Interobserver Agreement Research Articles

Prevalence of spinal meningeal diverticula in autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) patients develop cysts in the kidneys, liver, spleen, pancreas, prostate and arachnoid spaces. In addition, spinal meningeal diverticula have been reported. To determine whether spinal meningeal diverticula are associated with ADPKD, we compare their prevalence in ADPKD subjects to a control cohort without ADPKD. ADPKD subjects and age-and gender-matched controls without ADPKD undergoing abdominal MRI from mid-thorax to the pelvis from 2003 to 2023 were retrospectively evaluated for spinal meningeal diverticula by 4 blinded observers. Prevalence of spinal meningeal diverticula in ADPKD was compared to control subjects, using t-test and correlated with clinical and laboratory data, and magnetic resonance imaging (MRI) features, including cyst volumes and cyst counts. Identification of spinal meningeal diverticula in ADPKD (n=285, median age, 47 [37,56]; 54% female) and control (n=285, median age, 47 [37,57]; 54% female) subjects had high inter-observer agreement (Pairwise Cohen kappa=0.74). Spinal meningeal diverticula were observed in 145 of 285 (51%) ADPKD subjects compared with 66 of 285 (23%) control subjects without ADPKD (p<0.001). Spinal meningeal diverticula in ADPKD were more prevalent in women (98 of 153 [64%]) than men (47 of 132 [36%], p<0.001). The mean number of spinal meningeal diverticula per affected ADPKD subject was 3.6 + 2.9 compared to 2.4 + 1.9 in controls with cysts (p<0.001). The median volume/interquartile range (IQR, 25%/75%) of spinal meningeal diverticula was 400 mm3 (210, 740) in ADPKD compared to 250 mm3 (180, 440) in controls (p<0.001). Mean/SD spinal meningeal diverticulum diameter was greater in the sacrum (7.3 + 4.1 mm) compared to thoracic (5.4 + 1.8 mm) and lumbar spine (5.8 + 2.0 mm), p<0.001, suggesting that that hydrostatic pressure contributed to enlargement. ADPKD has a high prevalence of spinal meningeal diverticula, particularly in women. ADPKD = Autosomal dominant polycystic kidney disease.

Interobserver agreement between radiologists and artificial intelligence in mammographic breast density classification

Interobserver agreement between radiologists and artificial intelligence in mammographic breast density classification

Intraobserver and interobserver agreement of US findings in suspected lymph node metastasis in papillary thyroid carcinoma

Intraobserver and interobserver agreement of US findings in suspected lymph node metastasis in papillary thyroid carcinoma

Enhancement on CT for preoperative diagnosis of metastatic lymph nodes in thyroid cancer: a comparison across experience levels.

To investigate the diagnostic performance and interobserver agreement of quantitative CT parameters indicating strong lymph node (LN) enhancement in differentiated thyroid cancer (DTC), comparing them with qualitative analysis by radiologists of varying experience. This study included 463 LNs from 399 patients with DTC. Three radiologists independently analyzed strong LN enhancement on CT. Qualitative analysis of strong enhancement was defined as LN cortex showing greater enhancement than adjacent muscles on the arterial phase. Quantitative analysis included the mean attenuation value (MAV) of LN on arterial phase (LNA) and venous phase (LNV), LNA normalized to the common carotid artery (NAVCCA), internal jugular vein (NAVIJV), and sternocleidomastoid muscle (NAVSCM), attenuation difference [AD; (LNA - MAVSCM)], and relative washout ratio [((LNA - LNV)/LNA) × 100]. The interobserver agreement and diagnostic performance of the quantitative and qualitative analyses were evaluated. Interobserver agreement was excellent for all quantitative CT parameters (ICC, 0.83-0.94) and substantial for qualitative assessment (κ = 0.61). All CT parameters except for LNV showed good diagnostic performance for metastatic LNs (AUC, 0.81-0.85). NAVCCA (0.85, 95% CI: 0.8-0.9) and AD (0.85, 95% CI: 0.81-0.89) had the highest AUCs. All quantitative parameters except for NAVIJV had significantly higher AUCs than qualitative assessments by inexperienced radiologists, with no significant difference from assessments by an experienced radiologist. Quantitative assessment of LN enhancement on arterial phase CT showed higher interobserver agreement and AUC values than qualitative analysis by inexperienced radiologists, supporting the need for a standardized quantitative CT parameter-based model for determining strong LN enhancement. When assessing strong LN enhancement in DTC, quantitative CT parameters indicating strong enhancement can improve interobserver agreement, regardless of experience level. Therefore, the development of a standardized diagnostic model based on quantitative CT parameters might be necessary. Accurate preoperative assessment of LN metastasis in thyroid cancer is crucial. Quantitative CT parameters indicating strong LN enhancement demonstrated excellent interobserver agreement and good diagnostic performance. Quantitative assessment of contrast enhancement offers a more objective model for the identification of metastatic LNs.

