Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

Introduction Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non...

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Veröffentlicht in:Neuroradiology 2016-02, Vol.58 (2), p.133-139
Hauptverfasser: Santos, Emilie M. M., Yoo, Albert J., Beenen, Ludo F., Berkhemer, Olvert A., den Blanken, Mark D., Wismans, Carrie, Niessen, Wiro J., Majoie, Charles B., Marquering, Henk A.
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container_end_page 139
container_issue 2
container_start_page 133
container_title Neuroradiology
container_volume 58
creator Santos, Emilie M. M.
Yoo, Albert J.
Beenen, Ludo F.
Berkhemer, Olvert A.
den Blanken, Mark D.
Wismans, Carrie
Niessen, Wiro J.
Majoie, Charles B.
Marquering, Henk A.
description Introduction Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. Methods For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland–Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. Results The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Conclusion Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs.
doi_str_mv 10.1007/s00234-015-1607-4
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M. ; Yoo, Albert J. ; Beenen, Ludo F. ; Berkhemer, Olvert A. ; den Blanken, Mark D. ; Wismans, Carrie ; Niessen, Wiro J. ; Majoie, Charles B. ; Marquering, Henk A.</creator><creatorcontrib>Santos, Emilie M. M. ; Yoo, Albert J. ; Beenen, Ludo F. ; Berkhemer, Olvert A. ; den Blanken, Mark D. ; Wismans, Carrie ; Niessen, Wiro J. ; Majoie, Charles B. ; Marquering, Henk A. ; MR CLEAN investigators ; on behalf of the MR CLEAN investigators</creatorcontrib><description>Introduction Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. Methods For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland–Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. Results The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Conclusion Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs.</description><identifier>ISSN: 0028-3940</identifier><identifier>EISSN: 1432-1920</identifier><identifier>DOI: 10.1007/s00234-015-1607-4</identifier><identifier>PMID: 26494462</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Absorptiometry, Photon - methods ; Acute Disease ; Aged ; Algorithms ; Blood clots ; Brain ; Cerebral Angiography - methods ; Computed Tomography Angiography - methods ; Diagnostic Neuroradiology ; Female ; Humans ; Imaging ; Intracranial Thrombosis - diagnostic imaging ; Ischemia ; Male ; Medicine ; Medicine &amp; Public Health ; Netherlands ; Neurology ; Neuroradiology ; Neurosciences ; Neurosurgery ; Observer Variation ; Radiographic Image Enhancement - methods ; Radiographic Image Interpretation, Computer-Assisted - methods ; Radiology ; Reproducibility of Results ; Sensitivity and Specificity ; Stroke ; Stroke - diagnostic imaging ; Thromboembolism ; Thrombosis - diagnostic imaging ; Tomography</subject><ispartof>Neuroradiology, 2016-02, Vol.58 (2), p.133-139</ispartof><rights>The Author(s) 2015</rights><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-81bf6d46627c3d5e671da642fdd8c91d373a9e6c3117b4e9847e38132de4c6c63</citedby><cites>FETCH-LOGICAL-c573t-81bf6d46627c3d5e671da642fdd8c91d373a9e6c3117b4e9847e38132de4c6c63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00234-015-1607-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00234-015-1607-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,315,781,785,886,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26494462$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Santos, Emilie M. M.</creatorcontrib><creatorcontrib>Yoo, Albert J.</creatorcontrib><creatorcontrib>Beenen, Ludo F.</creatorcontrib><creatorcontrib>Berkhemer, Olvert A.</creatorcontrib><creatorcontrib>den Blanken, Mark D.</creatorcontrib><creatorcontrib>Wismans, Carrie</creatorcontrib><creatorcontrib>Niessen, Wiro J.</creatorcontrib><creatorcontrib>Majoie, Charles B.</creatorcontrib><creatorcontrib>Marquering, Henk A.</creatorcontrib><creatorcontrib>MR CLEAN investigators</creatorcontrib><creatorcontrib>on behalf of the MR CLEAN investigators</creatorcontrib><title>Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke</title><title>Neuroradiology</title><addtitle>Neuroradiology</addtitle><addtitle>Neuroradiology</addtitle><description>Introduction Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. Methods For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland–Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. Results The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Conclusion Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. 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M.</au><au>Yoo, Albert J.</au><au>Beenen, Ludo F.</au><au>Berkhemer, Olvert A.</au><au>den Blanken, Mark D.</au><au>Wismans, Carrie</au><au>Niessen, Wiro J.</au><au>Majoie, Charles B.</au><au>Marquering, Henk A.</au><aucorp>MR CLEAN investigators</aucorp><aucorp>on behalf of the MR CLEAN investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke</atitle><jtitle>Neuroradiology</jtitle><stitle>Neuroradiology</stitle><addtitle>Neuroradiology</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>58</volume><issue>2</issue><spage>133</spage><epage>139</epage><pages>133-139</pages><issn>0028-3940</issn><eissn>1432-1920</eissn><abstract>Introduction Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. Methods For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland–Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. Results The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Conclusion Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26494462</pmid><doi>10.1007/s00234-015-1607-4</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Absorptiometry, Photon - methods
Acute Disease
Aged
Algorithms
Blood clots
Brain
Cerebral Angiography - methods
Computed Tomography Angiography - methods
Diagnostic Neuroradiology
Female
Humans
Imaging
Intracranial Thrombosis - diagnostic imaging
Ischemia
Male
Medicine
Medicine & Public Health
Netherlands
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Observer Variation
Radiographic Image Enhancement - methods
Radiographic Image Interpretation, Computer-Assisted - methods
Radiology
Reproducibility of Results
Sensitivity and Specificity
Stroke
Stroke - diagnostic imaging
Thromboembolism
Thrombosis - diagnostic imaging
Tomography
title Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke
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