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Observational Study
. 2018 Aug;39(8):3277-3284.
doi: 10.1002/hbm.24076. Epub 2018 Apr 10.

Intra- and interobserver agreement for fetal cerebral measurements in 3D-ultrasonography

Maria E W A Albers  1   2 , Erato T I A Buisman  3 , René S Kahn  2   4 , Arie Franx  1 , N Charlotte Onland-Moret  5 , Roel de Heus  1
Affiliations
Observational Study

Intra- and interobserver agreement for fetal cerebral measurements in 3D-ultrasonography

Maria E W A Albers et al. Hum Brain Mapp. 2018 Aug.

Abstract

The aim of this study is to evaluate intra- and interobserver agreement for measurement of intracranial, cerebellar, and thalamic volume with the Virtual Organ Computer-aided AnaLysis (VOCAL) technique in three-dimensional ultrasound images, in comparison to two-dimensional measurements of these brain structures. Three-dimensional ultrasound images of the brains of 80 fetuses at 20-24 weeks' gestational age were obtained from YOUth, a Dutch prospective cohort study. Two observers performed offline measurement of the occipitofrontal diameter, intracranial volume, transcerebellar diameter, cerebellar volume, and thalamic width, area, and volume, independently. VOCAL was used for calculation of the volumes. The two-way random, single measures intraclass correlation coefficient (ICC) was used for analysis of agreement and Bland-Altman plots were configured. Intra- and interobserver agreement was almost perfect for occipitofrontal diameter (intra ICC 0.88, 95% CI 0.82-0.92; inter ICC 0.91, 95% CI 0.85-0.94), intracranial volume (intra ICC 0.96, 95% CI 0.91-0.98; inter ICC 0.97, 95% CI 0.96-0.98) and transcerebellar diameter (intra ICC 0.91, 95% CI 0.86-0.94; inter ICC 0.86, 95% CI 0.78-0.910). For cerebellar volume, the intraobserver agreement was almost perfect (0.85, 95% CI 0.76-0.90), whereas the interobserver agreement was substantial (0.75, 95% CI 0.44-0.88). Agreement was only moderate for thalamic measurements. Bland-Altman plots for the volume measurements are normally distributed with acceptable mean differences and 95% limits of agreement. The intra- and interobserver agreement of the measurement of intracranial and cerebellar volume with VOCAL was almost perfect. These measurements are therefore reliable, and can be used to investigate fetal brain development. Thalamic measurements are not reliable enough.

Keywords: brain; cerebellum; cerebrum; fetal; interobserver agreement; intraobserver agreement; three dimensional; ultrasound.

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Figures

Figure 1
Figure 1
Measurement of fetal brain structures: (a) occipitofrontal diameter, (b) intracranial volume, (c) transcerebellar diameter, (d) cerebellar volume, (e) width and area of thalami, and (f) volume of thalami. In (b, d, and f), the upper left image shows the tracing of the structure in the coronal view, the upper right image shows the sagittal view, and the bottom left image shows the axial view. The image in the bottom right shows the reconstructed 3D‐image of the structure
Figure 2
Figure 2
Bland–Altman plots of intra‐ and interobserver agreement of the first measurement of (a and b) the intracranial volume, (c and d) cerebellar volume, and (e and f) the volume of right thalamus. The solid line shows the mean difference, while the dashed lines show the 95% limits of agreement
See this image and copyright information in PMC

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