title: Three-dimensional Doppler evaluation of single spherical samples from the placenta: intra- and interobserver reliability.
abstract: OBJECTIVE
  To evaluate the intra- and interobserver reliability of assessment of three-dimensional power Doppler (3D-PD) indices from single spherical samples of the placenta.
  
  
  METHODS
  Women with singleton pregnancies at 24-40 weeks' gestation were included. Three scans were independently performed by two observers; Observer 1 performed the first and third scan, intercalated by the scan of Observer 2. The observers independently analyzed the 3D-PD datasets that they had previously acquired using four different methods, each using a spherical sample: random sample extending from basal to chorionic plate; random sample with 2 cm(3) of volume; directed sample to the region subjectively determined as containing more color Doppler signals extending from basal to chorionic plate; or directed sample with 2 cm(3) of volume. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were evaluated in each case. The observers were blinded to their own and each other's results. Additional evaluation was performed according to placental location: anterior, posterior and fundal or lateral. Intra- and interobserver reliability was assessed by intraclass correlation coefficients (ICC).
  
  
  RESULTS
  Ninety-five pregnancies were included in the analysis. All three placental 3D-PD indices showed only weak to moderate reliability (ICC < 0.66 and ICC < 0.48, intra- and interobserver, respectively). The highest values of ICC were observed when using directed spherical samples from basal to chorionic plate. When analyzed by placental location, we found lower ICCs for lateral and fundal placentae compared to anterior and posterior ones.
  
  
  CONCLUSIONS
  Intra- and interobserver reliability of assessment of placental 3D-PD indices from single spherical samples in pregnant women greater than 24 weeks' gestation is poor to moderate, and clinical usefulness of these indices is likely to be limited.
authors.affiliation: Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil. wpmartins@gmail.com
authors.forename: W P
authors.initials: WP
authors.lastname: Martins
authors.forename: J C
authors.initials: JC
authors.lastname: Lima
authors.forename: A W
authors.initials: AW
authors.lastname: Welsh
authors.forename: E
authors.initials: E
authors.lastname: Araujo Júnior
authors.forename: E
authors.initials: E
authors.lastname: Araujo
authors.forename: A H
authors.initials: AH
authors.lastname: Miyague
authors.forename: F M
authors.initials: FM
authors.lastname: Filho
authors.forename: N J
authors.initials: NJ
authors.lastname: Raine-Fenning
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015588:Observer Variation; D010920:Placenta / Q000000981:diagnostic imaging*; D011247:Pregnancy; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*