Thoracic magnetic resonance venography using Gadofosveset in patients with venous pathology—A comparative study of image quality and inter-rater variability

2016 ◽  
Vol 32 (7) ◽  
pp. 453-458 ◽  
Author(s):  
Michael Åkesson ◽  
Leena Lehti ◽  
Peter Höglund ◽  
Per Åkeson ◽  
Johan Wassélius
Keyword(s):  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Venography ◽  
Control Group ◽  
Routine Practice ◽  
Cohen’S Kappa ◽  
Reliable Technique ◽  
Cohen's Kappa ◽  
Diagnostic Capability ◽  
Rater Variability

Background High-quality non-invasive imaging of the deep venous system in the thorax is challenging, but nevertheless required for diagnosis of vascular pathology as well as for patient selection and preoperative planning for endovascular procedures. Purpose To compare the diagnostic quality of Gadofosveset-enhanced thoracic magnetic resonance venography, seven consecutive patients with suspected or known disease affecting the central thoracic veins were compared to seven consecutive magnetic resonance venography using conventional gadolinium-based contrast agents. Materials and methods Diagnostic capability, defined as the ability to assess vessel patency and pathologic conditions, for the major thoracic deep venous segments was assessed by two-independent readers. Both reviewers rated the overall subjective image quality on a four-graded scale, and inter-rater variability was analyzed using unweighted and weighted Cohen's kappa values. Results Diagnostic capability was generally considerably higher in the Gadofosveset group for all examined vessel segments. The overall images quality rating was significantly higher for the Gadofosveset group with a mean rating of 2.9 and 2.7 for the two-independent readers, compared to 1.2 and 1.0 for the control croup. Inter-rater variability showed less variability for the Gadofosveset group with a quadratic-weighted Cohen's Kappa value of 0.58 compared to 0.36 for the control group. Conclusion Our results show that Gadofosveset-enhanced magnetic resonance venography of the central thoracic veins is a reliable technique in clinical routine practice that results in diagnostic images, superior to conventional gadolinium-based contrast medium.

scholarly journals Gadofosveset-enhanced magnetic resonance venography in patients with venous pathology of the lower limbs – Comparison of diagnostic image quality and inter-rater variability with gadobutrol venography and computed tomography venography

2016 ◽  
Vol 31 (10) ◽  
pp. 737-743
Author(s):  
Michael Åkesson ◽  
Leena Lehti ◽  
Peter Höglund ◽  
Per Åkeson ◽  
Johan Wassélius
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Venography ◽  
Control Groups ◽  
Cohen’S Kappa ◽  
Reliable Technique ◽  
Cohen's Kappa ◽  
Diagnostic Capability ◽  
Computed Tomography Venography

Purpose This study was performed to compare the diagnostic quality of Gadofosveset-enhanced magnetic resonance venography with Gadobutrol-enhanced magnetic resonance venography and computed tomography venography for the deep veins of the lower extremities in patients with iliocaval venous pathology. Materials and methods Diagnostic capability and image quality were assessed by two independent readers. Inter-reader variability was analyzed by unweighted and quadratic weighted Cohen’s kappa values. Results The diagnostic capability was equal to or higher in the Gadofosveset group for all examined vessel segments compared with both control groups. The image quality score was significantly higher for the Gadofosveset group compared to both control groups. Inter-reader variability expressed by quadratic weighted Cohen’s kappa value (k) showed less variability in the Gadofosveset group compared to the control groups. Conclusion Our results show that Gadofosveset-enhanced magnetic resonance venography is a reliable technique in clinical routine practice, with image quality superior to both Gadobutrol-enhanced magnetic resonance venography and computed tomography venography.

scholarly journals Ultra-short Echo Time MR Imaging in Assessing Cartilage Endplate Damage And Association Between Its Lesion and Disc Degeneration For Chronic Low Back Pain Patients

2021 ◽  
Author(s):  
Zhilin Ji ◽  
Weiqiang Dou ◽  
Yaru Zhu ◽  
Yin Shi ◽  
Yuefen Zou
Keyword(s):  
Image Quality ◽  
Observer Agreement ◽  
Cohen’S Kappa ◽  
Kendall’S Tau ◽  
Cartilage Endplate ◽  
Cohen's Kappa ◽  
Echo Time ◽  
Short Echo Time ◽  
Ivd Degeneration ◽  
The Relationship

