title: Observer variability assessing US scans of the preterm brain: the ELGAN study.
abstract: BACKGROUND
  Neurosonography can assist clinicians and can provide researchers with documentation of brain lesions. Unfortunately, we know little about the reliability of sonographically derived diagnoses.
  
  
  OBJECTIVE
  We sought to evaluate observer variability among experienced neurosonologists.
  
  
  METHODS
  We collected all protocol US scans of 1,450 infants born before the 28th postmenstrual week. Each set of scans was read by two independent sonologists for the presence of intraventricular hemorrhage (IVH) and moderate/severe ventriculomegaly, as well as hyperechoic and hypoechoic lesions in the cerebral white matter. Scans read discordantly for any of these four characteristics were sent to a tie-breaking third sonologist.
  
  
  RESULTS
  Ventriculomegaly, hypoechoic lesions and IVH had similar rates of positive agreement (68-76%), negative agreement (92-97%), and kappa values (0.62 to 0.68). Hyperechoic lesions, however, had considerably lower values of positive agreement (48%), negative agreement (84%), and kappa (0.32). No sonologist identified all abnormalities more or less often than his/her peers. Approximately 40% of the time, the tie-breaking reader agreed with the reader who identified IVH, ventriculomegaly, or a hypoechoic lesion in the white matter. Only about 25% of the time did the third party agree with the reader who reported a white matter hyperechoic lesion.
  
  
  CONCLUSIONS
  Obtaining concordance seems to be an acceptable way to assure reasonably high-quality of images needed for clinical research.
authors: Division of Pediatric Neurology, Boston University Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors: Karl
authors: K
authors: Kuban
authors: Ira
authors: I
authors: Adler
authors: Elizabeth N
authors: EN
authors: Allred
authors: Daniel
authors: D
authors: Batton
authors: Steven
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authors: Bezinque
authors: Bradford W
authors: BW
authors: Betz
authors: Ellen
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authors: Cavenagh
authors: Sara
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authors: Durfee
authors: Kirsten
authors: K
authors: Ecklund
authors: Kate
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authors: Feinstein
authors: Lynn Ansley
authors: LA
authors: Fordham
authors: Frederick
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authors: Hampf
authors: Joseph
authors: J
authors: Junewick
authors: Robert
authors: R
authors: Lorenzo
authors: Roy
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authors: McCauley
authors: Cindy
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authors: Miller
authors: Joanna
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authors: Seibert
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authors: Specter
authors: Jacqueline
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authors: Wellman
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authors: Westra
authors: Alan
authors: A
authors: Leviton
mesh_terms: D001921:Brain / Q000002:abnormalities*; D002552:Cerebral Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging; D002983:Clinical Competence; D004453:Echoencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging*; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging*; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests