic risk factors (all p < 0.05). However, the patterns of these correlations varied by sex and specific risk factors. Also, VAT and SAT FF were only significantly associated with multiple cardiometabolic risk factors in women (all p < 0.05).ConclusionsVAT, hepatic fat, pancreatic fat, and pPAT were associated with cardiovascular metabolic risk factors independent of BMI. The patterns of these correlations were related to gender. These findings further the understanding of the association between ectopic fat deposition and cardiometabolic risk factors and help to better understand the obesity heterogeneity.

Comparison of Linear and Convex-Array Transducers in Assessing the Enhancement Characteristics of Suspicious Breast Lesions at Contrast-Enhanced Ultrasound (CEUS).

The purpose of this study was to determine the observer agreement in assessing the enhancement pattern of suspicious breast lesions with contrast-enhanced ultrasound (CEUS) using high and low frequency transducers. Methods: This prospective study included 70 patients with suspicious breast lesions detected at mammography and/or ultrasound and classified according to the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) in 4A, 4B, 4C, or 5, who underwent CEUS examinations between October 2020 and August 2021. Results: Participants’ ages ranged from 28 to 83 years (48.5 + 6.36, mean age + SD). We obtained a substantial agreement for the first reader (kappa = 0.614, p < 0.001) and a perfect agreement for the second and third reader (kappa = 1, p < 0.001) between the two transducers for the uptake pattern. A moderate agreement for the second and third reader (kappa = 0.517 and 0.538, respectively, p < 0.001) and only a fair agreement (kappa = 0.320, p < 0.001) in the case of the first reader for the perilesional enhancement was observed. We obtained an excellent inter-observer agreement (Cronbach’s Alpha coefficient = 0.960, p < 0.001) for the degree of enhancement, a good inter-observer agreement for the uptake pattern and perilesional enhancement (Cronbach’s Alpha coefficient = 0.831 and 0.853, respectively, p < 0.001), and a good and acceptable inter-observer agreement for internal homogeneity, perfusion defects and margins of the lesions (Cronbach’s Alpha coefficient = 0.703, 0.703 and 0.792, respectively, p < 0.001) concerning the evaluation of breast lesions with the linear-array transducer. Conclusions: The evaluation of suspicious breast lesions by three experts with high-frequency linear-array transducer and low-frequency convex-array transducer was comparable in terms of uptake pattern and perilesional enhancement. The agreement regarding the evaluation of the degree of enhancement, the internal homogeneity, and the perfusion defects varied between fair and substantial. For all CEUS characteristics, the inter-observer agreement was superior for linear-array transducer, which leads to more a homogeneous and reproducible interpretation.

Current Practice of Italian Association of Revision Surgery Members in the Treatment of Unified Classification System Type B Periprosthetic Femoral Fracture Around Hip Arthroplasty: A Cross-Sectional Survey.

IntroductionPeriprosthetic femoral fracture around hip arthroplasty are growing in the world, nevertheless management and treatment options for fractures “around the stem” are still debated due to lack of high-level studies.Materials and methodA 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione Italiana Riprotesizzazione) to assess their current opinion in the management of type B periprosthetic femoral fractures. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training.ResultsVancouver/UCS fracture classification showed a good interobserver agreement (k value = .76). ORIF were the treatment of choice for UCS type B1 fractures (100%), revision stem for B2 (85%) and B3 (100%). Locked plates were preferred to cable plate and cerclage without a plate for B1 fractures (50% vs 40% vs 10%); revision with modular stem was preferred to monoblock stem for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to postpone at 1-month weight-bearing in patients with B1 fractures. Regarding postoperative pharmacological treatment there was absolute lack of consensus.DiscussionThe primary finding of our survey confirmed the preference of ORIF for B1 fractures and stem revision for B2 and B3 fractures. However, there is no definitive operative technique for all UCS B fractures. Surgeons tended to favor locked plating over cable plating, although only slightly. This general lack of consensus coincides with the inconclusive evidence that currently exists in the literature, which demonstrates both favorable and unfavorable outcomes for both techniquesConclusionsThe absence of complete homogeneity among participants showed the need for prospective randomized studies to set up stronger guidelines for classification, management, surgical treatment, rehabilitation, and pharmacological support of periprosthetic femoral fractures.

