Intermethod Agreement Research Articles

Confocal scanning laser ophthalmoscope in the retromode imaging modality in exudative age-related macular degeneration

To evaluate the ability of confocal scanning laser ophthalmoscope (cSLO) in the retromode imaging modality in detecting retinal changes secondary to exudative age-related macular degeneration (AMD). Seventeen eyes of 13 consecutive patients affected by CNV secondary to AMD were evaluated with optical coherence tomography (OCT) to detect neuroretinal detachment (NRD), pigment epithelial detachment (PED), cystoid macular edema (CME), and epiretinal membranes (ERM). All eyes were examined with a cSLO equipped with infrared retromode (RM) imaging modality. Infrared and fundus autofluorescence images were also obtained (IR and FAF). The intermethod agreement between OCT and cSLO was evaluated considering single cSLO imaging modality separately (IR, FAF, and RM), and all imaging modalities together. Eight eyes (47 %) had NRD at OCT; intermethod agreement was poor for any single cSLO imaging modality considered separately (k: 0.14, 0.01, and 0.29 for cSLO IR, FAF, and RM, respectively). Four eyes had PED at OCT (24 %); intermethod agreement was mild for cSLO RM, poor for IR and FAF (k: 0.51, 0.16, and 0.00, respectively). CME was present in eight eyes (47 %); intermethod agreement was excellent for cSLO RM, poor for IR and FAF (k: 0.88, 0.38, and 0.26, respectively). ERM was present in three eyes (18 %); intermethod agreement was mild for cSLO IR, poor for FAF, and excellent for RM (k: 0.59, 0.00, and 0.76, respectively). cSLO RM imaging is a useful and reproducible technique in detecting retinal features associated with CNV, particularly CME.

Accuracy, intermethod agreement, and inter-reviewer agreement for use of magnetic resonance imaging and myelography in small-breed dogs with naturally occurring first-time intervertebral disk extrusion

To determine accuracy, intermethod agreement, and inter-reviewer agreement for multisequence magnetic resonance imaging (MRI) and 2-view orthogonal myelography in small-breed dogs with first-time intervertebral disk (IVD) extrusion. Prospective evaluation study. 24 dogs with thoracolumbar IVD extrusion. Each dog underwent MRI and myelography. Images obtained with each modality were independently evaluated and assigned standardized scores in a blinded manner by 3 reviewers. Results were compared with surgical findings. Inter-reviewer and intermethod agreements were assessed via κ statistics. Accuracy was assessed as the percentage of dogs for which ≥ 2 of 3 reviewers recorded findings identical to those determined surgically. Inter-reviewer agreement was substantial for site (κ = 0.70) and side of IVD extrusion (κ = 0.62) in T2-weighted magnetic resonance images and was substantial for site (κ = 0.72) and fair for side of extrusion (κ = 0.37) in myelographic images. Agreement for site between each modality and surgical findings was near perfect (κ = 0.94 and 0.88 for MRI and myelography, respectively). Intermethod agreement was substantial for site (κ = 0.71) and moderate for side of extrusion (κ = 0.40). Accuracy of MRI for site and side was 100% when results for T1-weighted, T2-weighted, and contrast-enhanced T1-weighted sequences were combined. Accuracy of myelography was 90.9% and 54.5% for site and side, respectively. Agreement between imaging results and surgical findings for identification of IVD extrusion sites in small-breed dogs was similar for MRI and myelography. However, MRI appeared to be more accurate than myelography and allowed evaluation of extradural compressive mass composition.

