Interobserver Assessments Research Articles

Reliability of interobserver and intraobserver assessments of the Tile versus Young-Burgess classifications for pelvic ring injuries

Tile and Young-Burgess classification systems have been widely used to classify pelvic ring injuries in clinical settings; however, these two systems are rarely mentioned in the literature despite their reproducibility and practical application. The purpose of this study was to assess the interobserver and intraobserver reliability of the Tile and Young-Burgess classification of pelvic ring injuries. Eight hundred seven patients with pelvic fractures who presented to two I-level trauma centres between January 2016 and June 2020 were recruited for this study. The anteroposterior, inlet, and outlet of the pelvis were observed on radiographic images, and CT scans were performed on each patient. The anteroposterior, inlet, and outlet of the pelvis were radiographed at each visit, and CT scans were performed. Four observers were recruited to classify the injury type according to the Young-Burgess and Tile classification systems. Interobserver and intraobserver reliability (kappa coefficient, κ) were applied to assess the reproducibility of the two classification systems. A total of 174 patients (21.56%) could not be classified with the Young-Burgess classification, and all patients could be classified according to the Tile system. The mean κ value of the interobserver reliability was 0.558 (range, 0.444 to 0.653) for the Tile classification, indicating moderate agreement, whereas the mean κ value was 0.637 (range, 0.560 to 0.713), indicating substantial agreement, when the Young-Burgess classification was used. The mean κ value for intraobserver reliability was 0.597 (range, 0.567 to 0.653) for the Tile classification and 0.776 (range, 0.748 to 0.803) for the Young-Burgess classification. More pelvic ring injuries could be classified with the Tile classification than could be classified with the Young-Burgess classification. However, the reproducibility of the Young-Burgess classification was greater than that of the Tile classification.

Evaluating T1-weighted MRI techniques for fetal gastrointestinal diagnostics: A comparative study

PurposeIn clinical practice, fetal gastrointestinal magnetic resonance imaging (MRI) encounters significant challenges. T1-weighted images are particularly susceptible to the effects of fetal and maternal movements compared to other weighted images, complicating the acquisition of satisfactory results. This study aimed to compare three fast 3D-T1 weighted gradient echo (GRE) sequences—free-breathing stack-of-stars VIBE (STAR-VIBE), breath-hold VIBE (BH-VIBE), and free-breathing multi-average VIBE (MA-VIBE)—for fetal gastrointestinal MRI in fetuses with both normal and abnormal gastrointestinal tracts between 21 and 36 weeks of gestation. MethodsThis study enrolled 67 pregnant women who underwent fetal abdominal MRI at our hospital between October 2022 and October 2023, during their gestational period of 21–36 weeks. Among these participants, 22 were suspected of having fetal gastrointestinal anomalies based on ultrasound findings, while the remaining 45 were considered to have normal fetal gastrointestinal development. All subjects underwent True fast imaging with steady-state precession sequence scanning along with three T1-weighted imaging techniques on a Siemens 1.5-T Aera scanner: STAR-VIBE, BH-VIBE, and MA-VIBE. Two radiologists evaluated image quality, intestinal clarity, and lesion conspicuity using a five-point scale where higher scores indicated superior performance for each technique; they were blinded to the acquisition schemes used. Interobserver variability assessments were also conducted. ResultsThe free-breathing MA-VIBE sequence demonstrated significantly better performance than both STAR-VIBE and BH-VIBE in terms of fetal gastrointestinal MRI quality (3.81 ± 0.40 vs. 3.35 ± 0.70 vs. 2.90 ± 0.64; p < .05). The STAR-VIBE and BH-VIBE sequences exhibited moderate consistency (kappa = 0.586 and kappa = 0.527 respectively; P < .05), whereas the MA-VIBE sequence showed higher consistency (kappa = 0.712; P < .05). ConclusionThe free-breathing MA-VIBE sequence provided superior visualization for assessing fetal intestinal conditions compared to other methods employed in this study. On a 1.5 T MRI device, T1-weighted images based on the free-breathing MA-VIBE sequence can effectively overcome motion artifacts and compensate for the reduced signal-to-noise ratio caused by the application of acceleration techniques, thus significantly improving the quality of T1-weighted images.

