Assessment of the Severity of Breast Artery Calcification on a Mammogram: Intraoperator and Interoperator Reproducibility

Purpose. To study approaches to the quantitative assessment of breast arterial calcification (BAC) – a new surrogate marker of high cardiovascular risk in women, to determine the most detailed way to quantify BAC and to assess the reproducibility of these parameters.Material and methods. Mammograms of 1,078 women were analyzed for the presence of BAC. The intraoperator reproducibility of the assessment of the severity of BAC using a 12-point scale (Margolies L et al., 2016) was studied by analyzing 20 mammograms by the same operator twice with an interval of at least 2 weeks. Inter-operator reproducibility was studied by analyzing 99 mammograms by two independent operators.Results. When assessing the intraoperative reproducibility of the total score for each mammary gland, the exact coincidence of the results was noted in 70% (95% confidence interval [CI] 53.5-83.4), in cases of difference of no more than 1 point – in 27.5% (95%CI 14.6-43.9), only in 1 case the difference in assessments was 2 points. No systematic error was found between the two measurements (p=1.0), the correlation coefficient was rs=0.973. The assessment of inter-operator reproducibility showed that the exact coincidence of indicators was present in 48.5% (95%CI 41.3-55.7), in 91.4% (95% CI 86.6-94.9) cases, the total score for each the mammary gland differed by no more than 1 point. There was no systematic error between the measurements of the two experts (p=0.438), the correlation coefficient was rs=0.942.Conclusion. A good intraoperator and interoperator reproducibility of indicators of the severity of BAC on a 12-point scale has been shown, which makes it possible to recommend it for use in science and practice.

Abdominal aorta measurements by a handheld ultrasound device compared with a conventional cart-based ultrasound machine

BACKGROUND: Ultraportable or pocket handheld ultrasound devices (HUD) may be useful for large-scale abdominal aortic aneurysm screening. However, the reproducibility of measurements has not been compared with conventional cart-based ultrasound machines. OBJECTIVES: Investigate the intra- and inter-operator reproducibility of a HUD compared with a conventional ultrasound machine for aortic screening. DESIGN: Analytical, cross-sectional. SETTING: Ultrasound department at a large tertiary care hospital in Riyadh. PATIENTS AND METHODS: Eligible male participants aged ≥60 years were invited to participate upon arriving for a non-vascular ultrasound appointment. Three repeated anteroposterior measurements of the transverse aorta were made at the proximal and distal locations for each machine before repeating the measurements on a subset of participants by a second blinded operator. Intraclass correlation coefficients (ICC) and the Bland-Altman method were used to analyze reproducibility. MAIN OUTCOME MEASURE: Inter-system and intra- and inter-operator ICCs. SAMPLE SIZE: 114 males with repeated measurements by second operator on a subset of 35 participants. RESULTS: The median age (interquartile range) of participants was 68 years (62–74 years). The intra- and inter-operator ICCs were all >0.800 showing almost perfect agreement except for the inter-operator reproducibility at the proximal location using a conventional machine (ICC= 0.583, P =.007) and the Butterfly device (ICC=0.467, P =.037). The inter-system ICCs (95% CI) were 0.818 (0.736–0.874) and 0.879 (0.799–0.924) at the proximal and distal locations, respectively. The mean difference in aortic measurement between the ultrasound systems was 0.3 mm (1.7%) in the proximal location and 0.6 mm (3.6%) in the distal location. In total, >91% of the difference in measurements between the machines was <3 mm. The mean scanning time was 4:16 minutes for the conventional system and 3:53 minutes for the HUD ( P =.34). CONCLUSIONS: Abdominal aortic screening using a HUD was feasible and reliable compared with a conventional ultrasound machine. A pocket HUD should be considered for large-scale screening. LIMITATIONS: No cases of abdominal aortic aneurysm in the sample and lack of blinding. CONFLICT OF INTEREST: None.

Ultrasonographic study of fetal facial profile markers during the first trimester