Multimodality correlations of patellar height measurement on X-ray, CT, and MRI

To investigate whether the universally accepted range of normal patellar height ratios derived from radiography for the Insall-Salvati (IS) and Blackburne-Peel (BP) methods could be similarly applied to both CT and MRI. Institutional review board approval was obtained with waiver of informed consent for this HIPPA-compliant study. A total of 45 knees in 42 patients (15 men, 27 women; age range 11 to 75 years, mean age 39 ± 20 years) who underwent tri-modality (radiograph, CT, and MRI) examinations were selected. All patients had knee imaging obtained for a variety of reasons and measurements were performed by two independent readers who were blinded to each other's measurements or the respective measurements derived from each of the methods. Paired t test was used to compare the mean values among the modalities. Inter-observer and inter-method agreements were assessed using intra-class correlation coefficients. Statistically significant, but small quantitative differences are noted between tri-modality patellar height ratios. For comparable results, the small addition of 0.13 and 0.10 are needed for the Insall-Salvati measurements on MRI and CT respectively, compared with radiographs. For the Blackburne-Peel ratio, an additional adjustment of 0.09 is needed between radiographs and MRI, but not between radiographs and CT. These adjustments are independent of gender. The interobserver reproducibility was excellent (ICC ≥ 0.94) for both the Insall-Salvati and Blackburne-Peel methods for all modalities. The results indicate that cut-off values for patella alta and baja derived from radiographs should not be directly transposed to CT and MRI; however, the adjustments are relatively minor. These measurements show excellent reproducibility for all modalities currently used for patellar height measurements.

Stroke volume obtained by electrical interrogation of the brachial artery: transbrachial electrical bioimpedance velocimetry

The goal of this study is to measure left ventricular stroke volume (SV) from the brachial artery (BA) using electrical bioimpedance. Doppler-derived SV was used for comparison. Twenty-nine healthy adults were recruited for study. Doppler echocardiographic-derived SV was obtained from the product of distal left ventricular outflow tract cross-sectional area and systolic velocity integral. SV from the BA was obtained by transbrachial electrical bioimpedance velocimetry (TBEV). Application of a current field across the left brachium was effected by injection of a constant magnitude, high frequency, low amperage, alternating current. Therein, a static voltage (U0) and pulsatile voltage change (ΔU(t)) were measured and converted to their corresponding impedances, Z0 and ΔZ(t). TBEV-derived SV was obtained by multiplying a square root value of the normalized, acceleration-based, peak first time derivative of ΔZ(t) by a volume conductor and systolic flow time. Inter-method agreement was determined by the Bland–Altman method. To assess the contribution of blood resistivity variations to ΔZ(t), BA diameters were measured at end-diastole and peak systolic expansion. Results indicate that since the BA demonstrates parabolic, laminar flow, with minimal diameter changes, blood resistivity variations are likely responsible for the derived impedance changes. Bland–Altman analysis shows that SV is obtainable by TBEV from healthy humans at rest.

Hepatic Tumors: Region-of-Interest versus Volumetric Analysis for Quantification of Attenuation at CT

To evaluate the reproducibility of liver tumor attenuation measurement performed by using the routinely used manual region-of-interest (ROI) method and that of measurement performed by using a semiautomated volumetric approach at computed tomography (CT). This HIPAA-compliant retrospective study had institutional review board approval. The requirement for patient informed consent was waived. Attenuation of colon cancer liver metastases in 208 patients was measured on portal venous phase multidetector CT images by using a single ROI, the average measurement in three ROIs on a single section, and with semiautomated segmentation of the entire tumor volume (volumetric attenuation) to evaluate intermethod agreement. Intraobserver and interobserver reproducibility were evaluated in the first 70 patients. Measurements were repeated after 30 days to assess intraobserver reproducibility. Differences between methods were tested by using repeated-measures analysis of variance. Intermethod, intraobserver, and interobserver agreements were tested by using Bland-Altman analysis and the Lin concordance correlation coefficient (ρc). P < .05 was considered to indicate a significant difference. A total of 208 pathologically proven colon cancer hepatic metastases larger than 20 mm in diameter in 100 women and 108 men (mean age, 61.6 years ± 11.6 [standard deviation]; range, 28-87 years) were evaluated. Attenuation was significantly different between the three methods of measurement (P < .001 for all). Volumetric measurements had better intraobserver agreement (precision = 3.3%, ρc = 0.996, P < .001) than single-ROI measurements (precision = 12.0%, ρc = 0.947, P < .001) and measurements averaged over three ROIs (precision = 9.3%, ρc = 0.965, P < .001). Volumetric measurements also had better interobserver agreement (precision = 3.6%, ρc = 0.993, P < .001) than single-ROI measurements (precision = 11.3%, ρc = 0.957, P < .001) and the average measurement in three ROIs (precision = 8.5%, ρc = 0.976, P < .001). Measurements of hepatic tumor attenuation at multidetector CT are reproducible. An approach based on the evaluation of whole-lesion attenuation demonstrated better reproducibility than ROI measurements.