Reliability of ultrasound shear-wave elastography in assessing tensor fascia latae, gluteus medius, and iliotibial band elasticity in health individuals

Purpose: Gluteus medius (GMed), tensor fascia latae (TFL), and iliotibial band (ITB) play important roles in stabilizing the hip joint and are often prone to overuse syndromes such as greater trochanteric pain syndrome and runner’s knee. Shear-wave elastography (SWE) presents a new avenue for rapidly assessing these structures in an out-patient setting. This study aims to assess the intra- and interobserver reliability of sWE in evaluating the GMed, TFL, and ITB. Materials and Methods: Twelve healthy volunteers (6 men and 6 women) were examined by two physiatrists using SWE. To assess inter-observer reliability, both physiatrists measured the thickness, velocity, and stiffness of GMed, TFL, and proximal and distal ITB. One physiatrist repeated the same measurements under identical conditions one week later to assess intra-observer reliability. Intra-class correlation coefficients (ICC) were calculated to evaluate reliability. Results: Inter-observer measurements showed poor reliability (ICC &lt; 0.4) for all parameters, except for GMed thickness (ICC=0.412), which was moderately reliable. Intra-observer measurements showed varying degrees of reliability, with TFL thickness (ICC=0.733), ITBP thickness (ICC=0.592), ITBD velocity (ICC=0.634), and ITBD stiffness (ICC=0.701) demonstrating moderate reliability. However, no excellent ICC scores were observed across both intra- and inter-observer assessments. Conclusion: While SWE demonstrates promise in assessing hip stabilizers, its inconsistent reliability across different parameters highlights the need for further research. Comparative studies involving healthy and pathological groups are needed for better understanding of SWE’s applicability in clinical settings.

Association between carpal height ratio and ulnar variance in normal wrist radiography

IntroductionThe wrist joint is a complex anatomical structure, and various radiographic parameters are utilized to assess its normal alignment and orientation. Among these parameters are carpal height ratio (CHR) and ulnar variance (UV). Previous literature has indicated that factors such as age and gender may influence these parameters; However, there is a lack of studies investigating these differences specifically in the Middle East or Jordan. Additionally, no prior research has explored the relationship between UV and CHR. Therefore, the objective of this study is to investigate these critical radiological parameters and their associations.MethodologyA cross-sectional study design was employed, wherein a total of 385 normal wrist X-rays were reviewed, and CHR and UV were measured. Intra-observer and inter-observer reliability assessments were conducted to ensure the consistency and accuracy of measurements. Additionally, the association between UV and CHR was measured and plotted for further analysis.ResultsIn our study, the mean CHR was 0.5 (range: 0.4 to 1.5), and the mean UV was − 0.3 mm (range: -5.8 mm to 4.1 mm). We found a significant negative correlation between CHR and age (p < 0.05). No significant gender differences were observed in UV and CHR. Additionally, a weak positive correlation was found between UV and CHR (Pearson correlation coefficient = 0.13, p = 0.01; adjusted R2 = 0.014, p = 0.02).ConclusionAge correlated significantly with a decline in carpal height ratio. Additionally, ulnar variance had a week positive yet significant correlation with carpal height ratio.Level of evidenceCross-sectional study, Level III.

Sex determination by Ct –scan analysis of the mastoid bone: A cross-sectional study

The mastoid bone, situated at the base of the skull and characterized by its compact structure in the petrous portion, being among the slowest-growing bones, has gained recognition as a valuable anthropological tool for sex determination.Thus, we have proposed to assess the reliability of the mastoid process in sex determination in a Tunisian population using CT-scan analysis.A cross-sectional study was conducted. CT scans forming the mastoid triangle were analyzed using a General Electric Bright Speed scanner. Nine measurements were taken by a single observer, ensuring reliability through intra- and inter-observer assessments. Normalization and statistical analyses, including logistic regression, were applied to identify sex-discriminating variables. The model's performance was evaluated using learning curves, cross-validation, and various metrics. The resulting logistic regression equation, coefficients, and intercept provided a predictive tool for sex determination.A total of 256 cranial CT scans (126 males, 130 females) were analyzed. Our study revealed that the mastoid region approach achieved an overall accuracy of 80.8 % in sex identification within the examined population. The method demonstrated a sensitivity of 78.9 % and specificity of 81.8 %. All investigated variables (AP, PM, AM, CMH, TMH, OSDmax, OCDmax, MA) exhibited discriminatory capabilities for sex determination, except for AIA. Notably, the most effective discriminators were AP, CMH, and OSDmax. Utilizing an ROC curve analysis to optimize mastoid variables for maximum sensitivity and specificity, we obtained excellent results, with an area under the curve reaching 91 %.

