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To compare the performance of CT and MRI radiomics for predicting the malignant potential of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, and to investigate their value compared to the revised 2017 international consensus Fukuoka guidelines.Sixty patients with surgically confirmed IPMNs (37 malignant and 23 benign) were included. Radiomics features were extracted from arterial and venous phase images of CT and T2-weighted images of MRI, respectively. Intraclass correlation coefficients for the radiomics features were calculated to assess the interobserver reproducibility. The least absolute shrinkage and selection operator algorithm was used for feature selection. Radiomics models were constructed based on selected features with logistic regression (LR) and support vector machine (SVM). A clinical and imaging model was constructed based on independent predictors of the revised 2017 Fukuoka guidelines determined in multivariate logistic regression with forward elimination.The reproducibility of MRI radiomics features was higher than that of CT radiomics features, regardless of arterial or venous phase features (all p0.001). MRI radiomics models achieved improved AUCs (0.879 with LR and 0.940 with SVM, respectively), than that of CT radiomics models (0.811 with LR and 0.864 with SVM, respectively). All radiomics models provided better predictive performance than the clinical and imaging model (AUC = 0.764).The MRI radiomics models with higher reproducibility radiomics features performed better than CT radiomics models for predicting the malignant potential of IPMNs. The performance of radiomics models was superior to the clinical and imaging model based on Fukuoka guidelines.

Background: Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography.Aims: We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites.Methods: We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of infra- and inter-observer reproducibility. Key secondary analysis was the identification of clinical and procedural characteristics predicting reproducibility.Results: The intra-observer CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The inter-observer CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low fractional flow reserve (FFR) were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03).Conclusions: The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01 +/--0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed by FFR.

Background We aimed to determine whether the histopathological grading of dysplastic nevi is an objective endeavour, considering interobserver variability, according to 2018 World Health Organization (WHO) Criteria. Methods In total, 179 cases of dysplastic nevi, with high and moderate degree of atypia, diagnosed and graded according to the previous criteria were reviewed by three pathologists. Then the observers graded the dysplastic nevi as low or high according to 2018 WHO criteria. Results Grading of dysplastic nevi was in complete agreement in 99 of 179 cases across three observers with a fair level of overall interobserver agreement (multirater Kfree: 0.40). The observers showed moderate to good agreement for most of the architectural features, except for criteria regarding focal continuous basal proliferation of melanocytes, density of non- nested junctional melanocytes and presence of dyscohesive nests of intraepidermal melanocytes. Whereas fair agreement was achieved for the cytological criteria. Conclusions The 2018 WHO criteria for dysplastic nevus will ensure a common approach to diagnosis and grading of dysplastic nevi. However, histopathological criteria, such as cytological features and focal continuous basal proliferation of melanocytes, should be improved, so as to ensure a more accurate surgical approach and risk assessment. This article is protected by copyright. All rights reserved.

PURPOSE: The reliability and reproducibility of T2-weighted imaging/fluid-attenuated inversion recovery (T2/FLAIR) mismatch were investigated in the diagnosis of isocitrate dehydrogenase (IDH) mutant astrocytoma between WHO grade II and III diffuse hemispheric gliomas. METHODS: WHO grade II and grade III diffuse hemispheric gliomas (n=133) treated in our institute were included in the study. Pathological findings and molecular markers of the cases were reviewed with the criteria of WHO 2016. The finding of mismatch between T2-weighted and FLAIR images in preoperative magnetic resonance imaging (MRI) of the cases was evaluated by two different radiologists. The readers reviewed MRIs independently, blinded to the histopathologic diagnosis or molecular subset of tumors. The cases were classified as IDH-mutant astrocytoma, oligodendroglioma and IDH-wildtype (IDH-wt) astrocytoma according to molecular and genetic features. RESULTS: T2/FLAIR mismatch positivity was observed in 46 patients (34.6%). T2/FLAIR mismatch positivity was observed in 42 of 75 IDH-mutant astrocytomas (56%) and 4 of 43 oligodendrogliomas (9.30%), while it was not seen among IDH-wt astrocytomas (0/15, 0%). The T2/FLAIR mismatch ratio was significantly different between IDH-mutant astrocytomas (WHO grade II and grade III) and oligodendrogliomas (chi-square, p