Agreement between two‐ and three‐dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor

To study intraobserver repeatability and intermethod agreement between two- (2D) and three-dimensional (3D) transperineal ultrasound methods in assessing fetal head descent during the first stage of labor. Fetal head descent was measured with transperineal ultrasound as the fetal head-perineum distance and the angle of progression in 106 primiparous women with prolonged first stage of labor. A single obstetrician performed all the scans, and another obstetrician analyzed the acquired 2D images and 3D volumes, blinded to clinical assessments and labor outcome. Intraobserver repeatability and intermethod agreement between 2D and 3D methods were analyzed. The repeatability coefficient was ± 4.1 mm in 2D acquisitions and ± 1.7 mm in 3D acquisitions of fetal head-perineum distance. The intraclass correlation coefficients (ICC) were 0.94 for 2D and 0.99 for 3D measurements. The angle of progression repeatability coefficients were ± 6.7° using 2D and ± 5.7° using 3D ultrasound and ICCs were 0.91 and 0.94, respectively. The intermethod ICC for fetal head-perineum distance in 2D vs 3D acquisitions was 0.95 and for angle of progression it was 0.93; the intermethod 95% limits of agreement were - 5.8 mm to + 7.2 mm and - 8.9° to + 13.7°, respectively. Cohen's kappa for 2D vs 3D acquisitions was 0.85 using 40 mm as a cut-off level for fetal head-perineum distance and 0.79 using 110° as cut-off level for angle of progression. For one ultrasound operator the intraobserver repeatability and agreement between 2D and 3D ultrasound methods in prolonged first stage of labor were good. Given that 2D methods are simpler to learn and can be analyzed quickly online, 2D equipment might therefore be preferred in the labor room.

IFCC standardised HbA1c: should the world be as one?

The central importance of HbA(1c) in monitoring glycaemic control was highlighted by the Diabetes Control and Complications Trial (DCCT) which showed that improved glycaemic control, as monitored by HbA(1c), delayed the onset of diabetic complications. Following this publication the issue of international standardisation of glycated haemoglobin (GHb) measurements became an important objective. The lack of international standardisation resulted in several countries developing National Standardisation Programmes. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on HbA(1c) Standardisation has established a reference measurement procedure (HPLC-MS or HPLC-CE) for HbA(1c) embracing the concept of metrological traceability. The reference method is anchored to a global network of 15 approved reference laboratories; this confers sustainability and a low level of uncertainty. Essential elements of a comprehensive reference measurement system additionally include the definition of the measurand and the unit of measurement. HbA(1c) is defined as haemoglobin (Hb) molecules having a stable adduct of glucose to the N-terminal valine of the β chain [Hb β chain (Blood) - N-(1-deoxyfructos-1-yl) Hb β chain] and that mmol/mol be used as the unit of measurement. These developments will result in improvements in inter-method and inter-laboratory agreement. Additionally, global acceptance of standardisation based on metrologically sound principles will enable clinical goals and diagnostic guidelines to be developed that can be adopted by all countries.

Reliability and Intermethod Agreement for Body Fat Assessment Among Two Field and Two Laboratory Methods in Adolescents