Prevalence of iatrogenic heart murmurs in a population of apparently healthy cats.

To determine the prevalence of iatrogenic heart murmurs in a population of apparently healthy cats and to investigate factors that may predispose cats to iatrogenic murmurs. Apparently healthy cats presenting for routine examinations were prospectively enrolled. Following a physical examination to confirm there were no abnormalities, a cardiac examination was performed before and during a provocative manoeuvre performed independently by two clinicians. The provocative manoeuvre was performed on the right side of the chest wall by applying gentle pressure with a stethoscope to ascertain whether a murmur became audible, graded using a modified descriptive scale (soft/moderate). The cat's heart rate before and during the provocative manoeuvre and their age, sex, body condition score and bodyweight were recorded. One hundred and six cats were prospectively enrolled. The average prevalence of iatrogenic murmurs was 28.2% with good interobserver agreement recorded on both the presence (kappa 0.67 and 0.62) and grade of the murmur (kappa 0.6 and 0.53). A significant association was noted between age and body condition score, with iatrogenic murmurs more likely in cats with increasing age and decreasing body condition score. There was no association between heart rate and the presence of an iatrogenic murmur. Iatrogenic murmurs are a common finding in cats with increasing prevalence noted in older and lean cats. Iatrogenic murmurs should therefore be considered as a differential diagnosis in a cat when an audible soft systolic right-sided murmur occurs with gentle pressure application to the chest wall during auscultation.

Reproducibility and diagnostic accuracy of pocket-sized ultrasound devices in ruling out compensated cirrhosis of mixed etiology

ObjectiveFibrosis is the key prognostic factor in chronic liver disease patients. Liver surface nodularity (LSN) is the ultrasonographic sign with the highest accuracy to detect advanced liver fibrosis. The use of pocket-sized ultrasound devices (PUDs) has been assessed in several clinical settings but never as regards chronic liver disease (CLD) severity. Our study aimed at evaluating the feasibility, reproducibility, and diagnostic accuracy of PUD in LSN identification.MethodsWe enrolled all the consecutive adults referred for percutaneous liver biopsy. Two independent operators evaluated LSN by PUD; one sonographer used standard ultrasound (US). Transient elastography (TE) and liver biopsy were performed on all the patients. PUD reproducibility was evaluated by Cohen’s k statistic. PUD, standard US, and TE results were compared with histology staging.ResultsA total of 104 consecutive patients (aged 54 ± 14 years) with mixed-etiology CLD were studied. Assessment by PUD was feasible in all the patients and showed very good inter-observer agreement with Cohen’s k = 0.87 (95% CI 0.72–0.95). The diagnostic accuracy estimates for PUD in diagnosing compensated cirrhosis (F = 4) were 87.5% sensitivity, 76.8% specificity, positive likelihood ratio (LR) 3.78, and negative likelihood ratio (LR-) 0.16, while those for standard US and TE (> 12.5 kPa) were, respectively, 87.5% sensitivity, 72.6% specificity, LR+ 3.2, and LR- 0.17, and 87.5% sensitivity, 90.5% specificity, LR + 9.2, and LR- 0.13.ConclusionsPUD reproducibility in assessing LSN was excellent even with operators of different experience. PUD performed very well in excluding advanced CLD. PUD can be used as a first-line tool for screening patients to undergo more invasive techniques, thus shortening the time for clinical decision-making.Key Points• PUD is highly reproducible in assessing the sign of liver surface nodularity.• PUD showed high diagnostic accuracy in excluding the presence of advanced chronic liver disease.• PUD can be used as a first-line tool for screening patients with CLD who should undergo more invasive techniques.