Background The Mitosis-Karyorrhexis Index (MKI) score is important in neuroblastoma evaluation and in the application of the International Neuroblastoma Pathology Classification (INPC). Currently, it is not standardized for smears. Hence, the aim of this study was to devise and validate methods for MKI evaluation in fine-needle aspiration biopsy (FNAB) of neuroblastoma. Methods A total of 50 cases of neuroblastoma diagnosed by FNAB from January 2017 to December 2019 were retrieved, and detailed cytomorphological evaluations were performed. The MKI was evaluated, and the eyeball visual assessment score (EVAS) was compared with the digital image visual analysis score (DIVAS) on cytology smears and corresponding histology sections of cell blocks. The interobserver reproducibility and concordance were calculated. INPC subtyping into favorable and unfavorable groups was performed by the collation of age, MKI, and cytomorphology and was correlated to clinical outcomes. Results Neuroblastoma was categorized as undifferentiated (22 of 50) or poorly differentiated (28 of 50) on cytomorphology. The overall concordance for the MKI by 3 observers was 86% (κ = 0.85), and this increased to 98% in the high MKI category. MKI evaluations on smears showed 96% concordance with cell block histology, and the EVAS was concordant with the DIVAS in 86% of the cases. Overall, the MKI was high in 39 cases, intermediate in 4 cases, and low in 7 cases. The INPC category was unfavorable in 90% (n = 45) and favorable in 10% (n = 5) and had significant correlations with outcomes (P = .029). Conclusions An MKI assessment on smears by digital image visual analysis is accurate, reproducible, and objective and should be incorporated into the routine reporting of neuroblastoma FNAB for diagnostic schemas as per the INPC.

AIM: Patient Specific Instrumentation (PSI) with 3D bone models have been used to improve the outcomes of Total Knee Arthroplasty (TKA). The PSI, however, needs a CT (Computed tomography)/MRI scan to reproduce a bone-based model. However, CT is not a routine imaging method in the TKA and has challenges such as high radiation exposure and increased investigation cost. Any technology or software which could accurately recreate 3D bone models using X-ray would be a cheaper and safer tool. This study is based on one such technology (XrayTo3D(®)) using X-ray to 3D as an alternative to other image-based 3D bone models and PSI available in the market. This study compares the accuracy of XrayTo3D(®) versus a Conventional CT to 3D, in the reconstruction of lower limb bones (femur and tibia). METHOD: In an analysis of 45 lower limbs, 11 anatomical parameters were measured [Medial Proximal Tibial Angle—MPTA, Tibial(T)-torsion, T-slope, T-length, Mechanical Lateral Distal Femoral Angle (mLDFA), F-version, F-length, Distal femoral Medio lateral width (F-ML), Distal Femoral Antero Posterior (F-AP), Proximal Tibia Antero Posterior (T-AP), Proximal Tibia Medio Lateral (T-ML) based on landmarks selected by three orthopaedic surgeons(numbers of the authors superscript), on two groups of 3D models, one reconstructed using XrayTo3D(®) and the other using CT. Mean and standard-deviation values were measured for all the parameters in both the groups. Statistical association between both the groups was measured by Pearson's correlation coefficient. Two-sided t tests of the mean values were calculated to compare the two measurement methods. The interobserver reproducibility within each group was measured by the intraclass correlation coefficient (ICC). Point-to-surface (P2S) error, in the distal femur and proximal tibia regions of the models reconstructed using XrayTo3D(®), were also measured. RESULTS: For all the 11 parameters, no statistically significant difference was found between the 2 groups (p > 0.05). Pearson's correlation coefficients for all the parameters were not significant. The interobserver reproducibility was ranging from 0.90 to 1.00 and 0.90 to 1.00 for the XrayTo3D(®) and CT groups, respectively. The mean P2S distance was 1.0 mm in distal femur and 1.1 mm in proximal tibia which was within the acceptable limits. CONCLUSION: The reconstruction accuracy of the XrayTo3D(®) is an accurate, safe and cost effective as compared to a CT-based method.

BACKGROUND R2* estimation reflects the paramagnetism of the tumor tissue, which may be used to differentiate between benign and malignant liver lesions when contrast agents are contraindicated. AIM To investigate whether R2* derived from multi-echo Dixon imaging can aid differentiating benign from malignant focal liver lesions (FLLs) and the impact of 2D region of interest (2D-ROI) and volume of interest (VOI) on the outcomes. METHODS We retrospectively enrolled 73 patients with 108 benign or malignant FLLs. All patients underwent conventional abdominal magnetic resonance imaging and multi-echo Dixon imaging. Two radiologists independently measured the mean R2* values of lesions using 2D-ROI and VOI approaches. The Bland–Altman plot was used to determine the interobserver agreement between R2* measurements. Intraclass correlation coefficient (ICC) was used to determine the reliability between the two readers. Mean R2* values were compared between benign and malignant FFLs using the nonparametric Mann–Whitney test. Receiver operating characteristic curve analysis was used to determine the diagnostic performance of R2* in differentiation between benign and malignant FFLs. We compared the diagnostic performance of R2* measured by 2D-ROI and VOI approaches. RESULTS This study included 30 benign and 78 malignant FLLs. The interobserver reproducibility of R2* measurements was excellent for the 2D-ROI (ICC = 0.994) and VOI (ICC = 0.998) methods. Bland–Altman analysis also demonstrated excellent agreement. Mean R2* was significantly higher for malignant than benign FFLs as measured by 2D-ROI (P < 0.001) and VOI (P < 0.001). The area under the curve (AUC) of R2* measured by 2D-ROI was 0.884 at a cut-off of 25.2/s, with a sensitivity of 84.6% and specificity of 80.0% for differentiating benign from malignant FFLs. R2* measured by VOI yielded an AUC of 0.875 at a cut-off of 26.7/s in distinguishing benign from malignant FFLs, with a sensitivity of 85.9% and specificity of 76.7%. The AUCs of R2* were not significantly different between the 2D-ROI and VOI methods. CONCLUSION R2* derived from multi-echo Dixon imaging whether by 2D-ROI or VOI can aid in differentiation between benign and malignant FLLs.