To increase knowledge about reliability and intermethods agreement for body fat (BF) is of interest for assessment, interpretation, and comparison purposes. It was aimed to examine intra- and inter-rater reliability, interday variability, and degree of agreement for BF using air-displacement plethysmography (Bod-Pod), dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and skinfold measurements in European adolescents. Fifty-four adolescents (25 females) from Zaragoza and 30 (14 females) from Stockholm, aged 13-17 years participated in this study. Two trained raters in each center assessed BF with Bod-Pod, DXA, BIA, and anthropometry (DXA only in Zaragoza). Intermethod agreement and reliability were studied using a 4-way ANOVA for the same rater on the first day and two additional measurements on a second day, one each rater. Technical error of measurement (TEM) and percentage coefficient of reliability (%R) were also reported. No significant intrarater, inter-rater, or interday effect was observed for %BF for any method in either of the cities. In Zaragoza, %BF was significantly different when measured by Bod-Pod and BIA in comparison with anthropometry and DXA (all P < 0.001). The same result was observed in Stockholm (P < 0.001), except that DXA was not measured. Bod-Pod, DXA, BIA, and anthropometry are reliable for %BF repeated assessment within the same day by the same or different raters or in consecutive days by the same rater. Bod-Pod showed close agreement with BIA as did DXA with anthropometry; however, Bod-Pod and BIA presented higher values of %BF than anthropometry and DXA.

Acute Ischemic Stroke: Infarct Core Estimation on CT Angiography Source Images Depends on CT Angiography Protocol

To test whether the relationship between acute ischemic infarct size on concurrent computed tomographic (CT) angiography source images and diffusion-weighted (DW) magnetic resonance images is dependent on the parameters of CT angiography acquisition protocols. This retrospective study had institutional review board approval, and all records were HIPAA compliant. Data in 100 patients with anterior-circulation acute ischemic stroke and large vessel occlusion who underwent concurrent CT angiography and DW imaging within 9 hours of symptom onset were analyzed. Measured areas of hyperintensity at acute DW imaging were used as the standard of reference for infarct size. Information regarding lesion volumes and CT angiography protocol parameters was collected for each patient. For analysis, patients were divided into two groups on the basis of CT angiography protocol differences (patients in group 1 were imaged with the older, slower protocol). Intermethod agreement for infarct size was evaluated by using the Wilcoxon signed rank test, as well as by using Spearman correlation and Bland-Altman analysis. Multivariate analysis was performed to identify predictors of marked (≥20%) overestimation of infarct size on CT angiography source images. In group 1 (n=35), median hypoattenuation volumes on CT angiography source images were slightly underestimated compared with DW imaging hyperintensity volumes (33.0 vs 41.6 mL, P=.01; ratio=0.83), with high correlation (ρ=0.91). In group 2 (n=65), median volume on CT angiography source images was much larger than that on DW images (94.8 vs 17.8 mL, P<.0001; ratio=3.5), with poor correlation (ρ=0.49). This overestimation on CT angiography source images would have inappropriately excluded from reperfusion therapy 44.4% or 90.3% of patients eligible according to DW imaging criteria on the basis of a 100-mL absolute threshold or a 20% or greater mismatch threshold, respectively. Atrial fibrillation and shorter time from contrast material injection to image acquisition were independent predictors of marked (≥20%) infarct size overestimation on CT angiography source images. CT angiography protocol changes designed to speed imaging and optimize arterial opacification are associated with significant overestimation of infarct size on CT angiography source images.

Radiological findings for hip dysplasia at skeletal maturity. Validation of digital and manual measurement techniques

To report on intra-observer, inter-observer, and inter-method reliability and agreement for radiological measurements used in the diagnosis of hip dysplasia at skeletal maturity, as obtained by a manual and a digital measurement technique. Pelvic radiographs from 95 participants (56 females) in a follow-up hip study of 18- to 19-year-old patients were included. Eleven radiological measurements relevant for hip dysplasia (Sharp's, Wiberg's, and Ogata's angles; acetabular roof angle of Tönnis; articulo-trochanteric distance; acetabular depth-width ratio; femoral head extrusion index; maximum teardrop width; and the joint space width in three different locations) were validated. Three observers measured the radiographs using both a digital measurement program and manually in AgfaWeb1000. Inter-method and inter- and intra-observer agreement were analyzed using the mean differences between the readings/readers, establishing the 95% limits of agreement. We also calculated the minimum detectable change and the intra-class correlation coefficient. Large variations among different radiological measurements were demonstrated. However, the variation was not related to the use of either the manual or digital measurement technique. For measurements with greater absolute values (Sharp's angle, femoral head extrusion index, and acetabular depth-width ratio) the inter- and intra-observer and inter-method agreements were better as compared to measurements with lower absolute values (acetabular roof angle, teardrop and joint space width). The inter- and intra-observer variation differs notably across different radiological measurements relevant for hip dysplasia at skeletal maturity, a fact that should be taken into account in clinical practice. The agreement between the manual and digital methods is good.