Myocardial perfusion quantification with Rb-82 PET: good interobserver agreement of Carimas software on global, regional, and segmental levels

PurposeTo estimate the interobserver agreement of the Carimas software package (SP) on global, regional, and segmental levels for the most widely used myocardial perfusion PET tracer—Rb-82.Materials and methodsRest and stress Rb-82 PET scans of 48 patients with suspected or known coronary artery disease (CAD) were analyzed in four centers using the Carimas SP.We considered values to agree if they simultaneously had an intraclass correlation coefficient (ICC) > 0.75 and a difference < 20% of the median across all observers.ResultsThe median values on the segmental level were 1.08 mL/min/g for rest myocardial blood flow (MBF), 2.24 mL/min/g for stress MBF, and 2.17 for myocardial flow reserve (MFR). For the rest MBF and MFR, all the values at all the levels fulfilled were in excellent agreement. For stress MBF, at the global and regional levels, all the 24 comparisons showed excellent agreement. Only 1 out of 102 segmental comparisons (seg. 14) was over the adequate agreement limit—23.5% of the median value (ICC = 0.95).ConclusionInterobserver agreement for Rb-82 PET myocardial perfusion quantification analyzed with Carimas is good at any LV segmentation level—global, regional, and segmental. It is good for all the estimates—rest MBF, stress MBF, and MFR.

Clinical assessment of tibial torsion differences. Do we always need a computed tomography?

BackgroundTibial torsional malalignment presents a well-known complication of intramedullary nailing for tibial shaft fractures.PurposeObjective of this study was to investigate the ability to clinically assess tibial torsion differences. Computed Tomography (CT) was used here as the gold standard. Further, intra- and inter-observer reliability of the clinical examination, and radiological measurements were calculated.MethodsFifty-one patients with torsion-difference CTs, obtained for various reasons, were asked to kneel on an examination couch with free hanging feet. All patients are positioned with 90° flexed knee and neutral ankle. A picture of the lower extremities was obtained from the back of the patient. Two blinded orthopedic surgeons were asked to look at the pictures and measure the tibial torsion with a digital goniometer, based on the axis of the femur in relation to the second ray of the foot. To determine the intra-observer variation, the torsional angles were calculated again after 4 weeks. To be able to compare values, two blinded radiologists calculated torsional differences based on computed tomography.ResultsAll patients were able to be positioned for clinical assessment (n = 51). Clinical assessment of torsional difference revealed 4.55° ± 6.85 for the first, respectively, 4.55° ± 7.41 for the second investigator. The second measurement of the first investigator revealed a value of 4.57° ± 6.9. There was a good intra-observer agreement for clinical assessment (ICC 0.993, p < 0.001). Also, the inter-observer agreement showed a good inter-observer agreement (ICC 0.949, p < 0.001). Evaluation of radiological inter-observer assessment could also show a good inter-observer agreement (ICC 0.922, p < 0.001). The clinical method showed a good correlation to the CT method (0.839, p < 0.001). Additionally, the Bland–Altman plot was used to compare graphically both measurement techniques, which proved the agreement.ConclusionIn summary, computed tomography-assisted measurement of tibial torsion and clinical assessment correlated significantly good. In addition to that, clinical measurement has a good intra- and inter-observer reliability. Clinical examination is a reliable and cost-effective tool to detect mal-torsion and should be part of the repertoire of every surgeon.