Mobile App for Enhanced Anterior Cruciate Ligament (ACL) Assessment in Conscious Subjects: "Pivot-Shift Meter".

Anterior cruciate ligament (ACL) instability poses a considerable challenge in traumatology and orthopedic medicine, demanding precise diagnostics for optimal treatment. The pivot-shift test, a pivotal assessment tool, relies on subjective interpretation, emphasizing the need for supplementary imaging. This study addresses this limitation by introducing a machine learning classification algorithm integrated into a mobile application, leveraging smartphones' built-in inertial sensors for dynamic rotational stability assessment during knee examinations. Orthopedic specialists conducted knee evaluations on a cohort of 52 subjects, yielding valuable insights. Quantitative analyses, employing the Intraclass Correlation Coefficient (ICC), demonstrated robust agreement in both intraobserver and interobserver assessments. Specifically, ICC values of 0.94 reflected strong concordance in the timing between maneuvers, while signal amplitude exhibited consistency, with the ICC ranging from 0.71 to 0.66. The introduced machine learning algorithms proved effective, accurately classifying 90% of cases exhibiting joint hypermobility. These quantifiable results underscore the algorithm's reliability in assessing knee stability. This study emphasizes the practicality and effectiveness of implementing machine learning algorithms within a mobile application, showcasing its potential as a valuable tool for categorizing signals captured by smartphone inertial sensors during the pivot-shift test.

A novel approach to craniofacial analysis using automated 3D landmarking of the skull

Automatic dense 3D surface registration is a powerful technique for comprehensive 3D shape analysis that has found a successful application in human craniofacial morphology research, particularly within the mandibular and cranial vault regions. However, a notable gap exists when exploring the frontal aspect of the human skull, largely due to the intricate and unique nature of its cranial anatomy. To better examine this region, this study introduces a simplified single-surface craniofacial bone mask comprising of 6707 quasi-landmarks, which can aid in the classification and quantification of variation over human facial bone surfaces. Automatic craniofacial bone phenotyping was conducted on a dataset of 31 skull scans obtained through cone-beam computed tomography (CBCT) imaging. The MeshMonk framework facilitated the non-rigid alignment of the constructed craniofacial bone mask with each individual target mesh. To gauge the accuracy and reliability of this automated process, 20 anatomical facial landmarks were manually placed three times by three independent observers on the same set of images. Intra- and inter-observer error assessments were performed using root mean square (RMS) distances, revealing consistently low scores. Subsequently, the corresponding automatic landmarks were computed and juxtaposed with the manually placed landmarks. The average Euclidean distance between these two landmark sets was 1.5 mm, while centroid sizes exhibited noteworthy similarity. Intraclass coefficients (ICC) demonstrated a high level of concordance (> 0.988), with automatic landmarking showing significantly lower errors and variation. These results underscore the utility of this newly developed single-surface craniofacial bone mask, in conjunction with the MeshMonk framework, as a highly accurate and reliable method for automated phenotyping of the facial region of human skulls from CBCT and CT imagery. This craniofacial template bone mask expansion of the MeshMonk toolbox not only enhances our capacity to study craniofacial bone variation but also holds significant potential for shedding light on the genetic, developmental, and evolutionary underpinnings of the overall human craniofacial structure.

Characterization of renal masses with MRI-based radiomics: assessment of inter-package and inter-observer reproducibility in a prospective pilot study.