Reliability of a Survey Tool for Measuring Consumer Nutrition Environment in Urban Food Stores

Despite the increase in the volume and importance of food environment research, there is a general lack of reliable measurement tools. This study presents the development and reliability assessment of a tool for measuring consumer nutrition environment in urban food stores. Cross-sectional design. A racially diverse downtown portion (6 ZIP code areas) in Albany, New York. A sample of 39 food stores was visited by our research team in 2009 to 2010. These stores were randomly selected from 123 eligible food stores identified through multiple government lists and ground-truthing. The Food Retail Outlet Survey Tool was developed to assess the presence of selected food and nonfood items, placement, milk prices, physical characteristics of the store, policy implementation, and advertisements on outside windows. For in-store items, agreement of observations between experienced and lightly trained surveyors was assessed. For window advertisement assessments, inter-method agreement (on-site sketch vs digital photo), and inter-rater agreement (both on-site) among lightly trained surveyors were evaluated. Percent agreement, Kappa, and prevalence-adjusted bias-adjusted kappa were calculated for in-store observations. Interclass correlation coefficients were calculated for window observations. Twenty-seven of the 47 in-store items had 100% agreement. The prevalence-adjusted bias-adjusted kappa indicated excellent agreement (≥0.90) on all items, except aisle width (0.74) and dark-green/orange colored fresh vegetables (0.85). The store type (nonconvenience store), the order of visits (first half), and the time to complete survey (>10 minutes) were associated with lower reliability in these 2 items. Both the inter-method and inter-rater agreements for window advertisements were uniformly high (intraclass correlation coefficient ranged 0.94-1.00), indicating high reliability. The Food Retail Outlet Survey Tool is a reliable tool for quickly measuring consumer nutrition environment. It can be effectively used by an individual who attended a 30-minute group briefing and practiced with 3 to 4 stores.

Agreement in Detecting Glaucomatous visual Field Progression by using Guided Progression Analysis and Humphrey Overview Printout

To examine the level of agreement among 3 clinicians in assessing glaucoma visual field progression by using 2 different methods. Each visual field was assessed by Humphrey Field Analyzer (HFA), program SITA standard 30-2 or 24-2. In each printout the first 3 fields were excluded to minimize learning effect: the fourth and fifth full-threshold or SITA Standard examinations were used as baseline. Three clinicians assessed the progression status of each series using both HFA overview printouts and the guided progression analysis (GPA). The level of agreement among the clinicians was evaluated using a weighted kappa statistic (k). A total of 510 tests, comprising 83 eyes with an average of 6.1 tests each, was assessed by the 3 specialists. The mean follow-up time was 5.8 ± 1.75 years (mean ± standard deviation). When the intraobserver intermethod agreement was evaluated, k ranged from 0.5 to 0.7. When the interobserver agreement was analyzed, if HFA overview printouts were used, k ranged from 0.4 to 0.7. But when GPA was used, k ranged from 0.2 to 0.6. The level of agreement on progression status between the clinicians was always higher when they used HFA overview printouts (median k = 0.54) than when they used GPA (median k = 0.37). Agreement among expert clinicians about visual field progression status was moderate when GPA printouts were used. Clinicians' agreement about patients' visual field progression status was better when HFA overview printouts were used than with GPA printouts.