The objective of this article was to study the reproducibility and reliability of the fetal corpus callosum measurements between two-dimensional (2D) and three-dimensional (3D) acquisitions. This prospective study enrolled 475 fetuses, monitored between 18 and 38 weeks of gestation by two operators. Starting from a transcerebellar axial plane, 3D and 2D mid-sagittal views of the corpus callosum were obtained. Measurements of length and thickness were performed and underwent quality control by independent reviewers. The acquisition time of the two methods was measured. Means, differences, and linear correlations were analyzed using t-test, regression and Pearson's correlation coefficients, and Bland–Altman's plots. This analysis was performed for each operator to test the interobserver reproducibility. Among the 432 cases measured using both methods, 380 (88%) were validated by quality control. The mean corpus callosum length and thickness were essentially the same using 2D and 3D measurements (2D: 33.8 ± 8.7 vs. 3D: 33.7 ± 8.7 mm, 2D: 2.2 ± 0.4 vs. 3D: 2.2 ± 0.4 mm, respectively; mean ± standard deviation [SD]). Linear regression coefficients and Pearson's coefficients were similar for length (2D: 0.8283 and 0.9191 vs. 3D: 0.8271 and 0.9095), but slightly different regarding thickness (2D: 0.6775 and 0.8231 vs. 3D: 0.5831 and 0.7636). Differences between 2D and 3D measurements, considering Bland–Altman's plots and correlated with gestational age, were acceptable (2D: 0.097 ± 0.559 mm, 3D: 0.004 ± 0.111 mm). The acquisition time required was significantly lower for 3D acquisitions (3D: 25.2 ± 14.5 seconds vs. 2D: 35.1 ± 19.4 seconds, p

Objective: To evaluate the interobserver agreement of the new AOSpine classification for subaxial cervical fractures. Methods: A descriptive study, which11 traumatic lesions of the subaxial cervical spine (through radiographic and tomographic images), were evaluated by 16 observers being: 6 senior surgeons, 4 fellows in spinal surgery and 6 physicians residents in Orthopedics and Traumatology by the new AOSpine classification, with subsequent statistical analysis of the results. An agreement analysis was performed using the Kappa coefficient, both individually and in combination, with an interpretation of the index performed using the standardized model for Landis and Koch. To determine the level of significance of the analyzes, values less than 0.05 were considered statistically significant. Results: In general, the level of agreement among the examiners was considered reasonable. The lesions “A0 (F3)”, “A4 (F3)”, “B1”, “B3”, “B3 (F3)”, “C”, “C (F3)” and “F3”showed a low level of agreement between the examiners. The level of reasonable agreement was obtained between fractures “A0”, “A1”, “A4”, “B2” and “C (F4)”. The only fracture that presented a moderate level of agreement was the “C (F4 BL)” lesion. This result indicates that the referred injury was the fracture of the subaxial column that presented the best level of agreement among the 16 examiners in the present study. Conclusions: The results of the study indicate an intermediate agreement of the new AOSpine classification for subaxial cervical lesion and point to the need to carry out studies that seek to evaluate this new classification in order to better evaluate its strengths and weaknesses, contributing for its improvement. Level of evidence III; Diagnostic study - investigation of a diagnostic test.