Variability of echocardiographic parameters in systemic right ventricle

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In transposition of the great arteries after atrial switch repair (TGA-AS), systemic circulation is supported by morphological RV. Initial remodeling of this systemic RV (sRV) is inevitably followed by ventricular enlargement and dysfunction. The evaluation of sRV size and function is therefore essential in the follow-up of TGA-AS patients. Although magnetic resonance imaging is considered the gold standard for sRV evaluation, transthoracic echocardiography (TTE) remains the most commonly used in everyday clinical practice. Comprehensive evaluation of sRV size and function is challenging even for experienced TTE operators. Furthermore, due to the lack of specific and standardized recommendations, TTE examinations also vary between operators and centres. Purpose We sought to determine interobserver variability in echocardiographic parameters for assessment of sRV size and function in patients with TGA-AS. Methods We retrospectively analysed echocardiographic recordings of all patients with TGA-AS from two national centres for adults with congenital heart disease (Centre 1: University Medical Centre Ljubljana, Slovenia and Centre 2: University Hospital Centre Zagreb, Croatia). Three congenital cardiologists (1 from Centre 1 and 2 from Centre 2), skilled in echocardiography and blinded for patients’ clinical data, reviewed offline TTE images on EchoPac (GE Vingmed Ultrasound). According to the recommendations, we obtained the following parameters of RV size and function: a) quantitative parameters: RV end diastolic dimension (RVEDD), RV hypertrophy (RVH), RV ejection fraction estimated in percentage (RV EF %), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid annulus S wave velocity (TDI S"), fractional area change (FAC), RV global longitudinal strain (RV GLS) and b) qualitative parameters: RV enlargement, RVEF by eyeballing and tricuspid regurgitation (TR). Qualitative parameters were classified into four categories: no/normal, mild, moderate, severe. Intraclass correlation coefficients (ICC) were calculated to evaluate interobserver variability, and values were classified into five reliability categories: &amp;lt;0.50 (poor), between 0.50 and 0.75 (moderate), between 0.75 and 0.90 (good), and above 0.90 (excellent interobserver agreement). Results In total, we identified 35 patients with TGA-AS (Centre 1: 15 patients, Centre 2: 20 patients). One patient was excluded from the analysis due to insufficient imaging data. In the remaining 34 patients, we showed excellent interobserver agreement in 5 parameters (TAPSE, RVEF eyeballing and RVEF %, RV GLS, TR) and good interobserver agreement in 4 parameters (RVEDD, RV enlargement, TDI S’, FAC). Only RVH showed moderate agreement (Table). Conclusion Echocardiographic parameters in sRV show good to excellent agreement between skilled investigators. According to our results, echocardiography performed by experienced operators is a reliable imaging method in sRV. Abstract Table

Preliminary study on the diagnostic value of cardiac magnetic resonance feature tracking for malignant ventricular arrhythmias in non-ischemic dilated cardiomyopathy.

BackgroundPatients with nonischemic dilated cardiomyopathy (NIDCM) and malignant ventricular arrhythmia (MVA) often have a poor prognosis and a high risk of sudden cardiac death. Although the diagnosis of MVA is straightforward by electrocardiogram (ECG), the underlying abnormalities of ventricular mechanics in these patients are unknown. This study aims to preliminarily explore the value of cardiac magnetic resonance feature tracking (CMR-FT) for MVA in dilated cardiomyopathy.MethodsIn this retrospective study, patients with NIDCM who met inclusion criteria were divided into an MVA group and a non-MVA group (included from January 2018 to September 2021). The interobserver agreement of myocardial strain parameters, including global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), were tested. The GLS, GCS, GRS, left ventricular ejection fraction (LVEF), Tpeak-Tend interval on ECG and brain natriuretic peptide (BNP) were compared between groups. Single-factor and multifactor receiver operating characteristic (ROC) curve analyses were conducted to calculate the area under the ROC curve (AUC), cut-off point, sensitivity, and specificity of these parameters in predicting MVA in NIDCM.ResultsA total of 161 NIDCM patients were included (54 in the MVA group). GLS, GCS, and GRS had good interobserver agreement (all intraclass correlation coefficients >0.80). The absolute GLS and GCS, GRS and LVEF were lower in the MVA group than the non-MVA group (P<0.001), Tpeak-Tend and BNP were higher (P<0.001). Single-factor ROC curve analysis showed that GLS, GCS and GRS had certain diagnostic value for MVA (AUC =0.795, 0.802, and 0.754, respectively). Among them, GCS had higher sensitivity and specificity (GCS 0.796/0.776, GLS 0.778/0.757, GRS 0.741/0.692). Multifactor ROC curve analysis showed the combination of GLS and GCS (AUC =0.810), the combination of GCS and GRS (AUC =0.802), the combination of GLS and GRS (AUC =0.787), the combination of GLS, GCS, and GRS (AUC =0.810).ConclusionsThe three-dimensional myocardial strain parameters (especially GLS and GCS) measured by CMR-FT had certain diagnostic value and could reflect the underlying abnormality of ventricular mechanics of NIDCM with MVA.