Background To establish reference ranges of fetal facial profile markers and study their correlations with crown-rump length (CRL) during the first trimester (11 ~ 13+ 6 weeks’ gestation) in a Chinese population. Methods Ultrasonographic images of measuring fetal nuchal translucency (NT) were retrospectively selected randomly in normal fetuses whose parents were both Chinese. The facial markers included inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA) and profile line (PL) distance. These markers were measured through ViewPoint 6 software by two experienced sonographers. Results Three hundred and eighty fetuses were selected. The ICCs (95 % CI) of intra-operator 1 reproducibility of IFA, MNM angle, FMA, PL distance were 0.944 (0.886 ~ 0.973), 0.804 (0.629 ~ 0.902), 0.834 (0.68 ~ 0.918) and 0.935 (0.868 ~ 0.969), respectively. The ICCs (95 % CI) of intra-operator 2 reproducibility of IFA, MNM angle, FMA, PL distance were 0.931 (0.857 ~ 0.967), 0.809 (0.637 ~ 0.904), 0.786 (0.600 ~ 0.892) and 0.906 (0.813 ~ 0.954), respectively. The ICCs (95 % CI) of inter-operator reproducibility of IFA, MNM angle, FMA, PL distance were 0.885 (0.663 ~ 0.953), 0.829 (0.672 ~ 0.915), 0.77 (0.511 ~ 0.891) and 0.844 (0.68 ~ 0.925), respectively. The average ± SD of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively. IFA and PL distance significantly decreased with CRL, while MNM angle and FMA significantly increased with CRL. Conclusions It was feasible to measure fetal facial markers during the first trimester. In Chinese population, the reference ranges of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively, and the measurements were found to correlate with CRL.

Ultrasonographic Study of Fetal Facial Profile Markers During First Trimester

Background: To establish normal reference ranges of fetal facial profile markers, and to study their correlation with crown-rump length (CRL) during first trimester (11~13+6 weeks’ gestation) in a Han Chinese population. Methods: Ultrasonographic images of measuring fetal nuchal translucency (NT) were retrospectively selected randomly in normal pregnancies where both parents were of Han Chinese ethnicity. The facial markers included inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA) and profile line (PL) distance. These markers were measured through ViewPoint 6 software by two experienced sonographers.Results: Three hundred and eighty fetuses were selected. The ICCs (95% CI) of intra-operator 1 reproducibility of IFA, MNM angle, FMA, PL distance were 0.944 (0.886~0.973), 0.804 (0.629~0.902), 0.834 (0.68~0.918) and 0.935 (0.868~0.969), respectively. The ICCs (95% CI) of intra-operator 2 reproducibility of IFA, MNM angle, FMA, PL distance were 0.931 (0.857~0.967), 0.809 (0.637~0.904), 0.786 (0.600~0.892) and 0.906 (0.813~0.954), respectively. The ICCs (95% CI) of inter-operator reproducibility of IFA, MNM angle, FMA, PL distance were 0.885 (0.663~0.953), 0.829 (0.672~0.915), 0.77 (0.511~0.891) and 0.844 (0.68~0.925), respectively. The average±SD of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78±0.54 mm, respectively. IFA and PL distance significantly decreased with CRL, while MNM angle and FMA significantly increased with CRL.Conclusion: It was feasible to measure fetal facial markers during first trimester. The normal range of each marker was obtained through large sample data, and the measurements were found to correlate with CRL.

Analyzing Femorotibial Cartilage Thickness Using Anatomically Standardized Maps: Reproducibility and Reference Data

Alterations in cartilage thickness (CTh) are a hallmark of knee osteoarthritis, which remain difficult to characterize at high resolution, even with modern magnetic resonance imaging (MRI), due to a paucity of standardization tools. This study aimed to assess a computational anatomy method producing standardized two-dimensional femorotibial CTh maps. The method was assessed with twenty knees, processed following three common experimental scenarios. Cartilage thickness maps were obtained for the femorotibial cartilages by reconstructing bone and cartilage mesh models in tree-dimension, calculating three-dimensional CTh maps, and anatomically standardizing the maps. The intra-operator accuracy (median (interquartile range, IQR) of −0.006 (0.045) mm), precision (0.152 (0.070) mm), entropy (7.02 (0.71) and agreement (0.975 (0.020))) results suggested that the method is adequate to capture the spatial variations in CTh and compare knees at varying osteoarthritis stages. The lower inter-operator precision (0.496 (0.132) mm) and agreement (0.808 (0.108)) indicate a possible loss of sensitivity to detect differences in a setting with multiple operators. The results confirmed the promising potential of anatomically standardized maps, with the lower inter-operator reproducibility stressing the need to coordinate operators. This study also provided essential reference data and indications for future research using CTh maps.