Background: Urine cytology remains to be the test of choice in the detection of high-grade urothelial carcinomas (HGUC) due to its favorable sensitivity. However, a significant rate of cases is reported under atypical/indeterminate categories, which result in a decrease in its specificity. Providing standardized cytologic criteria, one of the aims of The Paris System (TPS) is to reduce the use of indeterminate diagnoses and provide a higher predictive value in these categories. Aims: We compared the diagnostic performances of TPS and our original reporting system, and also investigated the interobserver reproducibility of the cytologic criteria used. Materials and Methods: A total of 386 urine samples were reviewed retrospectively. Original cytologic diagnoses have been made using similar cytologic features proposed by TPS. All slides were recategorized after the use of the cytologic criteria as described by TPS guideline. Results: After TPS, specificity of the test increased from 39.6% to 63.5, sensitivity decreased from 92.5% to 88.8%, and diagnostic accuracy increased from 63.6% to 75%. The use of negative category increased threefold. Frequencies of indeterminate categories of atypical urothelial cells (AUC) and suspicious for HGUC (SHGUC) decreased by 36% and 56.5%, respectively. A subsequent detection of HGUC after AUC and SHGUC categories increased by 38% and 64%, respectively. Interobserver agreement for TPS categorization was 39%. Conclusions: TPS improved diagnostic accuracy of urine cytology by reducing the use of indeterminate categories, and resulted in increase in their predictive value for subsequent diagnosis of HGUC. However, reproducibility of diagnostic categories seemed to be imperfect.

To evaluate the reproducibility of mid-trimester intracranial anatomy assessment. Women undergoing mid-trimester scan (between 18th to 25th gestational weeks) for fetal anatomy assessment were included in the study. Measurements of lateral ventricle (LV), cisterna magna (CM) and transverse cerebellar diameter (TCD) were obtained for reproducibility analyses. Inter-observer reproducibility analysis was made with correlation coefficients. A total of 162 women were included in the analysis while one woman was excluded from the study due to diagnosis of vermian agenesis. Correlation coefficient (CC) of cisterna magna measurements have shown weak to moderate interclass correlation (r=0.28, P=0.001). Measurements of lateral ventricle have shown moderate to strong interclass correlation (r=0.73, P, NA

Summary Intraductal biopsy is commonly used for preoperative evaluation of the etiology of biliary strictures. Interpretation of intraductal biopsies is frequently challenging. The diagnosis often suffers from interobserver disagreement, which has not been studied in the literature. We sought to assess interobserver concordance in the interpretation of intraductal biopsies. Eighty-five biopsies were retrieved, falling into five diagnostic categories: negative for dysplasia (NED), indefinite for dysplasia (IND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and carcinoma (CA). Eight gastrointestinal pathologists blindly reviewed all the slides. Agreement among pathologists was analyzed using Fleiss κ and weighted concordance coefficient S∗. A face-to-face consensus/training session was held to discuss the classification criteria, followed by a second round review. The overall interobserver agreement was fair in the first round review (κ = 0.39; S∗ = 0.56) and improved to moderate in the second round review (κ = 0.48; S∗ = 0.69). The agreement before and after consensus meeting was substantial to nearly perfect for CA (κ = 0.65, S∗ = 0.83; and κ = 0.80, S∗ = 0.91), fair for HGD (κ = 0.28, S∗ = 0.69; and κ = 0.40, S∗ = 0.63), and moderate for NED (κ = 0.47, S∗ = 0.50; and κ = 0.47, S∗ = 0.53). Agreement improved from fair to moderate for LGD (κ = 0.36, S∗ = 0.61; and κ = 0.49, S∗ = 0.71) and slight to fair for IND (κ = 0.16, S∗ = 0.51; and κ = 0.33, S∗ = 0.50). Compared with Hollande's fixed specimens, the agreement was higher in almost all diagnostic categories in formalin-fixed biopsies. Overall, interobserver concordance was improved after a consensus/training session. Interobserver reproducibility was high at the end of the diagnostic spectrum (CA) but fair to moderate for other diagnostic categories.

Background Immunocytochemical staining with p16/Ki67 has been suggested as a promising triage biomarker in cervical cancer screening. As dual staining is a subjective method, proper training may be required to ensure safe implementation in routine laboratories and reduce risk of misclassification. We determined concordance between novice evaluators and an expert, stratified by number of slides reviewed at three reading points. Methods The study was conducted at the Department of Pathology, Randers, Denmark. Women were eligible if they were aged ≥45, had been enrolled in one of two ongoing clinical studies, and had a dual stain slide available. Dual staining was performed using the CINtec plus assay. Slides were randomly selected from three reading points at which novice evaluators had reviewed, As training and experience in p16/Ki67 dual stain interpretation may affect concordance and possibly diagnostic accuracy of cervical precancer, it is important that future studies accurately describe any training and previous experience among evaluators to allow for a meaningful comparison of dual stain accuracy across studies. Furthermore, setting up proper dual stain training programs in routine screening laboratories is advisable to ensure sufficient interpretation skills among novice evaluators.