Clinical Characteristics, Outcomes, and Interobserver Agreement of Point-of-Care Ultrasound Detected Mesenteric Adenitis in Nonsurgical Pediatric Abdominal Pain: A Retrospective Cohort Study.

Point-of-care ultrasound (PoCUS) in the emergency department (ED) may facilitate the diagnosis of nonsurgical sources of abdominal pain after surgical causes are excluded. Identifying mesenteric adenitis is a feasible PoCUS application due to its ease of use and speed. However, there are scant data regarding the diagnosis of mesenteric adenitis by PoCUS. The objective of this study was to describe the clinical characteristics, outcomes, and interobserver agreement of mesenteric adenitis identified on PoCUS in pediatric patients with nonsurgical abdominal pain. This was a retrospective review at a tertiary-care, urban pediatric ED. All cases of mesenteric adenitis diagnosed on PoCUS from January 2018 to August 2022 were reviewed. Demographics and clinical data, including relevant outcomes, were recorded. All PoCUS videos were reviewed by a senior sonologist-physician for determination of mesenteric adenitis in children 21 years and younger with nonsurgical abdominal pain. Interobserver agreement by Cohen κ was calculated between experienced and novice physician sonologists blinded to diagnosis, who reviewed 77 six-second video clips for presence or absence of mesenteric adenitis. Thirty-three subjects were identified by PoCUS to have mesenteric adenitis in the setting of nonsurgical abdominal pain presenting to our ED. Most common indications for PoCUS were for suspected appendicitis, suspected intussusception, or undifferentiated abdominal pain. Forty-six percent of patients were male; median age was 9 years (interquartile range, 4-14 years). On 4-week clinical follow-up, 1 patient returned to our ED with a surgical abdomen. Cohen κ values were 0.83 (95% confidence interval, 0.70-0.97) between experienced sonologist-physicians and 0.76 (95% confidence interval, 0.61-.90) between novice and experienced sonologist-physicians. PoCUS can identify mesenteric adenitis, typically a diagnosis of exclusion, in pediatric patients with nonsurgical abdominal pain, both by novice and experienced physician-sonologists. Use of PoCUS may help ED clinicians identify a common cause of nonsurgical abdominal pain in children.

MRI analysis of and factors related to knee injuries in amateur marathon runners.

Marathons are the most challenging form of running, and amateur athletes may be more prone to injury due to a lack of professional knowledge and instruction in running. To analyze the MRI manifestations of and factors related to knee injuries in amateur marathon runners. Data were collected from a hospital database of 105 qualified amateur marathon athletes (65 males,40 females), between May 2018 and December 2021. 1.5T MR: sagittal fs-PDWI, sagittal T1WI and sagittal 3D-DESS sequence. The MRI manifestations of knee joint injury were analyzed and evaluated by two radiologists. The inter-observer agreement on MRI readings was analyzed using the kappa coefficient, and binary logistic regression analysis was employed to identify factors associated with knee injuries. The overall prevalence of knee cartilage lesions, meniscus lesions and bone marrow edema among amateur marathon runners was 45.7%, 72.4%, and 49.5% respectively. Our analysis revealed that older age (OR = 1.135, P<0.001), higher BMI (OR = 1.236, P = 0.044), and slower pace (OR = 2.305, P = 0.017) were associated with increased risk of articular cartilage disease. Furthermore, older age (OR = 1.425, P<0.001) was identified as a risk factor for meniscal lesions, while older age (OR = 1.088, P = 0.002) was bone marrow edema. Notably, no significant correlation was observed between knee joint injuries of amateur marathon athletes and gender or the monthly running distance (P>0.05). The occurrence of knee injuries among amateur marathon athletes was highly prevalent, with the patellofemoral joint cartilage and posterior horn of medial meniscus being frequently affected areas. Moreover, age, BMI, running years and pace were significant risk factors of knee joint injury.

Ultrasound findings and clinical characteristics in differentiating renal urothelial carcinoma from endophytic clear cell renal cell carcinoma.