Abstract Objective: To investigate the feasibility of ultra-short echo time (UTE) MRI in assessing cartilage endplate (CEP) damage and evaluating the relationship between total endplate score (TEPS) and lumbar intervertebral disc (IVD) degeneration.Materials and methods: 35 patients were measured for IVD using UTE imaging at 3T MR. Subtracted UTE images between short and long TEs were obtained to depict anatomy of CEP. The SNR and CNR were calculated to assess the image quality. A new grading criterion for endplate evaluation was developed based on Rajasekarank.S grading in this study. Two radiologists were employed to evaluate CEP and bony vertebral endplates (VEP) using new grading criterion and assess TEPS, independently. Cohen's kappa analysis was applied to evaluate the inter-observer agreement of endplate damage assessment between two radiologists, and the Kendall's TAU-B analysis was employed to determine the relationship between TEPS and IVD degeneration evaluated with Pfirrmann grading.Results: Well structural CEP was depicted on subtracted UTE images and confirmed by high SNR (33.0±2.92) and CNR values (9.4±2.08). Qualified subtracted UTE images were used by two radiologists to evaluate CEP and VEP damage. Excellent inter-observer agreement was confirmed by high value in Cohen's kappa test (0.839,P<0.001). Ensured by this, 138 endplates from 69 IVDs of 35 patients were classified into six grades based on the new grading criterion and TEPS of each endplate was calculated. In addition, the degeneration degree of IVDs were classified into five grades. Finally, using Kendall's TAU-B analysis, significant relationship was obtained between endplate damage related TEPS and IVD degeneration (r= 0.864,P<0.001).Conclusion: Ensured by high image quality, UTE imaging might be considered an effective tool to assess CEP damage. Additionally, further calculated TEPS has shown strong positive association with IVD degeneration, suggesting that the severity of endplate damage is highly linked with the degree of IVD degeneration.

scholarly journals Sparse 3D contrast-enhanced whole-heart imaging for coronary artery evaluation

Herz ◽  
2022 ◽  
Author(s):  
Uzair Ansari ◽  
Sonja Janssen ◽  
Stefan Baumann ◽  
Martin Borggrefe ◽  
Stephan Waldeck ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Image Quality ◽  
Cardiac Computed Tomography ◽  
Acquisition Time ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Whole Heart

Abstract Background We investigated the feasibility of evaluating coronary arteries with a contrast-enhanced (CE) self-navigated sparse isotropic 3D whole heart T1-weighted magnetic resonance imaging (MRI) study sequence. Methods A total of 22 consecutive patients underwent coronary angiography and/or cardiac computed tomography (CT) including cardiac MRI. The image quality was evaluated on a 3-point Likert scale. Inter-reader variability for image quality was analyzed with Cohen’s kappa for the main coronary segments (left circumflex [LCX], left anterior descending [LAD], right coronary artery [RCA]) and the left main trunk (LMT). Results Inter-reader agreement for image quality of the coronary tree ranged from substantial to perfect, with a Cohen’s kappa of 0.722 (RCAmid) to 1 (LCXprox). The LMT had the best image quality. Image quality of the proximal vessel segments differed significantly from the mid- and distal segments (RCAprox vs. RCAdist, p < 0.05). The LCX segments showed no significant difference in image quality along the vessel length (LCXprox vs. LCXdist, p = n.s.). The mean acquisition time for the study sequence was 553 s (±46 s). Conclusion Coronary imaging with a sparse 3D whole-heart sequence is feasible in a reasonable amount of time producing good-quality imaging. Image quality was poorer in distal coronary segments and along the entire course of the LCX.

scholarly journals Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Pia Iben Pietersen ◽  
Søren Mikkelsen ◽  
Annmarie T. Lassen ◽  
Simon Helmerik ◽  
Gitte Jørgensen ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Image Quality ◽  
Respiratory Symptoms ◽  
Prehospital Setting ◽  
Emergency Medical Technicians ◽  
Cohen’S Kappa ◽  
Thoracic Ultrasound ◽  
Cohen's Kappa ◽  
Emergency Medical