BACKGROUND The Paris System of Reporting Urine Cytology aims to screen samples for HGUC and to provide a universally acceptable reporting format for urine cytology specimens. However, studies detailing the reproducibility of this system, especially on cyto-centrifuge preparations, are lacking. METHODS 149 voided urine samples received in Department of Pathology were reviewed independently by five cytopathologists. To estimate the overall agreement, Gwet's AC and AC1statistics between each pair of raters were used. To measure the random error component, polychoric correlations were used. To assess the systematic error, Friedman test was used. RESULTS There was moderately good inter-rater agreement between the raters. Gwets AC2 ranged between 0.67 and 0.89 for the classification of the cases once the sample was found adequate for assessment, while the Gwet's AC1 ranged between 0.61 and 0.94 in assessing for adequacy. There were significant systematic differences between raters in their thresholds for the different categories as well as in differentiating between an adequate and inadequate sample (P value by Friedman test

Although the prognostic significance of grade in endometrial cancer is well known, grade 2 cases have not been evaluated separately in most of the previous studies. In this study, we aim to investigate whether the oncologic outcomes of grade 2 endometrioid endometrial carcinomas trend towards grade 1 or 3 tumors. Patients' records and pathological reports were reviewed retrospectively and eligible patients with endometrioid endometrial carcinoma were determined and distributed into 3 groups according to their 1988 International Federation of Gynecology and Obstetrics (FIGO) grade. Groups' characteristics and oncologic outcomes were compared. Differences between grades were tested with z-test and adjusted by Bonferroni method. Kaplan-Meier method was performed for the survival analysis. In total, 776 patients of endometrioid endometrial carcinoma were included in this study. Mean follow-up time was 52 ± 14 months. Patients' mean age was 56.3 ± 10.8 years. Even though grade 2 endometrioid endometrial carcinomas were different from both grade 1 and 3 in terms of the pathological features, survival analyses demonstrated that their oncologic outcomes trended towards grade 1. The grade was determined as an independent prognostic factor for overall survival (OS). The interobserver reproducibility will be improved among pathologists by combining FIGO grade 1 and 2 endometrioid endometrial carcinomas, while prognosis prediction is not likely to be affected.

Introduction Prior to the 2018 publication of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), a Web-based interobserver study was performed to evaluate MSRSGC reporting categories, identify cytomorphologic features that represent poor sources of agreement, and establish a baseline for future studies. Material and methods Study participants evaluated 75 images chosen from the MSRSGC image set, prior to the release of the Milan Atlas. Images spanned all diagnostic categories including typical and borderline cytomorphology. Participant demographics were collected on level of training, practice patterns, and experience. Results A total of 647 persons attempted access to the survey. Of these, 555 correctly answered the qualifying questions. Participants included: 16.5% ASCP Certified Cytotechnologists, 2.8% Specialist Cytotechnologists, 5.8% IAC Certified individuals, 14.3% Anatomic (AP) Certified Pathologists, 38.9% AP and Cytopathology Certified Pathologists, and 15.3% pathology trainees. Length of participant practice varied from 0 to 54 years. In our sample, 43.4% of participants came from academic centers, 17.6% from private hospitals; and 13.3% from commercial/private laboratories. Overall, 42% of respondents agreed with the reference interpretations of salivary gland lesions. The best agreement was seen in cytopathology certified pathologists. Among the MSRSGC categories, best agreement was found in Neoplasm-Benign (58.9%) and Non-Diagnostic (49.2%) categories, followed by Malignant (48.4%). The agreement rates for Salivary Gland Lesion of Uncertain Malignant Potential (SUMP) and Suspicious For Malignancy (SFM) were 23.6% and 22.7%, respectively. Conclusions Similar to the reproducibility studies conducted for gynecologic and urinary cytopathology, the most important factor in diagnostic reproducibility was a priori classification of image difficulty, although people with higher certifications performed better.

Purpose To compare the capabilities of intravoxel incoherent motion (IVIM) to those of monoexponential diffusion-weighted imaging for differentiating benign from malignant non-vascular, non-fatty soft tissue tumors (NVSFSTT). Material and methods A total of 64 patients with 64 histologically confirmed soft-tissue tumors were retrospectively included. There were 23 men and 41 women with a mean age of 52 ± 17 (SD) (range: 18–92 years). IVIM parameters, including molecular diffusion restriction coefficient (ADCtrue), perfusion fraction, and tissue perfusion related coefficient were compared to mean monoexponential ADC (ADCstd) values. Two readers calculated all parameters, which were compared to histopathological findings that were used as standard of reference. Results The overall performance of ADCtrue and ADCstd was similar for the benign-malignant differentiation of NFNVSTT with accuracies ranging from 73% to 75% for both readers (P = 0.3). Interobserver reproducibility was considered excellent for both ADCstd and all IVIM parameters (ICC = 0.81–0.96). When myxoid tumors were excluded from morphological analysis, an increase in sensitivity of 16–21% of ADCtrue was observed, with no changes in specificity values. The use of perfusion related IVIM parameters in association with ADCtrue did not improve tumor characterization. Conclusion The use of IVIM parameters does not improve the characterization of NVNFSTT by comparison with conventional monoexponential ADC calculation.