Assessment of cardiac amyloidosis with 99mTc-pyrophosphate (PYP) quantitative SPECT

Background 99mTc-PYP scintigraphy provides differential diagnosis of ATTR cardiomyopathy (ATTR-CM) from light chain cardiac amyloidosis and other myocardial disorders without biopsy. This study was aimed to assess the diagnostic feasibility and the operator reproducibility of 99mTc-PYP quantitative SPECT. Method Thirty-seven consecutive patients who underwent a 99mTc-PYP thorax planar scan followed by SPECT and CT scans to diagnose suspected ATTR-CM were enrolled. For the quantitative SPECT, phantom studies were initially performed to determine the image conversion factor (ICF) and partial volume correction (PVC) factor to recover 99mTc-PYP activity concentration in the myocardium for calculating the standardized uptake value (SUV) (unit: g/ml). SUVmax was compared among groups of ATTR-CM, AL cardiac amyloidosis, and other pathogens (others) and among categories of Perugini visual scores (grades 0–3). The intra- and inter-operator reproducibility of quantitative SPECT was verified, and the corresponded repeatability coefficient (RPC) was calculated. Results The ICF was 79,327 Bq/ml to convert count rate in pixel to 99mTc activity concentration. PVC factor as a function of the measured activity concentration ratio in the myocardium and blood-pool was [y = 1.424 × (1 − exp(− 0.759 × x)) + 0.104]. SUVmax of ATTR-CM (7.50 ± 2.68) was significantly higher than those of AL (1.96 ± 0.35) and others (2.00 ± 0.74) (all p < 0.05). SUVmax of grade 3 (8.95 ± 1.89) and grade 2 (4.71 ± 0.23) were also significantly higher than those of grade 1 (1.92 ± 0.31) and grade 0 (1.59 ± 0.39) (all p < 0.05). Correlation coefficient (R2) of SUVmax reached 0.966 to 0.978 with only small systematic difference (intra = − 0.14; inter = − 0.23) between two repeated measurements. Intra- and inter-operator RPCs were 0.688 and 0.877. Conclusions 99mTc-PYP quantitative SPECT integrated with adjustable PVC factors is feasible to quantitatively and objectively assess the burden of cardiac amyloidosis for diagnosis of ATTR-CM.

Therapeutic response monitoring after targeted therapy in an orthotopic rat model of hepatocellular carcinoma using contrast-enhanced ultrasound: Focusing on inter-scanner, and inter-operator reproducibility

Purpose To assess therapeutic response monitoring after targeted therapy in an orthotopic rat model of hepatocellular carcinoma (HCC) using CEUS with focusing on inter-scanner and inter-operator reproducibility. Materials and methods For reproducibility, CEUS was performed using two different US scanners by two operators in sixteen rat models of HCC. Using perfusion analysis software (VueBox ®), eleven parameters were collected, and intra-class correlation coefficient (ICC) was used to analyze reproducibility. Then seventeen rat models of HCC were divided into treatment group (n = 8, 30 mg/kg/day sorafenib for five days) and control group (n = 9). CEUS was performed at baseline and 14 days after first treatment, and changes of perfusion parameters were analyzed. Results In treatment group, CEUS perfusion parameters showed a significant change. The peak enhancement (PE, 2.50 x103±1.68 x103 vs 5.55x102±4.65x102, p = 0.010) and wash-in and wash out AUC (WiWoAUC, 1.07x105±6.48 x104 vs 2.65x104±2.25x104, p = 0.009) had significantly decreased two weeks after treatment. On the contrary, control group did not show a significant change, including PE (1.15 x103±7.53x102 vs 9.43x102± 7.81 x102, p = 0.632) and WiWoAUC (5.09 x104±3.25x104 vs 5.92 x104±3.20x104, p = 0.646). For reproducibility, the various degrees of inter-scanner reproducibility were from poor to good (ICC: <0.01–0.63). However, inter-operator reproducibility of important perfusion parameters, including WiAUC, WoAUC, and WiWoAUC, ranged from fair to excellent (ICC: 0.59–0.93) in a different scanner. Conclusion Our results suggest that CEUS is useful for assessment of the treatment response after targeted therapy and with fair to excellent inter-operator reproducibility.

Correlation of objective image quality and working length measurements in different CBCT machines: An ex vivo study

To investigate potential correlations between objective CBCT image parameters and accuracy in endodontic working length determination ex vivo. Contrast-to-noise ratio (CNR) and spatial resolution (SR) as fundamental objective image parameters were examined using specific phantoms in seven different CBCT machines. Seven experienced observers were instructed and calibrated. The order of the CBCTs was randomized for each observer and observation. To assess intra-operator reproducibility, the procedure was repeated within six weeks with a randomized order of CBCT images. Multivariate analysis (MANOVA) did not reveal any influence of the combined image quality factors CNR and SR on measurement accuracy. Inter-operator reproducibility as assessed between the two observations was poor, with a mean intra-class correlation (ICC) of 0.48 (95%-CI 0.38, 0.59) for observation No. 1. and 0.40 (95%-CI 0.30, 0.51) for observation No. 2. Intra-operator reproducibility pooled over all observers between both observations was only moderate, with a mean ICC of 0.58 (95%-CI 0.52 to 0.64). Within the limitations of the study, objective image quality measures and exposure parameters seem not to have a significant influence on accuracy in determining endodontic root canal lengths in CBCT scans. The main factor of variance is the observer.