This study aimed to evaluate the clinical characteristics and features of conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) in differentiating between renal urothelial carcinomas (RUC) and endophytic clear cell renal cell carcinomas (EccRCC). A total of 72 RUCs and 120 EccRCCs confirmed by pathology were assessed retrospectively. Both CUS and CEUS were performed within 4 weeks before the surgery. Logistic regression analyses were used to select statistically significant variables of clinical, CUS, and CEUS features for the differentiation of RUC and EccRCC. Sensitivity (SEN), specificity (SPE), and the area under the receiver-operating characteristic curve (AUC) were assessed for diagnostic performance. Inter- and intra-observer agreements of CUS and CEUS features were evaluated using the intra-class correlation coefficient(ICC). Multiple logistic regression analysis demonstrated that clinical (age >50 years old and hematuria), CUS (size <4.0 cm, hypo-echogenicity, irregular shape, hydronephrosis) and CEUS (absence of non-enhancement area, iso- /hypo-enhancement in cortical phase and absence of rim-like enhancement) features were independent factors for RUC diagnosis. When combining clinical characters with CUS and CEUS features into an integrated diagnostic criterion, the AUC reached 0.917 (95% CI 0.873-0.961), with a sensitivity of 95.8% and specificity of 87.5%. ICC ranged from 0.756 to 0.907 for inter-observer agreement and 0.791 to 0.934 for intra-observer agreement for CUS and CEUSfeatures. The combination of clinical features of age and hematuria with imaging features of CUS and CEUS can be useful for the differentiation between RUC and EccRCC.

Inter-observer and inter-modality concordance of non-contrast MR angiography and CT angiography for preoperative assessment of potential renal donors

BackgroundMagnetic resonance angiography (MRA) is rapidly being employed as an effective substitute for CTA, particularly in situations of poor kidney function. We aimed to examine the inter-observer and inter-modality reliability of non-contrast MR angiography (NC-MRA) and CTA as a non-invasive tool for assessing the anatomical findings of potential living kidney donors.ResultsAll potential donors were referred from specialized kidney transplantation center and underwent NC-MRA of the renal arteries using a respiratory-triggered magnetization prepared 3D balanced steady-state free precession (b-SSFP) with inversion recovery pulses and fat saturation (Inhance 3D Inflow Inversion Recovery (IFIR)). Two experienced radiologists reviewed NC-MRA images and were asked to evaluate both renal arteries anatomy and their branching pattern, presence of accessory or aberrant renal arteries, and identify any anatomical variant. Lin’s correlation test was performed to test MRA readings by each of the two observers against CTA findings which considered as the gold standard for assessment of renal arteries. Additionally, observers were asked to assess the image quality. The study included 60 potential kidney donors (43 males and 17 females) with mean age ± SD of 31.3 ± 5.6 years. Excellent to very good inter-observer agreement was found between both observers in the assessment of renal arteries by NC-MRA. There was perfect concordance between MRA and CTA findings in detecting early arterial division, caliber, and length of left extra-parenchymal segmental branches. Moderate concordance was found in the assessment of the supplied segments of extra-parenchymal segmental renal arterial branches and substantial concordance between both MRA observers’ findings in the remaining variables of the study. There was excellent agreement between both observers in the assessment of image quality parameters.ConclusionsNC-MRA for the renal arteries is an effective alternative for CTA without the risks of radiation or contrast media.

The value of D-dimer and platelet-lymphocyte ratio combined with CT signs for predicting intestinal ischemia in patients with bowel obstruction.

To investigate the diagnostic value of D-dimer, platelet-lymphocyte rate (PLR) and CT signs for intestinal ischemia in patients with bowel obstruction. We retrospectively analyzed the clinical and imaging data of 105 patients diagnosed with bowel obstruction, and performed univariate and multivariate analyses to determine the independent risk factors for intestinal ischemia in patients with bowel obstruction. Moreover, the receiver operating characteristic curve (ROC) was plotted to examine the diagnostic value of D-dimer, PLR and CT signs in patients with bowel obstruction. Besides, Kappa tests were used to assess inter-observer agreement. We included 56 men (53%) and 49 women (47%) with mean age of 66.05 ± 16 years. Univariate and multivariate analyses showed that D-dimer, PLR and two significant CT signs (i.e., increased unenhanced bowel-wall attenuation and mesenteric haziness) were independent risk factors for intestinal ischemia in patients with bowel obstruction. ROC analysis showed that the combined use of D-dimer, PLR and the said two CT signs had better performance than single indicators in predicting intestinal ischemia in patients with bowel obstruction. The area under the curve (AUC) of the joint model III was 0.925 [95%CI: 0.876-0.975], with a sensitivity of 79.2% [95CI%: 67.2-91.1] and a specificity of 91.2% [95%CI: 83.7-98.9]. The combined use of D-dimer, PLR and CT signs has high diagnostic value for intestinal ischemia in patients with bowel obstruction and will prompt surgical exploration to evaluate intestinal blood flow.