Correlation Of Computerized Tomography (CT) Severity Score For COVID-19 Pneumonia With Clinical Outcomes.

Though various computerized tomography (CT) severity scores have been described for risk prognostication for coronavirus disease 2019 (COVID-19), most are challenging to calculate and have variable inter-observer agreement. The objective of this study was to develop a simple CT severity score (CT-SS) with good inter-observer agreement and assess its correlation with clinical outcome. This retrospective study was conducted at the Aga Khan University Hospital (AKUH), from April-August 2020. All patients who were PCR positive for COVID-19 and underwent CT chest examination at AKUH were included. Severity of disease was described on the basis of a 10-point CT severity score (CT-SS) devised at our institution. CT-SS were categorized as Low (0-7) and High (8-10). Inter-observer reliability between radiologist and COVID-19 intensivist was assessed using the Kappa statistic. A total of 73 patients were included, the majority male (58.9%) with mean age 55.8±13.93 years. The CT-SS rated on 0-10 showed substantial inter-observer reliability between radiologist and intensivist with a Kappa statistic of 0.78. Patients with CT-SS 8-10 had a significantly higher ICU admission & intubation rate (53.8% vs. 23.5%) and mortality rate (35.9% vs. 11.8%; p=0.017), as compared to those with CT-SS 0-7. We conclude that the described CT severity score (CT-SS) is a quick, effective, and easily reproducible tool for prediction of adverse clinical outcome in patients with COVID 19 pneumonia. The tool shows good inter-observer agreement when calculated by radiologist and physician independently.

Association Between Cytological and Histological Grading of Breast Cancer and its Usefulness in Patient Treatment

Introduction: Breast cancer is the most common cancer in women throughout the globe, and the modern therapeutic available options have been widely researched currently. For a developing nation with limited resources, such as Pakistan, a quick, affordable, and least invasive technique like FNAC may give useful information. Aim: The aim of this study was; 1 Perform and evaluate cytomorphological classification of all breast cancer patients using the Robinson's three-tier grading system. 2 Histopathological evaluation and classification of all samples of MRM by using a modified BR classification system. 3 Correlation of histo-morphological and cytomorphological classification systems. Place and Duration: In the Pathology department of Khyber Teaching Hospital Peshawar for six months duration from February 2018 to July 2018. Material and methods: A prospective study was conducted in which two independent observers classified all breast cancer patients on the basis of cytology and histology of the tissue and cyto-histological correlation. Results: This study provided good individual correlation and inter-observer agreement in the cytopathological classification of breast cancer aspirates. Conclusion: Cytopathological classification may be useful for these patients and should therefore be included in routine reports. Keywords: Breast carcinoma; Cytopathology; Robinson classification system

Sensitivity and specificity of potassium hydroxide and calcofluor white stain to differentiate between fungal and Pythium filaments in corneal scrapings from patients of Pythium keratitis.