Objective: To evaluate the intra- and interobserver reproducibility of radiographic cranial parameters. Method: A study of the reproducibility of the radiographic cranial parameters (cranial incidence, cranial tilt, cranial slope and spinocervical angle) of 40 patients by 4 observers with different levels of experience. Results: Cranial incidence (CI) showed poor intraobserver concordance; for the other cranial parameters, good to excellent concordance was observed. In the assessment of interobserver concordance, all the parameters analyzed showed statistical significance, with good CI concordance. Conclusion: Cranial parameters are easily reproducible by orthopedists with different levels of experience. CI showed good interobserver concordance, but only reasonable intraobserver concordance among more experienced observers. Level of evidence IV; Diagnostic Study.

Introduction/Background* Molecular/genomic profiling is the most accurate method to assess prognosis of endometrial cancer patients. Similarly, the adoption of radiomics showed important results for screening, diagnosis and prognosis, across various radiological systems and oncologic specialties. Here, we aim to correlate radiomic features obtained from ultrasound images with the molecular/genomic profiling to identify new hallmarks for stratification of endometrial cancer patients into different classes of risk. Methodology This prospective single-arm observational study Patients with newly diagnosed endometrial cancer will have ultrasonographic evaluation and radiomic analysis of the ultrasonographic images. Then patients will have surgery followed by molecular/genomic evaluation. We will correlate radiomic features with molecular/genomic profiling to classify prognosis. Major Inclusion/Exclusion Criteria : Consecutive patients (aged 18 years or more) with newly diagnosed endometrial cancer. Patients should have preoperative ultrasonographic evaluation followed by surgery. Result(s)* The central hypothesis is that combining radiomic features with molecular features might allow identifying various classes of risk for endometrial cancer, e.g. predicting unfavorable molecular/genomic profiling. The rationale for the proposed research is that once validated, radiomics applied to ultrasonographic images would be an effective, innovative and cheap method for tailor operative and postoperative treatment modality in endometrial cancer. Primary Endpoint : The main endpoints will: (i) to define the mechanism by which radiomic features predict the classification of endometrial cancer into various classes of risk e.g. predicting unfavorable molecular/genomic profiling as defined by molecular classification; (ii) to determinate the scaled impact of radiomic features assessed on ultrasonographic images of endometrial tumors; and (iii) to assess the intraobserver and interobserver reproducibility of radiomic features on ultrasonographic images of endometrial tumors. Overall, 100 patients for study cohort and 40 for the validation cohort. Conclusion* We expect that the radiomic analysis of ultrasonographic images by means of radiomic classifier of risks will provide comparable results to molecular/genomic. (Trial Registration: GR-2019-12370566 Bando per la Ricerca Finalizzata 2019, Ministero della 24 Salute, Repubblica Italiana)

Purpose In asymmetrical mandibles, it is often challenging to identify the mandibular midline. The median lingual foramen (MLF) is located at the midline of the anterior mandible. The purpose of this study is to evaluate the reproducibility of identifying the MLF compared to conventional landmarks on cone beam computed tomography's (CBCT's) to mark the mandibular midline. Material and Methods Ten symmetrical class II, 10 symmetrical class III, ten asymmetrical class II and 10 asymmetrical class III patients were included. On CBCTs, the cephalometric landmarks menton, pogonion, genial tubercle and MLF were identified twice by two observers. Results A high intra‐ and interobserver reproducibility was found for all landmarks, the highest being the MLF. The gain in accuracy is 0.998 mm, 0.824 mm and 0.361 mm compared to pogonion, genial tubercle and menton, respectively (P‐value

Purpose The proliferation marker Ki67 has prognostic and predictive values in breast cancer, and the cutoff of the Ki67 label index (LI) is a key index for chemotherapy. However, poor interobserver consistency in Ki67 assessment has limited the clinical use of Ki67, especially in luminal cancers. Here, we reported a modified Ki67 assessment method, size-set semiautomatic counting (SSSAC) and investigated its interobserver reproducibility. Methods One hundred invasive breast cancer tissues were set immunostained for Ki67 in one laboratory, scanned as digital slides, and sent to 41 pathologists at the laboratories of 16 hospitals for Ki67 LI assessment using size-set semiautomatic counting (SSSAC), size-set visual assessment (SSVA) and size-set digital image analysis (SSDIA) with a specific image viewing software (Aperio Image Scope, Leica, Germany). The intraclass correlation coefficient (ICC) and Bland-Altman plot were used to evaluate interobserver reproducibility. The Wilcoxon signed-rank test was used to analyze the difference in the Ki67 values assessed by SSSAC and SSDIA. Results SSSAC demonstrated better interobserver reproducibility (ICC = 0.942) than SSVA (ICC = 0.802). The interobserver reproducibility was better in Ki67 homogeneously stained slides and centralized hot-spot slides than in scattered hot-spot slides. The Ki67 value assessed with SSSAC was obviously higher than that assessed with SSDIA (negative ranks (SSDIA SSSAC): N = 17, sum of ranks = 478.50; Z = −6.837; P, Highlights • A modified method for Ki67 LI assessment based on digital image, size-set semiautomatic counting (SSSAC). • Investigated the interobserver reproducibility of SSSAC for Ki67 LI assessment of 100 cases in 41 pathologists of 16 hospitals. • SSSAC has better interobserver reproducibility than current visual assessment and was more accurate than DIA in Ki67 assessment. • SSSAC is a better choice for Ki67 LI assessment.

