title: Diffusion-weighted quantitative MRI of pleural abnormalities: Intra- and interobserver variability in the apparent diffusion coefficient measurements.
abstract: To assess intra- and interobserver variability in the apparent diffusion coefficient (ADC) measurements of pleural abnormalities.
  
  
  
  Diffusion-weighted magnetic resonance imaging was performed in 34 patients to characterize pleural abnormalities, with a 1.5T unit at b values of 0/150/500/800 sec/mm2. In two sessions held 3 months apart, on perfusion-free ADC maps, two independent readers measured the ADC of pleural abnormalities (two readings for each reader in each case) using different methods of region-of-interest (ROI) positioning. In three methods, freehand ROIs were drawn within tumor boundaries to encompass the entire lesion on one or more axial slices (whole tumor volume [WTV], three slices observer-defined [TSOD], single-slice [SS]), while in two methods one or more ROIs were placed on the more restricted areas (multiple small round ROI [MSR], one small round ROI [OSR]). Measurement variability between readings by each reader (intraobserver repeatability) and between readers in first reading (interobserver repeatability) were assessed using intraclass correlation coefficient (ICC) and coefficient of variation (CoV). Analysis of variance (ANOVA) was performed to compare ADC values between the different methods. The measurement time of each case for all methods in first reading was recorded and compared between methods and readers.
  
  
  
  All methods demonstrated good (MSR, OSR) and excellent (WTV, TSOD, SS) intra- and interreader agreement, with best and worst repeatability in WTV (lower ICC, 0.977; higher CoV, 3.5%) and OSR (lower ICC, 0.625; higher CoV, 22.8%), respectively. The lower 95% confidence interval of ICC resulted in fair to moderate agreement for OSR (up to 0.379) and in excellent agreement for WTV, TSV, and SS (up to 0.918). ADC values of OSR and MSR were significantly lower compared to other methods (P < 0.001). The OSR and SS required less measurement time (10 and 21/22 sec, respectively) compared to the others (P < 0.0001), while the WTV required the longest measurement time (132/134 sec) (P < 0.0001).
  
  
  
  ADC measurements of pleural abnormalities are repeatable. The SS method has excellent repeatability, similar to WTV, but requires significantly less measurement time. Thus, its use should be preferred in clinical practice.
  
  
  
  4 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:769-782.
authors.affiliation: Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy.
authors.forename: Adriano Massimiliano
authors.initials: AM
authors.lastname: Priola
authors.affiliation: Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy.
authors.forename: Sandro Massimo
authors.initials: SM
authors.lastname: Priola
authors.affiliation: Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Gned
authors.affiliation: Department of Mathematics, Giuseppe Peano, University of Torino, Torino, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Giraudo
authors.affiliation: Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Brundu
authors.affiliation: Department of Pathology, San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy.
authors.forename: Luisella
authors.initials: L
authors.lastname: Righi
authors.affiliation: Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Veltri
mesh_terms: D000328:Adult; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010994:Pleura / Q000000981:diagnostic imaging; D010995:Pleural Diseases / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: apparent diffusion coefficient; diffusion-weighted magnetic resonance imaging; measurement variability; pleura; region of interest