Accelerated territorial arterial spin labeling based on shared rotating control acquisition: an observer study for validation

Shared rotating control acquisition can shorten the imaging time of territorial arterial spin labeling (tASL) by 33% compared with the normal control acquisition scheme but potentially results in an inaccurate estimate of vascular territories due to imperfect magnetization transfer compensation. Our purpose was to validate the accuracy of the shared rotating control acquisition method in evaluation of vascular territories. Twenty-four patients underwent tASL at a 3.0-T MRI with the conventional normal control acquisition method. Composite vascular territory maps, in which the blood flows from the right and left internal carotid arteries and the posterior circulation were encoded in red-green-blue, were generated as a normal averaged control-label scheme and as a simulated shared rotating control scheme. Two observers independently reported the most dominant territorial flow in 26 brain regions corresponding to the arterial segments at three post-labeling time points. Inter-reader and inter-method agreements were analyzed using κ statistics. Overall inter-reader agreements were excellent for both the normal control and the shared rotating control methods (κ = 0.98, respectively). Overall inter-method agreement was also excellent (κ = 0.98), although relatively low agreement was noted in the bilateral posterior cerebral artery territories (κ = 0.79 to 0.93). Our results suggested that tASL using shared rotating control acquisition can provide information on the vascular territories comparable to that obtained using the normal control acquisition while substantially shortening the imaging time.

Maximum number of target lesions required to measure responses to transarterial chemoembolization using the enhancement criteria in patients with intrahepatic hepatocellular carcinoma

The European Association for the Study of the Liver (EASL) criteria and, more recently, the modified Response Evaluation Criteria in Solid Tumors (mRECIST), have been widely adopted for evaluating responses to locoregional therapies for hepatocellular carcinoma (HCC). We wished to establish the optimum maximum number of target lesions that need to be measured in enhancement estimations. From a prospective registry in our institution we identified 160 consecutive patients who had at least two measurable HCCs of nodular type exceeding 10mm in diameter, and who initially underwent transarterial chemoembolization (TACE). Intra-patient and inter-method agreement on confirmed response status were evaluated based on a maximum of one, two, or three target lesions selected among the measurable lesions according to size, versus all baseline lesions. Per patient analyses showed that the most consistent response distribution under both EASL and mRECIST was obtained using two or three targets versus all measurable lesions. These features were maintained even in analyses of subgroups stratified according to size, distribution, and number of tumors. The kappa values of comparisons between using a maximum of two or three targets versus using all the lesions were near 1.0, significantly higher than those obtained under both criteria using just the largest tumor. Similar conclusions were obtained when either two or three targets were measured. Our data indicate that evaluating the largest two lesions is generally the most useful procedure for measuring TACE responses under both EASL and mRECIST.

Comparison Between Laser Scanning In Vivo Confocal Microscopy and Noncontact Specular Microscopy in Assessing Corneal Endothelial Cell Density and Central Corneal Thickness

To compare central corneal thickness (CCT) and endothelial cell density (ECD) with laser scanning confocal microscope Heidelberg Retina Tomograph (HRT) II Rostock Corneal Module and noncontact specular microscope Tomey EM-3000 and to assess intra- and interobserver agreement in normal corneas. This prospective study included 48 normals (69.6 ± 7.2 years, range: 55-80 years) who underwent CCT and ECD with both Tomey and HRT 3 times by 2 independent observers. Measurement differences between instruments, agreement between devices, and test-retest variability (TRV) were determined. Mean CCTs with Tomey and HRT were 529.4 ± 35.4 and 536 ± 37.6 μm (P = 0.06), respectively; average ECDs with Tomey and HRT were 2473.5 ± 242.2 and 2539.7 ± 338.6 cells per square millimeter (P = 0.04), respectively. The mean of the differences (HRT minus Tomey) was 6.5 ± 17 μm for CCT and 65 ± 135.1 cells per square millimeter for ECD. Differences between instruments were not related to CCT (P = 0.35), whereas significantly increased with increasing ECD (P = 0.0001). Intraexaminer TRV for Tomey and HRT were 3.9 ± 3.7 and 22.2 ± 18.4 μm for CCT and 73 ± 63.4 and 152.2 ± 148.4 cells per square millimeter for ECD, respectively; interexaminer TRV was 4.6 ± 4.2 and 23.8 ± 17.3 μm for CCT and 84.9 ± 72.3 and 159.8 ± 149.8 cells per square millimeter for ECD. HRT II Rostock Corneal Module and the Tomey EM-3000 showed an overall good intermethod agreement. HRT showed a tendency to slightly overestimate CCT measurements, significantly underestimate ECD measurements in eyes with a reduced cell density (< 2290 cells per square millimeter), and overestimate ECD in eyes with a high cell density. Both instruments showed low intra- and interobserver TRV for both CCT and ECD measurements, which tended to be less for Tomey.

