title: Middle cerebral artery pulsatility index: reliability at different sampling sites.
abstract: OBJECTIVE
  To analyze the interobserver reliability of measurement of the middle cerebral artery (MCA) pulsatility index (PI) at two different sampling sites.
  
  
  METHODS
  This study included 100 consecutive singleton pregnancies between 24 and 40 weeks with normal fetal growth. The PI was calculated by two independent operators at proximal and distal sampling sites of the near-field MCA. Reliability analyses were performed between observers at each sampling site by means of the intraclass correlation coefficient (ICC) for agreement. Differences between observers were explored and agreement limits calculated by means of the Bland-Altman test.
  
  
  RESULTS
  Satisfactory flow velocity waveforms were obtained successfully in each fetus at both sampling sites. Peak systolic, end-diastolic and time-averaged maximum velocities were significantly higher at the proximal compared with the distal sampling site. Conversely, PI was significantly higher at the distal compared with the proximal site. ICCs for PI were 0.3 and 0.33 at the proximal and the distal sampling sites, respectively. The 95% interval of the PI differences between observers were +0.91 and -1.14 at the proximal and +1.03 and -1.08 at the distal sampling sites. In about 30% of the cases the PI difference between observers was greater than 0.5 at both sampling sites.
  
  
  CONCLUSIONS
  Moderate interobserver reliability in the measurement of end-diastolic and time-averaged maximum MCA flow velocities results in limited agreement of the PI calculation at both proximal and distal sampling sites. These results may preclude its clinical applicability.
authors.affiliation: Obstetric Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain. FFIGUERA@clinic.ub.es
authors.forename: F
authors.initials: F
authors.lastname: Figueras
authors.forename: S
authors.initials: S
authors.lastname: Fernandez
authors.forename: E
authors.initials: E
authors.lastname: Eixarch
authors.forename: O
authors.initials: O
authors.lastname: Gomez
authors.forename: J M
authors.initials: JM
authors.lastname: Martinez
authors.forename: B
authors.initials: B
authors.lastname: Puerto
authors.forename: E
authors.initials: E
authors.lastname: Gratacos
mesh_terms: D000293:Adolescent; D000328:Adult; D001775:Blood Circulation / Q000502:physiology*; D005260:Female; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000196:embryology; D015588:Observer Variation; D011247:Pregnancy; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data