Abstract Background In a prehospital setting, the severity of respiratory symptoms in patients calling for an ambulance differ. The initial evaluation, diagnosing, and thereby management can be challenging because respiratory symptoms can be caused by disease in many organs. Ultrasound examinations can contribute with important information and support the clinical decision-making. However, ultrasound is user-dependent and requires sufficient knowledge and training. The aim of this study was to explore the quality of thoracic ultrasound examinations performed on patients by emergency medical technicians and paramedics in a prehospital, clinical setting. Methods From November 2018 – April 2020, Danish emergency medical technicians and paramedics (n = 100) performed thoracic ultrasound examinations on patients with respiratory symptoms using a portable ultrasound device. The ultrasound examinations were stored and retrospectively assessed by a reviewer blinded to the patients’ symptoms and history, as well as the emergency medical technicians’ and paramedics’ findings. The image quality was scored from 1 to 5. The findings determined by the reviewer was then correlated with a questionnaire filled out by the emergency medical technicians and paramedics regarding ultrasonic findings and potential change in treatment or management of the patient. The agreement in percentage and as Cohen’s kappa was explored. Results A total of 590 ultrasound examinations were assessed, resulting in a median image quality score of 3 (IQ1 = 4, IQ3 = 3). The overall agreement in percentage between the emergency medical technicians and paramedics and reviewer was high (87.7% for a normal scan, 89.9% for interstitial syndrome, 97.3% for possible pneumothorax, and 96.3% for pleural effusion). Cohen’s kappa varied from 0.01 for possible pneumothorax to 0.69 for pleural effusion. Based on the questionnaires (n = 406), the ultrasound examination entailed a change in treatment or visitation in 48 cases (11.7%) which in this study population encompasses a number-needed-to-scan of 8.5. Conclusion Emergency medical technicians and paramedics perform focused thoracic ultrasound examinations with adequate image quality sufficient to determine if pathology is present or not. The emergency medical technicians’ and paramedics’ assessment correlates to some extent with an experienced reviewer and their findings are most reliable for the inclusion of a normal scan or inclusion of pleural effusion. Implementation could possibly impact the number of patients receiving correct prehospital treatment and optimal choice of receiving facility.

scholarly journals Magnetic Resonance Venography Findings In A Group Of Patients With Multiple Sclerosis

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Ali Qasim Al-Baghdady
Keyword(s):  
Multiple Sclerosis ◽  
Nervous System ◽  
Magnetic Resonance ◽  
Venous Thrombosis ◽  
Signs And Symptoms ◽  
Magnetic Resonance Venography ◽  
Control Group ◽  
P Value ◽  
Cross Sectional ◽  
Wide Range

Background: Multiple sclerosis is a chronic heterogeneous demyelinating axonal and inflammatory disease involving the Central Nervous System [CNS] white matter with a possibility of gray matter involvement in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms. Cerebral venous insufficiency theory was raised as a possible etiology for the disease at 2008 by Zamboni an Italian cardiothoracic surgeon. This theory was defeated by Multiple Sclerosis[ MS] researchers and scientists who thought that the disease is an autoimmune rather than vascular. Objective: To assess the findings of Magnetic Resonance Venography [MRV] in a group of patients with MS and to compare these results with a healthy control group Magnetic Resonance Venography[ MRV] findings. Type of the study: A case – control cross sectional study. Methods: it was conducted at Neurosciences Hospital MS clinic from Oct.2014 to Dec. 2015, recruiting sequentially 50 patients who attend the MS clinic; 19 male and 31 females, their age was ranged from 16 to 53 year old. Diagnosis of MS was based on fulfillment of McDonald 2010 criteria for MS diagnosis, detailed history , examination and Expanded Disability Status Scale( EDSS)[see Appendix1] were recorded according to structured questionnaire forum. Each patient was send for Magnetic Resonance Venography[ MRV] using 3 Tessla Phillips model Achieva, 2012. The results of MRV were interpreted by specialist radiologist. Statistical analyses were done using SPSS version 21 with P value less than 0.05 was considered significant. Results: Fifty patients with Multiple Sclerosis were involved in the study female 31, male 19, their ages were ranged between 21 and 60 year old. Magnetic Resonance Venography [MRV] findings suggest of venous thrombosis were seen in [4 / 50] 8% of patients and [46 /50] 92% of the patients in this study have no findings of venous thrombosis. The comparison with the control group showed no significant statistical difference. Conclusion: Magnetic Resonance Venography[MRV] finding is not statistically different between healthy people and Multiple Sclerosis patient

Is Graphology Useful in Assessing Major Depression?

2018 ◽  
Vol 122 (2) ◽  
pp. 398-410 ◽  
Author(s):  
Marco Giannini ◽  
Pietro Pellegrini ◽  
Alessio Gori ◽  
Yura Loscalzo
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Clinical Sample ◽  
Control Group ◽  
Handwriting Analysis ◽  
Psychiatric Assessment ◽  
Major Depressive ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
And Control

This study aimed to develop a handwriting analysis protocol for assessing severe major depressive disorder, in order to evaluate whether graphological analysis could be considered an objective tool and hence if it could be useful for clinicians in their early diagnosis. We modified and improved the methodology described by Lorusso et al. by proposing different graphic indexes based both on the literature and on the observation of a preliminary sample of 13 handwritings of patients affected by major depressive disorder. Then, we recruited 80 participants, divided into two groups: clinical sample ( n = 44) and control group ( n = 36). We used Cohen's Kappa to evaluate the reliability of agreement among four professional graphologists and the consensus between the psychiatric assessment and the ratings given by the judges. We found satisfactory results. Using our protocol, we obtained higher values for Cohen’s Kappa as compared with Lorusso et al. The agreement among graphologists is K = .62, while the K values for the agreement between psychiatric assessment and graphologists range between .47 and .60. The substantial improvements obtained in comparison with Lorusso et al. are encouraging and support further attempts.