Intraobserver, interobserver, and intermethod agreement for results of myelography, computed tomography-myelography, and low-field magnetic resonance imaging in dogs with disk-associated wobbler syndrome

To determine intraobserver, interobserver, and intermethod agreement for results of myelography, computed tomography-myelography (CTM), and low-field magnetic resonance imaging (MRI) in dogs with disk-associated wobbler syndrome (DAWS). Prospective cross-sectional study. 22 dogs with DAWS. All dogs underwent myelography, CTM, and low-field MRI. Each imaging study was interpreted twice by 4 observers who were blinded to signalment and clinical information of the patients. The following variables were assessed by all 3 techniques: number, site, and direction of spinal cord compressions; narrowed intervertebral disk spaces; vertebral body abnormalities; spondylosis deformans; and abnormal articular facets. Intervertebral foraminal stenosis was assessed on CTM and MRI images. Intraobserver, interobserver, and intermethod agreement were calculated by κ and weighted κ statistics. There was very good to good intraobserver agreement for most variables assessed by myelography and only moderate intraobserver agreement for most variables assessed by CTM and low-field MRI. There was moderate to fair interobserver and intermethod agreement for most variables assessed by the 3 diagnostic techniques. There was very good or good intraobserver, interobserver, or intermethod agreement for the site and direction of the worst spinal cord compression as assessed by all the imaging modalities; abnormal articular facets and intervertebral foraminal stenosis were the least reliably assessed variables, with poor interobserver agreement regardless of imaging modality used. There was considerable variation in image interpretation among observers and between use of various imaging modalities; these imaging techniques should be considered complementary in assessment of dogs with DAWS.

Avaliação dos diferentes métodos de medida de força de compressão em três equipamentos mamográficos diferentes

OBJETIVO: Verificar a concordância dos resultados apresentados por diferentes métodos de medida e as variações apresentadas na aplicação deles em diferentes equipamentos mamográficos. MATERIAIS E MÉTODOS: Foram realizadas 10 medidas de força de compressão para cada método proposto em cada equipamento avaliado (Mammomat 3000-Siemens, Mammo Diagnostic UC-Philips e Alpha ST-GE), sendo avaliadas as diferenças entre esses equipamentos mamográficos para aplicação dos mesmos métodos de medida e as diferenças entre os métodos aplicados. RESULTADOS: Diferenças significativas foram observadas entre os resultados para os diferentes métodos propostos, sendo o valor medido com auxílio de "balança tipo de banheiro", o que subestimou o valor da força de compressão. Cada sistema de compressão mostrou diferentes respostas para os métodos propostos. CONCLUSÃO: Diferenças foram verificadas para os sistemas de compressão e métodos utilizados. Dessa forma, a escolha do modo de realização do teste de compressão torna-se importante para aceitação de equipamentos mamográficos, e a competência para a definição do método mais adequado e realista é do responsável técnico. Sugere-se que a medida de força de compressão seja realizada com auxílio de dinamômetro de extensão e não de compressão se não se conhece o funcionamento do sistema de compressão do mamógrafo.

Sonographic measurement of cervical volume in nonpregnant women using the geometric formula for a cylinder versus the three‐dimensional automated virtual organ computer‐aided analysis (vocal)

To sonographically evaluate the volume of uterine cervix in nonpregnant women with use of the geometric formula for a cylinder and to assess agreement with the reference Virtual Organ Computer-Aided AnaLysis (VOCAL) method. Three-dimensional ultrasound volume datasets of the uterine cervix from 81 women were obtained prospectively within a 1-year period. Volume measurements were performed using VOCAL and the geometric formula for a cylinder. Reliability was evaluated using intraclass correlation coefficient and Bland-Altman plots were produced to examine intermethod agreement. Time needed to perform measurements was compared with Student's t test. There was good agreement between VOCAL and the geometric formula for a cylinder (mean percentage difference, -0.78%; 95% limits of agreement, -17.59-16.03%). Measurements made by the formula for a cylinder were slightly greater than VOCAL by a mean (±SE) of 0.78% (±0.95%). A high degree of reliability was observed between the two methods (intraclass correlation coefficient, 0.97; 95%CI, 0.95-0.98). Cervical volume estimation with the geometric formula for a cylinder was faster to obtain. This method comparison study shows that the geometric formula for a cylinder has good agreement with VOCAL and can determine the volume of the cervix in a faster way.