To evaluate radiomics features' reproducibility using inter-package/inter-observer measurement analysis in renal masses (RMs) based on MRI and to employ machine learning (ML) models for RM characterization. 32 Patients (23M/9F; age 61.8 ± 10.6years) with RMs (25 renal cell carcinomas (RCC)/7 benign masses; mean size, 3.43 ± 1.73cm) undergoing resection were prospectively recruited. All patients underwent 1.5T MRI with T2-weighted (T2-WI), diffusion-weighted (DWI)/apparent diffusion coefficient (ADC), and pre-/post-contrast-enhanced T1-weighted imaging (T1-WI). RMs were manually segmented using volume of interest (VOI) on T2-WI, DWI/ADC, and T1-WI pre-/post-contrast imaging (1-min, 3-min post-injection) by two independent observers using two radiomics software packages for inter-package and inter-observer assessments of shape/histogram/texture features common to both packages (104 features; n = 26 patients). Intra-class correlation coefficients (ICCs) were calculated to assess inter-observer and inter-package reproducibility of radiomics measurements [good (ICC ≥ 0.8)/moderate (ICC = 0.5-0.8)/poor (ICC < 0.5)]. ML models were employed using reproducible features (between observers and packages, ICC > 0.8) to distinguish RCC from benign RM. Inter-package comparisons demonstrated that radiomics features from T1-WI-post-contrast had the highest proportion of good/moderate ICCs (54.8-58.6% for T1-WI-1min), while most features extracted from T2-WI, T1-WI-pre-contrast, and ADC exhibited poor ICCs. Inter-observer comparisons found that radiomics measurements from T1-WI pre/post-contrast and T2-WI had the greatest proportion of features with good/moderate ICCs (95.3-99.1% T1-WI-post-contrast 1-min), while ADC measurements yielded mostly poor ICCs. ML models generated an AUC of 0.71 [95% confidence interval = 0.67-0.75] for diagnosis of RCC vs. benign RM. Radiomics features extracted from T1-WI-post-contrast demonstrated greater inter-package and inter-observer reproducibility compared to ADC, with fair accuracy for distinguishing RCC from benign RM. Knowledge of reproducibility of MRI radiomics features obtained on renal masses will aid in future study design and may enhance the diagnostic utility of radiomics models for renal mass characterization.

An interpretable framework for inter-observer agreement measurements in TILs scoring on histopathological breast images: A proof-of-principle study.

Breast cancer, a widespread and life-threatening disease, necessitates precise diagnostic tools for improved patient outcomes. Tumor-Infiltrating Lymphocytes (TILs), reflective of the immune response against cancer cells, are pivotal in understanding breast cancer behavior. However, inter-observer variability in TILs scoring methods poses challenges to reliable assessments. This study introduces a novel and interpretable proof-of-principle framework comprising two innovative inter-observer agreement measures. The first method, Boundary-Weighted Fleiss' Kappa (BWFK), addresses tissue segmentation predictions, focusing on mitigating disagreements along tissue boundaries. BWFK enhances the accuracy of stromal segmentation, providing a nuanced assessment of inter-observer agreement. The second proposed method, the Distance Based Cell Agreement Algorithm (DBCAA), eliminates the need for ground truth annotations in cell detection predictions. This innovative approach offers versatility across histopathological analyses, overcoming data availability challenges. Both methods were applied to assess inter-observer agreement using a clinical image dataset consisting of 25 images of invasive ductal breast carcinoma tissue, each annotated by four pathologists, serving as a proof-of-principle. Experimental investigations demonstrated that the BWFK method yielded gains of up to 32% compared to the standard Fleiss' Kappa model. Furthermore, a procedure for conducting clinical validations of artificial intelligence (AI) based cell detection methods was elucidated. Thoroughly validated on a clinical dataset, the framework contributes to standardized, reliable, and interpretable inter-observer agreement assessments. This study is the first examination of inter-observer agreements in stromal segmentation and lymphocyte detection for the TILs scoring problem. The study emphasizes the potential impact of these measures in advancing histopathological image analysis, fostering consensus in TILs scoring, and ultimately improving breast cancer diagnostics and treatment planning. The source code and implementation guide for this study are accessible on our GitHub page, and the full clinical dataset is available for academic and research purposes on Kaggle.