Purpose:To assess the sensitivity of potassium hydroxide and calcofluor white (KOH+CFW) mount in the diagnosis of Pythium keratitis and concordance among microbiologists.Methods:Three microbiologists evaluated the microscopic images of KOH + CFW mounts of confirmed cases of Pythium and fungal keratitis seen between January 2019 and February 2021. The filaments were compared using specific differentiating features. The sensitivity and specificity of KOH + CFW in diagnosing Pythium infection were evaluated along with concordance among the microbiologists.Results:Sixty consecutive cases with confirmed growth of fungus or Pythium insidiosum (n = 29) were evaluated. The sensitivity of KOH + CFW in the correct identification of Pythium filaments ranged from 79.3% to 96.5% among three microbiologists. There was good interobserver (k = 0.76–0.90) and intraobserver (k = 0.70–0.97) agreements among three microbiologists. The differentiating findings (P < 0.0001) suggestive of Pythium filaments were the absence of septae in 23 (79.3%) and collapsed walls in 22 (75.9%) cases.Conclusion:KOH + CFW has good sensitivity and specificity in the diagnosis of Pythium keratitis with good interobserver and intraobserver concordance.

Qualitative Assessment of Perfusion Maps Derived from Pulsed Arterial Spin Labeling Magnetic Resonance Imaging (PASL MRI) in Patients with Cognitive Disorders

Background: Dementia and its most common cause, Alzheimer's disease (AD), are growing health problems worldwide. In the pathological process, before the emergence of symptoms, magnetic resonance imaging (MRI) may be used as a non-invasive method for measuring brain perfusion. Objectives: This study aimed to investigate the feasibility and variability of brain perfusion maps derived from pulsed arterial spin labeling (PASL) MRI in a heterogeneous group of patients with cognitive disorders. Patients and Methods: In this cross-sectional study, 85 out of 134 patients with cognitive disorders, including 23 cases of AD, 24 cases of mild cognitive impairment (MCI), 31 cases of depression, and seven cases of subjective memory impairment (SMI), were considered eligible for the study. All patients were evaluated qualitatively with 3D PASL sequences, using inline cerebral blood flow (CBF) maps. Mental examinations and neuropsychological tests were also performed beforehand. Results: Based on the CBF maps, bilateral parietal hypoperfusion was significant in the AD and MCI groups (83 and 67%, respectively), compared to patients with depression or SMI (P &lt; 0.01). However, it was significantly low in depressed patients (13%), and there was no hypoperfusion in the SMI group. There was a good interobserver agreement, based on the kappa coefficient in all groups (0.78%; 95% CI: 0.65 - 0.91). Conclusion: The PASL MRI technique can be valuable for evaluating cognitive disorders, as it is non-invasive, rapid, and easily accessible. Besides, the qualitative assessment of CBF maps using this technique is reproducible and feasible in routine clinical practice.

Right adrenal vein identification using unenhanced magnetic resonance imaging.

Unenhanced magnetic resonance imaging (MRI) is known to be useful in characterizing adrenal adenomas through the implementation of in-phase (IPI) and opposed-phase imaging (OPI) based on chemical shift artifacts. However, whether unenhanced MRI can contribute to the identification of right adrenal vein (RAV) remains unclear. The aim of this study was to evaluate the feasibility of unenhanced MRI for the identification of RAV. This retrospective study reviewed 30 patients (16 men; median age 60 years; range 34-76 years) who underwent MRI and subsequent adrenal venous sampling (AVS). Chemical shift MRI was acquired using echo times of 2.3 ms (OPI) and 4.6 ms (IPI) with a slice thickness of 3 mm and a gap of 1 mm. T2-weighted imaging (T2WI) was also performed. Identification of RAVs was performed by 2 independent radiologists. Inter-observer agreement on a 3-point rating scale was evaluated using κ statistics. The identification rate of RAVs was compared between OPI, IPI, and T2WI using McNemar's test. Good inter-observer agreement was found for the OPI (κ = 0.744), whereas fair agreement was obtained for both other sequences (IPI: κ = 0.375; T2WI: 0.348). For both raters, the identification rate of RAVs was higher with OPI (36/60; 60.0%) than with other sequences (IPI: 16/60, 26.7%; T2WI: 9/60, 15.0%; p < 0.05, each). OPI may play a screening role in the identification of RAVs preceding AVS, which could reduce the required radiation exposure and doses of contrast agent.