The optimal tumor response assessment in patients with HCC after treatment of TACE.

215 Background: WHO or RECIST has been considered as suboptimal methods for tumor response assessment in HCC, especially receiving locoregional therapies. Recently, new modified methods having concept of viable tumor has been proposed. Herein we compared the efficacy to assess response and to predict prognosis between WHO, RECIST, EASL, mRECIST in HCC patients receiving TACE. Methods: We retrospectively reviewed 141 HCC patients who were newly diagnosed and received TACE between August 2005 and November 2006. Among them, 98 patients who were available for assessing treatment response were analyzed at 1 month after 2nd TACE. We evaluated intermethod aggreement between methods and assessed the efficacy predicting time to progression (TTP) and overall survival (OS). Results: The results of tumor responses (number of CR/ PR/ SD/ PD) by WHO/ RECIST/ EASL/ mRECIST were 1/ 14/ 74/ 9, 1/ 12/ 77/ 8, 34/ 34/ 25/ 5, 34/ 28/ 31/ 5, respectively. The κvalue of intermethod agreement for EASL vs WHO, EASL vs RECIST, mRECIST vs WHO, and mRECIST vs RECIST was 0.102, 0.088, 0.112 and 0.122, respectively. The κvalue for WHO vs RECIST and EASL vs mRECIST was 0.759 and 0.883 (p=0.00). Hazard ratios for TTP in responders compared with nonresponders were 0.313 (95% CI; 0.19-0.52, p=0.00) for EASL and 0.335 (95% CI; 0.21-0.54, p=0.00) for mRECIST. Hazard ratios for survival in responders compared with nonresponders were 0.208 (95% CI; 0.12-0.37, p=0.00) for EASL and 0.269 (95% CI; 0.15-0.48, p=0.00) for mRECIST. In the univariate analysis, tumor size, infiltrative type, PVT, EASL responder, and mRECIST responder were significant risk factors for survival. Multivariate analysis showed EASL responder (HR 0.165, 95% CI 0.056-0.486, p=0.001) and infiltrative type (HR 4.504, 95% CI 1.579-12.848, p=0.005) were independent predictable factors for survival. Conclusions: The recent proposed methods showed different characteristics from preexisting methods in assessing treatment response and furthermore, responder by EASL method was independent predictor for survival in HCC patients receiving TACE. EASL method should be applied as response assessment method for HCC patients receiving TACE. No significant financial relationships to disclose.

Agreement between pQCT- and DXA-derived indices of bone geometry, density, and theoretical strength in females of varying age, maturity, and physical activity

Measurement of bone mass, geometry, density, and strength are critical in bone research and clinical studies. For peripheral quantitative computed tomography (pQCT), single and repeated measurements are particularly adversely affected by movement and positional variation. Dual-energy X-ray absorptiometry (DXA)-derived indices may alleviate these problems and provide useful alternative assessments. To evaluate this hypothesis, distal radius DXA and pQCT indices were compared in 101 healthy females aged 8.0 to 22.8 years (prepuberty to adulthood), reflecting a broad range of body sizes, physical maturity, and activity exposures. At the diaphysis, correlations were ρ = +0.74 to +0.98, with strong intermethod agreement for most indices. At the metaphysis, correlations were ρ = +0.64 to +0.97; intermethod agreement improved with modifications to the simplified geometric formulas more closely reflecting metaphyseal bone geometry. Further improvements may be possible because skeletal size and maturity-related biases in agreement were detected. Overall, DXA-derived indices may provide a useful assessment of bone geometry, density, and theoretical strength contingent on appropriate consideration of their limitations.