In vitro accuracy of ultra-low dose cone-beam CT for detection of proximal caries.

This study aimed to assess the accuracy of ultra-low dose (ULD) cone-beam CT (CBCT) for detection of proximal caries. This in vitro study evaluated 104 molar and premolar teeth. The teeth were mounted in dry skulls and underwent CBCT with 4 protocols of high-resolution (HR), normal (NORM), ULD-HR, and ULD-NORM; 78 CBCT images were scored by 3 observers for the presence and penetration depth of caries twice with a 2-week interval using a 5-point Likert scale. The teeth were then sectioned and observed under a stereomicroscope (gold standard). The 4 protocols were compared with each other and with the gold standard. The receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated and compared by the Chi-square test (alpha = .05). The interobserver agreement ranged from 0.5233 to 0.6034 for ULD-NORM, 0.5380 to 0.6279 for NORM, 0.5856 to 0.6300 for ULD-HR, and 0.6614 to 0.7707 for HR images. The intra-observer agreement ranged from 0.6027 to 0.8812 for ULD-HR, 0.7083 to 0.7556 for HR, 0.6076 to 0.9452 for ULD-NORM, and 0.7012 to 0.9221 for NORM images. Comparison of AUC revealed no significant difference between NORM and ULD-NORM (P > .05), or HR and ULD-HR (P > .05). The highest AUC belonged to HR (0.8529) and the lowest to NORM (0.7774). Considering the significant reduction in radiation dose in ULD CBCT and its acceptable diagnostic accuracy for detection of proximal caries, this protocol may be used for detection of proximal carious lesions and assessment of their depth.

Reproducibility of c-Met Immunohistochemical Scoring (Clone SP44) for Non-Small Cell Lung Cancer Using Conventional Light Microscopy and Whole Slide Imaging.

Emerging therapies for non-small cell lung cancer targeting c-Met overexpression have recently demonstrated promising results. However, the evaluation of c-Met expression can be challenging. We aimed to study the inter and intraobserver reproducibility of c-Met expression evaluation. One hundred ten cases with non-small cell lung cancer (40 biopsies and 70 surgical specimens) were retrospectively selected in a single laboratory (LPCE) and evaluated for c-Met expression. Six pathologists (4 seniors and 2 juniors) evaluated the H-score and made a 3-tier classification of c-Met expression for all cases, using conventional light microscopy (CLM) and whole slide imaging (WSI). The interobserver reproducibility with CLM gave global Cohen Kappa coefficients (ƙ) ranging from 0.581 (95% CI: 0.364-0.771) to 0.763 (95% CI: 0.58-0.92) using the c-Met 3-tier classification and H-score, respectively. ƙ was higher for senior pathologists and biopsy samples. The interobserver reproducibility with WSI gave a global ƙ ranging from 0.543 (95% CI: 0.33-0.724) to 0.905 (95% CI: 0.618-1) using the c-Met H-score and 2-tier classification (≥25% 3+), respectively. ƙ for intraobserver reproducibility between CLM and WSI ranged from 0.713 to 0.898 for the c-Met H-score and from 0.600 to 0.779 for the c-Met 3-tier classification. We demonstrated a moderate to excellent interobserver agreement for c-Met expression with a substantial to excellent intraobserver agreement between CLM and WSI, thereby supporting the development of digital pathology. However, some factors (scoring method, type of tissue samples, and expertise level) affect reproducibility. Our findings highlight the importance of establishing a consensus definition and providing further training, particularly for inexperienced pathologists, for c-Met immunohistochemistry assessment in clinical practice.