Assessment of Cardiac Amyloidosis with 99mTc-Pyrophosphate (PYP) Quantitative SPECT

Background: 99mTc-PYP scintigraphy provides differential diagnosis of ATTR cardiomyopathy (ATTR-CM) from light chain cardiac amyloidosis and other myocardial disorders without biopsy. This study was aimed to assess the diagnostic feasibility and the operator reproducibility of 99mTc-PYP quantitative SPECT.Method: Thirty-seven consecutive patients underwent a 99mTc-PYP thorax planar scan followed by SPECT and CT scans to diagnose suspected ATTR-CM were enrolled. For the quantitative SPECT, phantom studies were initially performed to determine the image conversion factor (ICF) and partial volume correction (PVC) factor to recover 99mTc-PYP activity concentration in myocardium for calculating the standardized uptake value (SUV) (unit: g/ml). SUVmax was compared among groups of ATTR-CM, AL cardiac amyloidosis and other pathogens (Others), and among categories of Perugini visual scores (Grade: 0-3). The intra- and inter-operator reproducibility of quantitative SPECT was verified, and the corresponded repeatability coefficient (RPC) was calculated.Results: The ICF was 79,327 Bq/ml to convert count rate in pixel to 99mTc activity concentration. PVC factor as a function of the measured activity concentration ratio in myocardium and blood-pool was [y=1.424*(1-exp(-0.759*x)) +0.104]. SUVmax of ATTR-CM (7.50±2.68) was significantly higher than those of AL (1.96±0.35) and Others (2.00±0.74) (all p<0.05). SUVmax of Grade 3 (8.95±1.89) and Grade 2 (4.71±0.23) were also significantly higher than those of Grade 1 (1.92±0.31) and Grade 0 (1.59±0.39) (all p <0.05). Correlation coefficient (R2) of SUVmax reached 0.966 to 0.978 with only small systematic difference (intra=-0.14; inter=-0.23) between two repeated measurements. Intra- and inter-operator RPCs were 0.688 and 0.877.Conclusions: 99mTc-PYP quantitative SPECT integrated with adjustable PVC factors is feasible to quantitatively and objectively assess the burden of cardiac amyloidosis for diagnosis of ATTR-CM.

Assessment of Cardiac Amyloidosis with 99mTc-Pyrophosphate (PYP) Quantitative SPECT

Background: 99mTc-PYP scintigraphy provides differential diagnosis of ATTR cardiomyopathy (ATTR-CM) from light chain cardiac amyloidosis and other myocardial disorders without biopsy. This study was aimed to assess the diagnostic feasibility and the operator reproducibility of 99mTc-PYP quantitative SPECT. Method: Thirty-seven consecutive patients underwent a 99mTc-PYP thorax planar scan followed by SPECT and CT scans to diagnose suspected ATTR-CM were enrolled. For the quantitative SPECT, phantom studies were initially performed to determine the image conversion factor (ICF) and partial volume correction (PVC) factor to recover 99mTc-PYP activity concentration in myocardium for calculating the standardized uptake value (SUV) (unit: g/ml). SUVmax was compared among groups of ATTR-CM, AL cardiac amyloidosis and other pathogens (Others), and among categories of Perugini visual scores (Grade: 0-3). The intra- and inter-operator reproducibility of quantitative SPECT was verified, and the corresponded repeatability coefficient (RPC) was calculated. Results: The ICF was 79,327 Bq/ml to convert count rate in pixel to 99mTc activity concentration. PVC factor as a function of the measured activity concentration ratio in myocardium and blood-pool was [y=1.424*(1-exp(-0.759*x)) +0.104]. SUVmax of ATTR-CM (7.50±2.68) was significantly higher than those of AL (1.96±0.35) and Others (2.00±0.74) (all p<0.05). SUVmax of Grade 3 (8.95±1.89) and Grade 2 (4.71±0.23) were also significantly higher than those of Grade 1 (1.92±0.31) and Grade 0 (1.59±0.39) (all p <0.05). Correlation coefficient (R2) of SUVmax reached 0.966 to 0.978 with only small systematic difference (intra=-0.14; inter=-0.23) between two repeated measurements. Intra- and inter-operator RPCs were 0.688 and 0.877.Conclusions: 99mTc-PYP quantitative SPECT is feasible to quantitatively and objectively assess the burden of cardiac amyloidosis for diagnosis of ATTR-CM.