SYMPTOM BURDEN AND QUALITY OF LIFE FOR NURSING HOME RESIDENTS WITH DEMENTIA: UPLIFT TRIAL EARLY DATA

Abstract Communication difficulties in nursing home (NH) residents with dementia make valid assessment of symptoms and quality-of-life (QOL) challenging. Thus, researchers and clinicians frequently rely on proxy-based measures. The End-of-life Dementia-Comfort Assessment in Dying (EOLD-CAD) and two single-item QOL measures (7-point item; 5-point item) have been used in several studies, though evaluation of their psychometric properties is limited. We used baseline data from an ongoing multi-site randomized trial (UPLIFT) to describe symptoms and QOL and examine the measures’ validity and reliability in 138 residents with moderate to severe dementia living at 16 facilities. Descriptive data and assessments of convergent validity and inter-rater reliability are provided. Based on assessments by 134 staff and 45 family, physical symptoms, physical distress, and emotional distress were reported as infrequent by staff and family; indications of well-being were more frequently observed. Median QOL was the same for staff and family observers (4=“Life is so-so” [7-point item]; 3=“Fair” [5-point item]). Inter-observer assessments of resident QOL (staff vs. family) were correlated (7-point item: r=0.47, ICC=.643; 5-point item: r=0.48, ICC=.645, p&amp;lt;.05 for all). Seven of 18 EOLD-CAD symptoms were significantly positively correlated. ICC values varied between high or moderately high: shortness-of-breath (ICC=.74), choking (ICC=.65), gurgling (ICC=.81), agitation (ICC=.51), fear (ICC=.46), crying (ICC=.65), peace (ICC=.57), and care resistance (ICC=.68) (p&amp;lt;.05 for all). Choking and gurgling were the most prominently reported symptoms by both groups.Early findings provide a contemporary assessment of QOL and symptoms among NH residents with dementia. Measurement properties affirm general reliability and validity of study instruments.

Intra- and interobserver assessments of intestinal wall thickness and segmentations from transverse sections of feline abdominal ultrasound images.

Measurements of intestinal wall thicknesses from ultrasound imaging (US) are routinely used to support diagnoses of intestinal disorders in cats, however published studies describing observer agreement are currently lacking. The aim of this retrospective, observer agreement study was to quantify inter- and intraobserver repeatability and agreement in the measurement of intestinal wall layer thicknesses and the segmentation of transverse sections of small intestines in US images of 20 cats. Intestinal wall layer thickness measurements of the mucosa, submucosa, muscularis, serosa layer, and total thickness of these layers were performed on five cats with small cell epitheliotropic lymphoma, five with inflammatory bowel disease, and 10 with other conditions. Thickness measurements and the segmentation encompassing the serosa layer were obtained from five observers four times non-sequentially. The average standard deviation in thickness measurements (95% confidence interval) in the mucosa, submucosa, muscularis, serosa, and total thickness were 0.35 (0.07-0.95), 0.24 (0.07-0.52), 0.22 (0.06-0.49), 0.20 (0.05-0.49), and 0.57 (0.11-1.60) mm, respectively. The average intraclass correlation coefficients, which estimates the degree of consistency in thickness measurements and segmentation areas for each observer, ranged from 0.355 to 0.870 and 0.850 to 0.993, respectively. The interclass correlation coefficient, which estimates the degree of consistency when measuring a thickness or segmentation area over all observers ranged from 0.115 to 0.753, and 0.811 to 0.902, respectively. The overall average Dice Coefficient, which estimates the extent of overlap of the segmentations for all observers was 0.957 (0.933 to 0.972). Our results suggest segmentations of small intestines have a higher interobserver agreement than measurements of intestinal wall thicknesses.

Evaluation of a Fluoroscopic Angiography Protocol in Hispaniolan Amazon Parrots (Amazona ventralis).