Reduced dynamic changes in pulmonary artery compliance during isometric handgrip exercise in patients with heart failure

Exercise intolerance is a debilitating symptom in heart failure (HF), adversely affecting both quality of life and long-term prognosis. Emerging evidence suggests that pulmonary artery (PA) compliance may be a contributing factor. This study aims to non-invasively assess PA compliance and its dynamic properties during isometric handgrip (HG) exercise in HF patients and healthy controls, using cardiovascular magnetic resonance (CMR). We prospectively enrolled 36 subjects, comprising 17 HF patients (NYHA class II and III) and 19 healthy controls. Participants performed an HG test, and we assessed changes in PA compliance and hemodynamic flow parameters using advanced CMR techniques. We also explored the relationship between CMR-derived PA compliance metrics and established clinical indicators, ensuring the validity of our findings through intra- and interobserver agreements. HF patients had significantly lower resting PA compliance compared to controls (28.9% vs. 50.1%, p < 0.01). During HG exercise, HF patients exhibited a dampened adaptability in PA compliance. Hemodynamic responses, including heart rate and blood pressure, were not significantly different between the groups. Further analyses revealed a significant correlation between changes in PA compliance and functional capacity, and an inverse relationship with NYHA class. Our study demonstrates a marked difference in PA vascular responses during HG exercise between HF patients and healthy controls. The compromised adaptability in PA compliance in HF patients is correlated with diminished functional capacity. These findings have significant clinical implications and may guide future interventional strategies in HF management.

Forensic age estimation by MRI of the knee – comparison of two classifications for ossification stages in a German population

Aim and objectivesIn forensic age estimation e.g. for judicial proceedings surpassed age thresholds can be legally relevant. To examine age related differences in skeletal development the recommendations by the Study Group on Forensic Age Diagnostics (AGFAD) are based on ionizing radiation (among others orthopantomograms, plain x-rays of the hand). Vieth et al. and Ottow et al. proposed MRI-classifications for the epiphyseal-diaphyseal fusion of the knee joint to define different age groups in healthy volunteers. The aim of the present study was to directly compare these two classifications in a large German patient population.Materials and methodsMRI of the knee joint of 900 patients (405 female, 495 male) from 10 to 28 years of age were retrospectively analyzed. Acquired T1-weighted turbo spin-echo sequence (TSE) and T2-weighted sequence with fat suppression by turbo inversion recovery magnitude (TIRM) were analyzed for the two classifications. The different bony fusion stages of the two classifications were determined and the corresponding chronological ages assigned. Differences between the sexes were analyzed. Intra- and inter-observer agreements were determined using Cohen’s kappa.ResultsWith the classification of Ottow et al. it was possible to determine completion of the 18th and 21st year of life in both sexes. With the classification of Vieth et al. completion of the 18th year of life for female patients and the 14th and 21st year of life in both sexes could be determined. The intra- and inter-observer agreement levels were very good (κ > 0.82).ConclusionIn the large German patient cohort of this study it was possible to determine the 18th year of life with for both sexes with the classification of Ottow et al. and for female patients with the classification of Vieth et al. It was also possible to determine the 21st year of life for all bones with the classification of Ottow et al. and for the distal femur with the classification of Vieth et al.

P-322 Development of a CD138-based histopathological scoring system to diagnose chronic endometritis

Abstract Study question Does a standardized histopathological classification system lead to a robust interobserver agreement to diagnose chronic endometritis (CE) and can an accurate computation algorithm be developed? Summary answer The proposed scoring system has a particularly good to excellent interobserver agreement among pathologists. A machine-learning algorithm outperformed pathologists in the clinically most relevant 2-tier-system. What is known already Plasma cell (PC) presence in the stromal endometrium has been proposed as a marker for CE, yet no standardized classification system that considers the amount or distribution of PCs exists. Also, interobserver agreement has been insufficiently reported in the previous publications on the topic. Without a robust histopathological score, the potential clinical impact of CE on ART treatment outcomes cannot be investigated. This issue is strongly reflected in the heterogeneity of the current diagnostic and therapeutic approaches, specifically for patients experiencing repeated implantation failure (RIF) or recurrent pregnancy loss (RPL). Study design, size, duration A 5-tier classification system based on CD138-positive PCs (Roche B-A38/automated Ventana system) was established: class0 (no PCs), classIPC (isolated PCs), class1 (³1 cluster of 5-19 PCs/0.25mm2), class2 (³1 cluster of 20-49 PCs/0.25mm2), class3 (³1 cluster of 50 or more PCs/0.25mm2). A test set of 78 endometrial biopsies (collected over two years) was selected by a certified pathologist who sorted &amp;gt;1000 biopsies to ensure the full spectrum of PC counts/distribution was accounted for. Participants/materials, setting, methods The 3DHistech-platform digitized the slides (pixel size 0.2738x0.2738mm) and a scoring session was set up in the Pathomation software suite. Six pathologists scored independently after training. Overall agreement was expressed by Fleiss’ Kappa values. Pairwise interobserver agreement was calculated using Cohen’s Kappa statistics. A supervised machine-learning algorithm was developed in QuPath(V0.4.2) and considered a seventh observer in the interobserver agreement calculations. Main results and the role of chance The CD138-based semiquantitative scoring system showed particularly good to excellent interobserver agreement among all observers. Overall agreement values were 0.722 for the 5-tier system and 0.858 for the 2-tier system (0+IPC versus 1 + 2+3, which was considered the clinically most relevant classification, i.e. CE absent versus diagnosed). Pairwise interobserver agreement was 0.871-0.951. Intra-class correlations varied from 0.727 to 0.839 in the 5-tier system and 0.893 to 0.965 in the 2-tier system. All findings were statistically significant (p &amp;lt; 0.001). The supervised machine-learning algorithm was able to compete with human pathologist observers and outperformed them in the 2-tier system. The proposed classification system provides a framework for assessing the presence and severity of endometrial PC infiltration and can guide further research. Limitations, reasons for caution Inconsistent staining intensity, non-specific epithelial staining and background interference are common problems that might limit interlaboratory use of the algorithm. Furthermore, the algorithm has not yet been associated to patient/clinical parameters. Accurate analysis of an endometrial biopsy might still be insufficient to provide a formal diagnosis of CE. Wider implications of the findings To unravel the association between PCs in endometrial biopsies (as a proxy for the diagnosis of CE) and the reproductive outcomes following ART, a standardized methodology is of crucial importance for future studies. Higher accuracy, efficieny and automation are advantages when using computer-aided diagnostics for CE. Trial registration number BUN 143202042810