scholarly journals Accuracy in local staging of prostate cancer by adding a three-dimensional T2-weighted sequence with radial reconstructions in magnetic resonance imaging

2018 ◽  
Vol 7 (2) ◽  
pp. 205846011875460 ◽  
Author(s):  
Fredrik Jäderling ◽  
Tommy Nyberg ◽  
Michael Öberg ◽  
Stefan Carlsson ◽  
Mikael Skorpil ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Rater Agreement ◽  
Resonance Imaging ◽  
Operating Characteristics ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Local Staging

Background The evidence supporting the use of magnetic resonance imaging (MRI) in prostate cancer detection has been established, but its accuracy in local staging is questioned. Purpose To investigate the additional value of multi-planar radial reconstructions of a three-dimensional (3D) T2-weighted (T2W) MRI sequence, intercepting the prostate capsule perpendicularly, for improving local staging of prostate cancer. Material and Methods Preoperative, bi-parametric prostate MRI examinations in 94 patients operated between June 2014 and January 2015 where retrospectively reviewed by two experienced abdominal radiologists. Each patient was presented in two separate sets including diffusion-weighted imaging, without and with the 3D T2W set that included radial reconstructions. Each set was read at least two months apart. Extraprostatic tumor extension (EPE) was assessed according to a 5-point grading scale. Sensitivity and specificity for EPE was calculated and presented as receiver operating characteristics (ROC) with area under the curve (AUC), using histology from whole-mount prostate specimen as gold standard. Inter-rater agreement was calculated for the two different reading modes using Cohen’s kappa. Results The AUC for detection of EPE for Readers 1 and 2 in the two-dimensional (2D) set was 0.70 and 0.68, respectively, and for the 2D + 3D set 0.62 and 0.65, respectively. Inter-rater agreement (Reader 1 vs. Reader 2) on EPE using Cohen’s kappa for the 2D and 2D + 3D set, respectively, was 0.42 and 0.17 (i.e. moderate and poor agreement, respectively). Conclusion The addition of 3D T2W MRI with radial reconstructions did not improve local staging in prostate cancer.

scholarly journals Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Janne Pesonen ◽  
Michael Shacklock ◽  
Pekka Rantanen ◽  
Jussi Mäki ◽  
Lauri Karttunen ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ankle Dorsiflexion ◽  
Control Group ◽  
Structural Differentiation ◽  
Cohen’S Kappa ◽  
Kappa Score ◽  
Perfect Agreement ◽  
Cohen's Kappa ◽  
Straight Leg Raise ◽  
Hip Internal Rotation

Abstract Background The straight leg raise (SLR) is the most commonly applied physical tests on patients with sciatica, but the sensitivity and specificity ratings for disc hernia and neural compression leave areas for improvement. Hip internal rotation tensions the lumbosacral nerve roots and ankle dorsiflexion tensions the sciatic nerve along its course. We added these movements to the SLR (extended SLR = ESLR) as structural differentiators and tested inter-rater reliability in patients with LBP, with and without sciatica. Methods Forty subjects were recruited to the study by the study controller (SC), 20 in the sciatic group and in the control group. Two independent examiners (E1&E2) performed the ESLR and did not communicate to the subjects other than needed to determine the outcome of the ESLR. First, SLR was performed traditionally until first responses were evoked. At this hip flexion angle, a location-specific structural differentiation was performed to confirm whether the emerged responses were of neural origin. Cohen’s Kappa score (CK) for interrater reliability was calculated for ESLR result in detection of sciatic patients. Also, the examiners’ ESLR results were compared to the traditional SLR results. Results The interrater agreement between Examiner 1 and Examiner 2 for the ESLR was 0.85 (p < 0.001, 95%CI: 0.71–0.99) translating to almost perfect agreement as measured by Cohen’s Kappa When the ESLR was compared to the traditional SLR, the overall agreement rate was 75% (30/40). Kappa values between the traditional SLR and the E1’s or E2’s ESLR results were 0.50 (p < 0.0001; 95%CI 0.27–0.73) and 0.54 (p < 0.0001; 95%CI 0.30–0.77), respectively. Conclusions ESLR with the addition of location-specific structural differentiation is a reliable and repeatable tool in discerning neural symptoms from musculoskeletal in patients with radiating low back pain. We recommend adding these movements to the standard SLR with aim of improving diagnostic ability.

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