Fluoroscopic angiography evaluates the heart and vascular tree in real time and can be recorded for further diagnostic analysis and measurements. Although reports have been published of the use of fluoroscopic angiography in birds, this technique has not been evaluated in any avian species. The purpose of this study was to evaluate a fluoroscopic angiography protocol in 12 adult Hispaniolan Amazon parrots (Amazona ventralis). Under general anesthesia, the birds were positioned in right lateral (LAT) recumbency on a fluoroscopy table. A bolus of nonionic iodinated contrast agent was injected through a catheter inserted into the basilic or medial metatarsal vein during video acquisition. The same bolus was repeated to obtain the ventrodorsal (VD) view with the bird placed in dorsal recumbency. Eleven studies were performed. A total of 19 (10 VD, 9 LAT) continuous, real-time, fluoroscopic angiograms were successfully captured. The brachiocephalic trunk, aorta, pulmonary arteries, pulmonary veins, and caudal vena cava were visualized, and selected intraluminal measurements collected. The intraobserver and interobserver variability for 3 observers was calculated. Intraobserver agreement was found to be near perfect (intraclass correlation coefficient ≥0.95), whereas interobserver agreement was moderate to substantial (intraclass correlation coefficient ≥0.52). Coefficients of variation were excellent (VD 0.99, LAT 0.99) for intraobserver assessments and moderate (VD 0.72, LAT 0.52) for interobserver assessments. For the interobserver assessments, the VD projection measurements performed better than the LAT measurements. These results suggest that although there was some variation between different observers, relatively consistent vascular measurements could be obtained. The described fluoroscopic angiography protocol is a repeatable and reliable technique that could be useful for the diagnosis and monitoring of cardiovascular diseases in birds.

Quantification of SPECT Concentric Ring Artifacts by Radiomics and Radial Features

(1) Background: Concentric ring artifacts in reconstructed SPECT images indicate the presence of detector non-uniformity in gamma camera systems. The identification of these artifacts is generally visual and not quantitative. The aim of our study was to evaluate observer assessments of the presence of concentric rings in reconstructed SPECT phantom images and to verify whether quantitative texture analysis can detect such artifacts, which are detrimental to accurate tumor detection. (2) Methods: Test data were acquired as part of the quarterly quality assurance program using a standardized SPECT phantom containing solid spheres, solid rods, and a water solution of 99mTc. Forty separate SPECT acquisitions were analyzed to assess the presence of ring artifacts. Two experienced medical physicists independently reviewed transaxial images and graded the severity of artifacts on a five-point scale. Quantitative radiomic features were computed for volumes of interest located in the uniform phantom section. In addition to these, radial contrast (RContrast) and radial root-mean-square contrast (RRMSC) were also calculated and derived from the radial profile of summed slices transformed into polar coordinates. (3) Results: Artifacts were considered sufficiently severe to warrant camera re-tuning in 10 rod sections, 17 sphere sections, and 16 uniform sections. In the uniform sections, there was “good agreement” for inter-observer and intra-rater assessments (κ = 0.66, Fisher exact p &lt; 0.0001 and κ = 0.61, and Fisher exact p = 0.001, respectively). The two radial features agreed significantly (p &lt; 0.001) with visual severity judgment of ring artifacts in uniform sections and were selected as informative about the presence of ring artifacts by LASSO approach. The increased magnitude of RContrast and RRMSC correlated significantly with increasingly severe artifact scores (ρ = 0.65–0.66, p &lt; 0.0001). (4) Conclusions: There was good agreement between the physicists with respect to the presence of circular ring artifacts in uniform sections of SPECT quality assurance scans, with the artifacts accurately detected by radial contrast and noise-to-signal ratio measurements.

Interobserver and intraobserver variability in magnetic resonance imaging evaluation of patients with suspected disc herniation