P-246 Use of image recognition to quantify oocyte quality improved the accuracy of prediction of blastulation by 26-48%

Abstract Study question Can an AI oocyte quality model improve blastulation prediction accuracy? Summary answer An AI oocyte quality model presented an overall accuracy of 61-74%. Exhibiting an improvement of 26-48% for prediction of blastulation over random. What is known already Nowadays, the assessment of whether sufficient oocytes have been cryopreserved is purely based on patient age and number of oocytes collected. No morphological abnormalities provide quantitative guidance about the reproductive potential of the oocyte. Additionally, interobserver agreement and prediction of blastulation by experienced embryologists has been reported to be worse than chance (Behr et al., 2018). Therefore, there is a need to implement oocyte quality assessment tools to predict blastulation in oocyte donation, cryopreservation programs and IVF treatments. Study design, size, duration A retrospective study using an AI oocyte quality score (CHLOE-OQ, Fairtility Ltd) was performed in three private clinics evaluating 1749 oocytes that were inseminated with ICSI and cultured between October 2019 and December 2021. Overall and per clinic analysis were conducted (Clinic 1 n = 1131; Clinic 2 n = 576; Clinic 3: n = 42). Participants/materials, setting, methods An AI model provided an oocyte quality (OQ) score to assess prediction of blastulation, measured by binary logistic regression (AUC) per clinic and overall. The correlation between the OQ score and blastulation was measured using t-test. OQ score was classified into groups, Group A: 0.9-1.0, Group B: 0.7-0.9, Group C: 0.4-0.7 and Group D: 0-0.4. Blastulation rate was assessed in each OQ score subgroup using chi-square. Main results and the role of chance OQ score prediction of blastulation presented an overall accuracy of 63% (1107/1749). Accuracy per clinic ranged from 61-74%, Clinic 1: 61% (690/1131), Clinic 2: 67% (386/576) and Clinic 3: 74% (31/42). Exhibiting an improvement of 24-48% for prediction of blastulation over random. Oocyte quality score was predictive of blastulation per clinic and overall Clinic 1: AUC 0.62, n = 1130; Clinic 2: AUC 0.62, n = 575; Clinic 3: AUC 0.78, n = 41; Overall: AUC=0.62, p &amp;lt; 0.001, n = 1749). Overall blastocyst development rate was 53% (929/1749). OQ score was higher in oocytes that blastulated than those that did not blastulate (0.85 ± 0.14 vs 0.74 ± 0.2, p &amp;lt; 0.001). There was a significant direct association between OQ score subgroups and blastulation rate. Group A with the highest score subgroup had the highest blastulation rate [61% (554/903), p &amp;lt; 0.05]. The blastulation rates for Group B [53% (283/539) p &amp;lt; 0.001], Group C [38%, (71/188), p &amp;lt; 0.001] and Group D [18% (21/119), p &amp;lt; 0.001] were decreasingly lower. Limitations, reasons for caution This study was done in 3 centers in the same country. Therefore, further studies should focus on diversifying in terms of geographical location to address generalization of this AI assessment. Further studies should focus on comparing the efficacy of blastulation prediction by humans. Wider implications of the findings Using AI to do an objective oocyte assessment aids clinicians in determining the optimal time to transition to oocyte donor programs. It assists the decision-making for oocyte banking, minimizing unnecessary cycles and guiding timely additional oocyte collections. This approach at the point of cryopreservation, mitigates risks associated with delayed decisions. Trial registration number N/A

Performance of the First-Trimester Cervical Consistency Index to Predict Preterm Birth.