Background: A number of guidelines have been developed to improve standardization of the terminology and criteria for cytologic specimens obtained from the thyroid, pancreas, lung, and salivary glands. A major goal of these guidelines is to improve reproducibility and understanding of the reporting of diagnostic results among cytopathologists and between cytopathologists and clinicians. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology (IAC YSRB) is the most recent of these guidelines. The value of this system is, in part, dependent upon interobserver reproducibility. Design: Ninety consecutive fine-needle aspiration biopsies (FNAB) of the breast, performed over a 6-year period, were independently evaluated by 4 board-certified pathologists blinded to the original diagnoses. The 5 diagnostic categories used were those of the IAC YSRB according to published criteria for these categories. Observed agreement and chance corrected agreement (Fliess κ) were calculated. Differences in κ values were evaluated using the T statistic of Gwent. Statistical calculations were performed using STATA v16.0 (STATA Corp., College Station, TX, USA). Results: Overall agreement between observers was good. Observed unweighted agreement was 69% and weighted agreement was 91%. The majority of diagnoses were concordant (68.6%). Conclusions: Interobserver agreement of 4 cytopathologists was good using the 5 categories of the IAC YRSB (69%). Agreement was greater among pathologists with more years of experience. The IAC YSRB system appears to provide greater agreement among viewers than guidelines for cytologic specimens obtained from some other body sites (salivary gland and lung). Most discrepancies were only by a single category, with only 22/113 (19%) differing by more than one category.

ObjectivesWe aimed to determine the interobserver reproducibility in diagnosing low-grade ductal carcinoma in situ (DCIS). We also aimed to compare the interobserver variability using a proposed two-tiered grading system as opposed to the current three-tiered system.MethodsThree expert breast pathologists and one junior pathologist identified low-grade DCIS from a set of 300 DCIS slides. Months later, participants were asked to grade the 300 cases using the standard three-tiered system.ResultsUsing the two-tiered system, interobserver agreement among breast pathologists was considered moderate (κ = 0.575). The agreement was similar (κ = 0.532) with the junior pathologist included. Using the three-tiered system, pathologists’ agreement was poor (κ = 0.235).ConclusionsPathologists’ reproducibility on diagnosing low-grade DCIS showed moderate agreement. Experience does not seem to influence reproducibility. Our proposed two-tiered system of low vs nonlow grade, where the intermediate grade is grouped in the nonlow category has shown improved concordance.

Background The present study was undertaken to ascertain the prevalence of published data with errors in the numerical significant figures in established surgical and medical journals in 2017. The frequency of errors was not only summarized but was also correlated to the published journal impact factor for the seven journals reviewed. Methods All original investigations and other analysis reporting quantitative statistical results published in seven surgical and medical journals in 2017 were electronically reviewed for errors in reporting significant figures of the published statistical findings. Errors in significant figures were placed into one of three author defined categories: calculated significant figure errors, interval precision errors, and P value reporting errors. Tests for intraobserver and interobserver reproducibility were conducted blindly to ensure validity and reproducibility between different readers. Results A total of 1675 articles published in 2017 were identified and reviewed. In total, 730 articles (44%) were reported to have an error in one category, with error rates ranging from 25% to 68% depending on publishing journal. The error rate for each journal were easily reproduced by different observers (κ coefficient range: 0.55-0.81) and correlated with its 2016 impact factor (r = 0.97, R2 = 0.95, P Conclusions Published findings are frequently reported incorrectly in the surgical and medical literature and can be potentially misleading. The pervasiveness of errors correlates to fewer citations as measured by the lower impact factor.