ObjectiveMagnetic resonance imaging (MRI) is usually the modality of choice to assess sciatica and intervertebral disc herniation. Despite remarkable progression in diagnostic imaging and surgical techniques, definite diagnosis based on imaging interpretation is still a great challenge. The aim of this study was to determine interobserver and intraobserver variability in reporting lumbar MRI between two neuroradiologists based on the new 2014 version of disc nomenclature. Patients and methodsThe study population was composed of 134 irresponsive to conservative therapy patients with clinical presentations of disc herniation and lumbar radiculopathy. MRI was taken from all the participants using a 1.5 T MRI system. Two neuroradiologists evaluated the images, separately and one of them did it twice and interpreted the scans in sagittal and axial planes. Disc bulge, disc herniation and nerve root compression were evaluated at each level. Interobserver and interaobserver agreements between two neuroradiologists, and one neuroradiologist in two times of reporting were calculated for the evaluation of bulging and herniated discs and nerve root compression by applying the Kappa statistics. ResultsBulging disc, herniated disc, the type of disc, location of the discs, and nerve root compression diagnosis were significantly in excellent agreement (kappa>0.7, p-value<0.001) through intraobserver assessments, while interobserver assessments presented statistically significant with a fair agreement (kappa:0.4–0.7 and p-value<0.05). ConclusionRemarkable intraobserver agreement was found between diagnoses of disc-related pathologies of the lumbar spine while interobserver assessments revealed only fair concordance.

Four-Dimensional Volume-Strain Expression in Asymptomatic Primary Hypertension Patients Presenting with Subclinical Left Atrium-Ventricle Dysfunction

Objective: The purpose of this study was to evaluate the different components of left atrial (LA) dysfunction predictors in asymptomatic primary systemic hypertension patients with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (4D) longitudinal and circumferential strain values. Methods and Results: Patients with no left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) are all asymptomatic regarding primary blood hypertension. Thirty NLVH patients and 30 LVH patients according to LV mass index and 40 controls analyzed by 4D echocardiography were prospectively enrolled. LA volumes and longitudinal and circumferential strains were measured using 4D volume-strain echocardiography with a Vivid E95 Version 203 instrument. Correlation analysis indicated a significant relation between LV 4D mass index and LA 4D longitudinal/circumferential strain (r = –0.446 to 0.381, p = 0.000–0.042). LVH patients had a reduced LA emptying fraction compared with NLVH patients and control subjects (p < 0.01). NLVH patients had an impaired LA conduit function and increased contractile function compared with the control group (p < 0.01). LVH patients had increased LA volumes and significantly decreased reservoir, conduit and contractile functions compared with the controls (p < 0.01). LVH patients had increased LA volumes and decreased reservoir and contractile functions compared with NLVH patients (p < 0.01). The clinical utility of LA 4D volume-strain measurement was verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with NLVH, LVH and control group comparisons. Interclass correlation coefficients of interobserver and intraobserver assessments in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively. Conclusions: LVH patients showed increased LA volumes and decreased LA emptying fractions. LA reservoir, conduit and contractile functions were significantly impaired in LVH patients. Decreased LA conduit function and increased contractile function were revealed in NLVH patients. LA volumetric and functional analyses with 4D volume-strain echocardiography may facilitate the recognition of subtle LA and LV dysfunctions in asymptomatic systemic hypertension patients.

Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpson’s monoplanar methods

ABSTRACT: The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson’s monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p&lt;0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson’s monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p&lt;0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson’s monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.

Characterization of Doppler spectrum of hepatic veins and correlation with structural and functional variables of the right ventricle in healthy dogs.

BackgroundSpectral Doppler assessment of hepatic veins may provide information on heart function.Hypothesis/ObjectivesTo assess the normal pattern of hepatic venous flow using spectral Doppler ultrasound examination; to correlate this information with structural and functional variables of the right ventricle (RV), and to analyze the impact of age, sex, body weight quartiles, heart rate, cardiac rhythm, and systolic arterial pressure on the results in healthy dogs.AnimalsSixty‐five healthy dogs.MethodsCross‐sectional observational study. The direction and maximum velocity of each of the 4 possible components of venous flow were determined from pulsed‐wave Doppler examination of the hepatic veins. In addition, structural and functional parameters (TAPSE, longitudinal strain, FAC%, S′, Et/At, and E′t/ A′t) of the RV were evaluated.ResultsThe same phase patterns for different waves were seen in all animals: A and V were retrograde waves, and S and D were anterograde waves. The velocity of the spectral waves increased with body weight (P < .05) and could be correlated with functional indices of the RV. A significant difference was found when comparing morphometric indices with body weight quartiles (P < .05). In addition, intra‐and inter‐observer assessments showed low variability. The mean duration of the examinations was 5.2 minutes.Conclusions and Clinical ImportanceHepatic spectral Doppler findings can be correlated with systolic and diastolic indices of the RV and vary with body weight.