Background/Objectives: Preterm birth (PTB) remains a significant global health challenge. Previous attempts to predict preterm birth in the first trimester using cervical length have been contradictory. The cervical consistency index (CCI) was introduced to quantify early cervical changes and has shown promise across various clinical scenarios in the mid-trimester, though testing in the first trimester is lacking. This study aims to assess the cervical consistency index performance in predicting preterm birth during the first trimester of pregnancy. Methods: In this prospective cohort study, focused exclusively on research, women with singleton pregnancies, both with and without a history of spontaneous preterm birth (sPTB), were included. The primary outcome was sPTB before 37 weeks, with a secondary outcome of sPTB before 34 weeks. CCI measurements were taken between 11+0 to 13+6 weeks of gestation. Receiver operating characteristic (ROC) curves were generated, and sensitivity and specificity were calculated for the optimal cut-off and for the 5th, 10th, and 15th percentile. Intraobserver and interobserver agreements were assessed using the intraclass correlation coefficient (ICC). Results: Among the 667 patients analyzed, the rates of sPTB before 37 and 34 weeks were 9.2% (61/667) and 1.8% (12/667), respectively. The detection rates (DRs) for CCI predicting PTB before 37 and 34 weeks were 19.7% (12/61) and 33.3% (4/12). Negative predictive values were 91.8% (546/595) and 98.7% (588/596), while the areas under the curve (AUC) for sPTB before 37 and 34 weeks were 0.62 (95% CI: 0.54-0.69) and 0.80 (95% CI: 0.71-0.89), respectively. Of the 61 patients with preterm birth, 13 (21.3%) had a preterm birth history; in this group, the CCI percentile 10th identified 39% (5/13). Intraobserver ICC was 0.862 (95% CI: 0.769-0.920), and interobserver ICC was 0.833 (95% CI: 0.722-0.902). Conclusions: This study suggests that utilizing CCI in the first trimester of pregnancy could serve as a valuable tool for predicting preterm birth before 34 weeks of gestation, demonstrating robust intraobserver and interobserver reliability.

Super-resolution deep learning reconstruction approach for enhanced visualization in lumbar spine MR bone imaging

ObjectivesThis study aims to assess the effectiveness of super-resolution deep-learning-based reconstruction (SR-DLR), which leverages k-space data, on the image quality of lumbar spine magnetic resonance (MR) bone imaging using a 3D multi-echo in-phase sequence. Materials and methodsIn this retrospective study, 29 patients who underwent lumbar spine MRI, including an MR bone imaging sequence between January and April 2023, were analyzed. Images were reconstructed with and without SR-DLR (Matrix sizes: 960 × 960 and 320 × 320, respectively). The signal-to-noise ratio (SNR) of the vertebral body and spinal canal and the contrast and contrast-to-noise ratio (CNR) between the vertebral body and spinal canal were quantitatively evaluated. Furthermore, the slope at half-peak points of the profile curve drawn across the posterior border of the vertebral body was calculated. Two radiologists independently assessed image noise, contrast, artifacts, sharpness, and overall image quality of both image types using a 4-point scale. Interobserver agreement was evaluated using weighted kappa coefficients, and quantitative and qualitative scores were compared via the Wilcoxon signed-rank test. ResultsSNRs of the vertebral body and spinal canal were notably improved in images with SR-DLR (p < 0.001). Contrast and CNR were significantly enhanced with SR-DLR compared to those without SR-DLR (p = 0.023 and p = 0.022, respectively). The slope of the profile curve at half-peak points across the posterior border of the vertebral body and spinal canal was markedly higher with SR-DLR (p < 0.001). Qualitative scores (noise: p < 0.001, contrast: p < 0.001, artifact p = 0.042, sharpness: p < 0.001, overall image quality: p < 0.001) were superior in images with SR-DLR compared to those without. Kappa analysis indicated moderate to good agreement (noise: κ = 0.56, contrast: κ = 0.51, artifact: κ = 0.46, sharpness: κ = 0.76, overall image quality: κ = 0.44). ConclusionSR-DLR, which is based on k-space data, has the potential to enhance the image quality of lumbar spine MR bone imaging utilizing a 3D gradient echo in-phase sequence.Clinical relevance statement: The application of SR-DLR can lead to improvements in lumbar spine MR bone imaging quality.

