title: Reliability of fractional anisotropy measurement for children with cerebral palsy.
abstract: OBJECTIVE
  Periventricular leukomalacia (PVL) is the leading cause of disability in children with cerebral palsy (CP). Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique for detecting microstructural lesions of white matter. Fractional anisotropy (FA) is a widely used DTI index with clinical significance in children with CP. This study aims to estimate the reliability of FA for children with CP.
  
  
  METHODS
  Four observers measured FA values in 78 children with spastic CP from PVL. Region of interests (ROIs) were placed in three anatomical loci at each side: medial and lateral portions of posterior limb of internal capsule and ascending sensory tract. Intra- and interobserver reliability indices including intraclass correlation coefficient (ICC), standard error of measurement, smallest real difference percentage (SRD%), and limit of agreement using Bland-Altman analysis were examined.
  
  
  RESULTS
  Intraobserver ICCs were 0.85 or greater in all ROIs, and SRD% ranged from 3.59 to 12.33%. Interobserver ICCs exceeded 0.90 in all ROIs, and the SRD% were less than 10%. The Bland-Altman analysis showed good intra- and interobserver agreements. The reliability was not affected by severity of impairment.
  
  
  CONCLUSIONS
  Reliability of DTI-derived FA value using ROIs was satisfactory in children with PVL.
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Kyunghoon
authors.initials: K
authors.lastname: Min
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Yu
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Junyoung
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Jae Sun
authors.initials: JS
authors.lastname: Shim
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Hee Song
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Sang Heum
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: MinYoung
authors.initials: M
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D016880:Anisotropy; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007223:Infant; D007969:Leukomalacia, Periventricular / Q000209:etiology / Q000473:pathology*; D008297:Male; D009128:Muscle Spasticity / Q000150:complications; D015588:Observer Variation; D015203:Reproducibility of Results