Assessing the Validity of Animal-Based Indicators of Sheep Health and Welfare: Do Observers Agree?

Sixteen animal-based indicators of sheep welfare, previously selected by a stakeholder panel, and based on the Farm Animal Welfare Council (FAWC) Five Freedoms, were assessed in terms of the level of inter-observer agreement achieved during on-farm testing. Eight observers independently tested the 16 indicators on 1158 sheep from 38 farms in England and Wales. Overall inter-observer agreement was evaluated by Fleiss’s kappa (κ), and the pair-wise agreement of each observer was compared to a ‘test standard’ observer (TSO). Inter-observer assessments of the welfare indicators; dental abnormality, cleanliness score (ventral abdomen), mastitis, tail length, skin lesions, body condition scoring and lameness produced ‘fair to good’ levels of agreement (0.40 &lt; κ &lt; 0.75) and joint swellings had ‘excellent’ levels of agreement (κ ≥ 0.75). The very low apparent prevalence (&lt;0.8%) of sheep with specific outcomes such as pruritis, wool loss, myiasis, thin body condition, diffuse or severe skin lesions limited kappa analysis for these indicators. Overall, findings suggest that observers of differing experience, training and occupation were reliable in assessing key animal-based indicators of sheep health and welfare.

Speckle tracking stress echocardiography in children: interobserver and intraobserver reproducibility and the impact of echocardiographic image quality

Speckle tracking echocardiography (STE) is increasingly used during functional assessments. However, reproducibility and dependence on echocardiographic image quality for speckle tracking stress echocardiography in pediatric patients have not been studied to date. 127 consecutive normotensive children without structural heart disease (mean age 13.4 ± 3.0 years, 50.4% female) underwent a stepwise semisupine cycle ergometric protocol. Left ventricular (LV) myocardial peak strain and strain rate were assessed at rest and during exercise. Interobserver and intraobserver assessments were performed and analyzed regarding echocardiographic image quality. LV peak global strain and strain rate were well reproducible with narrow limits of agreement without any significant bias both at rest and during all stages of exercise testing. Moreover, strain rate reproducibility slightly deteriorated in values between −1.5 and −3 s−1. Surprisingly, there was no significant difference in reproducibility between optimal, intermediate and poor quality of echocardiographic images. STE derived strain and strain rate measurements in children are feasible and highly reproducible during semisupine cycle ergometric stress echocardiography. Echocardiographic image quality does not seem to influence strain (rate) reproducibility. Myocardial deformation measurements in images with suboptimal visualization quality must be interpreted with caution.

Error in geometric morphometric data collection: Combining data from multiple sources.

This study compares two- and three-dimensional morphometric data to determine the extent to which intra- and interobserver and intermethod error influence the outcomes of statistical analyses. Data were collected five times for each method and observer on 14 anthropoid crania using calipers, a MicroScribe, and 3D models created from NextEngine and microCT scans. ANOVA models were used to examine variance in the linear data at the level of genus, species, specimen, observer, method, and trial. Three-dimensional data were analyzed using geometric morphometric methods; principal components analysis was employed to examine how trials of all specimens were distributed in morphospace and Procrustes distances among trials were calculated and used to generate UPGMA trees to explore whether all trials of the same individual grouped together regardless of observer or method. Most variance in the linear data was at the genus level, with greater variance at the observer than method levels. In the 3D data, interobserver and intermethod error were similar to intraspecific distances among Callicebus cupreus individuals, with interobserver error being higher than intermethod error. Generally, taxa separate well in morphospace, with different trials of the same specimen typically grouping together. However, trials of individuals in the same species overlapped substantially with one another. Researchers should be cautious when compiling data from multiple methods and/or observers, especially if analyses are focused on intraspecific variation or closely related species, as in these cases, patterns among individuals may be obscured by interobserver and intermethod error. Conducting interobserver and intermethod reliability assessments prior to the collection of data is recommended.