The Value of Labial Gland Biopsies as a Diagnostic Test for Sjögren’s Syndrome

PurposeThere are a number of diagnostic criteria that can be used to support a diagnosis of Sjögren’s syndrome (SS), a chronic autoimmune condition often characterised by xerostomia and xerophthalmia. Of the available investigations, the most invasive is the labial gland biopsy (LGB) for histopathology, which is associated with a risk of long-term altered sensation to the lip. A positive histological diagnosis is currently considered to be one of the most objective criteria, however there is debate about the interobserver agreement between pathologists, as well as the sensitivity and specificity of this test. We aim to determine if the diagnostic value of the LGB is significant enough to warrant the surgical procedure and its associated risks.MethodsThis study involved assessing the degree of agreement between members of a pathology team for a cohort of 50 LGBs taken for the purpose of confirming or excluding SS. The Tarpley system was used, which involves the allocation of a ‘focus score’. Additionally, the histological diagnoses were compared to the relevant serological findings where available.ResultsAll cases within the cohort had adequate tissue for assessment. 84% agreement (Cohen’s Kappa = 0.585) was seen between the current team’s consensus and the original reporting pathologist on whether the appearance was supportive of SS. However, only 58% agreement was seen for focus scores (Weighted Kappa = 0.496). The agreement between the serology result and whether the histology was supportive of SS was 79% (Cohen’s Kappa = 0.493).ConclusionThe findings raise the possibility that undue emphasis is placed on the value of a histological SS diagnosis. The current system for assessing and grading these biopsies is ambiguous in nature, with a low threshold considered indicative of SS. Due to the risk of complications associated with a LGB, alternative minimally invasive investigations should always be considered. The histological findings in isolation, particularly when a low focus score is seen, may not be predictive of a diagnosis of SS.

Validation of LI-RADS Treatment Response Algorithm after Loco-Regional Therapy of Hepatocellular Carcinoma

Abstract Background Hepatocellular carcinoma (HCC) is the third cause of cancer related death worldwide and liver cirrhosis is the most common predisposing factor for HCC. Loco-regional therapy as radiofrequency ablation (RFA) or trans-arterial chemoembolization (TACE) have very important role as potentially curative or palliative methods for treatment of HCC. Objective To investigate the potential application of LI-RADS Treatment Response [LRTR] algorithm in terminology and diagnostic performance after local- regional treatment of hepatic lesions. Methods During the period from September 2021 to March 2022, the present study included 31 patients: 26 were males and 5 were females with hepatocellular carcinoma treated by loco-regional therapy including 21 conventional TACE and 10 RF. Their ages ranged between 51 - 80 years with mean age of 70 years old. Results There were excellent inter-observer agreements between both reader radiologists regarding the classification of treated HCC: LR-TR viable, LR-TR non- viable and LR-TR equivocal according to major features of LIRADS. DWI and ADC as well as T1 and T2 pre-contrast signal are considered good ancillary features in evaluating post treatment response of treated HCC. Conclusion Our study demonstrates that LIRADS treatment response algorithm is a good reporting system for explaining the outcome of the treated HCC with loco-regional therapy as it doesn’t depend only on APHE and mentions that there is expected post-treatment enhancement pattern that does not denote viability. This isn’t found in modified RECIST criteria.

Evaluation of the Quality and Reliability of YouTube Videos on Gender Dysphoria

Purpose: Many people search for information on YouTube on almost every medical topic. The aim of this study was to assess the quality and reliability of YouTube videos concerning Gender Dysphoria. Methods: We searched for Gender Dysphoria on YouTube on June 7, 2023 and conducted a detailed evaluation of the first 100 unique English videos by two expert observers. The videos were evaluated using modified DISCERN scale, Global Quality Scale (GQS), and Video Power Index (VPI). Results: The kappa coefficient for interobserver agreement was 0.892. For all 100 videos, the median value of the modified DISCERN score was 2.5 (1-4.8), and GQS score was 3 (1-5), and 68% of the videos rated as poor to moderate reliability and quality (modified DISCERN score ≤3, GQS ≤3). Reliable videos were uploaded by professional sources in a higher rate than unreliable videos (48% vs 12%, p