Quantification Threshold Pixel Technique of Magnetic Resonance Imaging in Paraspinal Muscles Atrophy among Discopathy Patients

Purpose: To evaluate the relationship between lumbosacral discopathy status and paraspinal atrophic changes (Cross-sectional area (CSA) and fatty infiltration (FI)) among different age groups. Materials and Methods: We retrospectively evaluated 200 patients with confirmed discopathy who were examined by lumbosacral Magnetic Resonance Imaging (MRI) at the two main governmental hospitals in Gaza Strip. Using ImageJ software and quantification threshold technique, we measured the CSA and FI of paraspinal muscles {multifidus (MF) & erector spinae (ES)}. The interpretation of MRI images was performed by two radiologists with a good inter-observer agreement between the radiological discopathy findings. Results: The highest percentage and severity of discopathy were noticed at the level of L4/5 (89.5%), followed by L5/S1 (14.5%). The FI is increased towards lower levels of L3/4 to L5/S1. No correlation was found between discopathy level, the severity of discopathy, and CSA of MF & ES muscles. In contrast, a correlation was observed between FI of MF & ES muscles, discopathy level, and severity. Also, the results illustrated no significant relation was observed between CSA of MF & ES muscles and age groups (P > 0.05), while a significant correlation was reported between FI and age groups (P < 0.05). Conclusion: The MRI quantification threshold pixel technique for paraspinal muscles reflected the atrophic changes like CSA and FI in discopathy patients.

High-resolution three\u2011dimensional contrast\u2011enhanced magnetic resonance venography in children: comparison of gadofosveset trisodium with ferumoxytol

BackgroundGadofosveset is a gadolinium-based blood pool contrast agent that was approved by the United States Food and Drug Administration in 2008. Its unanticipated withdrawal from production in 2016 created a void in the blood pool agent inventory and highlighted the need for an alternative agent with comparable imaging properties.ObjectiveThe purpose of our study is to compare the diagnostic image quality, vascular contrast-to-noise ratio (CNR) and temporal signal characteristics of gadofosveset trisodium and ferumoxytol at similar molar doses for high-resolution, three-dimensional (3-D) magnetic resonance (MR) venography in children.Materials and methodsThe medical records and imaging data sets of patients who underwent high-resolution 3-D gadofosveset-enhanced MR venography (GE-MRV) or ferumoxytol-enhanced MR venography (FE-MRV) were retrospectively reviewed. Two groups of 20 pediatric patients (age- and weight-matched with one patient common to both groups; age range: 2 days–15 years) who underwent high-resolution 3-D GE-MRV or FE-MRV at similar molar doses were identified and analyzed. Qualitative analysis of image quality and vessel definition was performed by two blinded pediatric radiologists. Interobserver agreement was assessed with the AC1 (first-order agreement coefficient) statistic. Signal-to-noise ratio (SNR) and CNR of the inferior vena cava and aorta were measured in the steady-state venous phase. Medical records were retrospectively reviewed for any adverse reactions associated with either contrast agent.ResultsMeasured SNR and CNR of the inferior vena cava were higher for FE-MRV than GE-MRV (P = 0.034 and P < 0.001, respectively). The overall image quality score and individual vessel scores of FE-MRV were equal to or greater than GE-MRV (P = 0.084), with good interobserver agreement (AC1 = 0.657). The venous signal on FE-MRV was stable over the longest interval measured (1 h, 13 min and 46 s), whereas venous signal on GE-MRV showed more variability and earlier loss of signal. No adverse reactions were noted in any patient with either contrast agent.ConclusionFerumoxytol produces more uniform and stable enhancement throughout the entire venous circulation in children than gadofosveset, offering a wider time window for optimal image acquisition. FE-MRV offers a near-ideal approach to high-resolution venography in children at all levels of anatomical complexity.