OBJECTIVE. The objective of our study was to investigate the potentials of enhanced dual-source dual-energy CT (DECT) and three-planar measurements for differentiating invasive pulmonary adenocarcinomas (IPAs) from preinvasive lesions appearing as pure ground-glass nodules (pGGNs). MATERIALS AND METHODS. Thirty-nine patients with 53 pGGNs who underwent enhanced dual-source DECT were included in this retrospective study. All pGGNs were pathologically confirmed and categorized into two groups: preinvasive lesions or IPAs. The traditional CT features of the pGGNs were evaluated on unenhanced images. Quantitative parameters were measured on iodine-enhanced images of dual-source DECT in three planes, and both intra- and interobserver reproducibility analyses were performed to assess the measurement reproducibility of quantitative parameters. To identify significant factors for differentiating IPAs from preinvasive lesions, we performed logistic regression analysis and ROC curve analysis. RESULTS. For traditional CT features, only lesion size and unenhanced CT attenuation value showed significant differences between preinvasive lesions and IPAs (p < 0.05). Preinvasive lesions and IPAs exhibited significant differences in attenuation on virtual images, so-called "virtual HU" or "VHU," and the modified normalized iodine concentration (NIC) (p < 0.05), and both intra- and interobserver agreement for the quantitative measurements were excellent. Multivariate logistic regression analysis revealed that larger lesion size (adjusted odds ratio [OR], 3.65) and higher modified NIC (adjusted OR, 19.01) were significant differentiators of IPAs from preinvasive lesions (p < 0.05). ROC curve analysis revealed that modified NIC showed excellent performance (AUC, 0.924) and significantly higher performance than lesion size (AUC, 0.711) for differentiating IPAs from preinvasive lesions. CONCLUSION. In pGGNs, a lesion with a modified NIC value of more than 0.29 can be a very specific discriminator of IPAs from preinvasive lesions, and IPAs can be accurately and reliably differentiated from preinvasive lesions using enhanced dual-source DECT and three-planar measurements.

Purpose. To present a new method of measuring ocular axial dimensions, termed OCT biometry (B-OCT). Design. Observational cross-sectional study and evaluation of new diagnostic technology. Methods. B-OCT was implemented in the spectral domain OCT device for posterior and anterior segment imaging (REVO NX, Optopol Technology). A total of 349 eyes (214 of healthy subjects, 115 of patients with cataract, and 20 with severe macular diseases) were enrolled in the study. The results of B-OCT were compared to swept source OCT-based IOLMaster 700 (Carl Zeiss Meditec). Differences in measurement values between the two biometers were determined using the paired t-test. Agreement was assessed through intraclass correlation coefficients (ICCs) and Bland–Altman plots. Results. B-OCT obtained with REVO NX provides excellent interobserver reproducibility (ICC for: axial length (AXL) = 1.000; central corneal thickness (CCT) = 0.933; anterior chamber depth (ACD) = 0.933; lens thickness (LT) = 0.985) and intraobserver repeatability (ICC for: AXL = 1.000; CCT ≥ 0.994; ACD = 0.998; LT ≥ 0.993). The correlation between measurements made using both devices was outstanding (ICC for: AXL, healthy = 1.000; AXL, cataractous = 1.000; ACD, healthy = 0.998; ACD, cataractous = 0.997; LT, healthy = 0.998; LT, cataractous = 0.997; CCT, healthy = 0.989; CCT, cataractous = 0.979). The mean AXL measurement difference in healthy eyes was −0.001 ± 0.016 mm (the 95% LoA ranged from −0.034 to 0.031); mean ACD difference was 0.000 ± 0.024 mm (95% LoA, −0.047 to 0.047); mean LT difference was −0.002 ± 0.024 mm (95% LoA, −0.050 to 0.046); and mean CCT difference was −0.8 ± 5.1 μm (95% LoA, −10.81 to 9.26). The mean AXL measurement difference in cataractous eyes was −0.003 ± 0.022 mm (95% LoA, −0.046 to 0.039); mean ACD difference was 0.003 ± 0.029 mm (95% LoA, −0.054 to 0.059); mean LT difference was −0.002 ± 0.025 (95% LoA, −0.051 to 0.048); and mean CCT difference was 2.7 ± 6.4 μm (95% LoA, −9.80 to 15.7). Conclusion. The study shows small, nonsignificant differences between the biometric measurements obtained with REVO NX B-OCT and IOLMaster 700, which is of high significance for IOL power selection. As B-OCT utilizes a conventional OCT device, the measurements of the ocular axial dimensions are combined with high-resolution macular scans for the simultaneous assessment of central retina as a part of screening for macular pathology. The presented method is the first spectral domain OCT-based biometry technique and the only one integrated into a standard OCT device. Thus, it brings novel functionality to OCT technology.

Aims: The nuclear proliferation marker Ki67 assayed by immunohistochemistry has multiple potential uses in breast cancer, but an unacceptable level of interlaboratory variability has hampered its clinical utility. The International Ki67 in Breast Cancer Working Group has undertaken a systematic programme to determine whether Ki67 measurement can be analytically validated and standardised among laboratories. This study addresses whether acceptable scoring reproducibility can be achieved on excision whole sections. Methods and results: Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 and sections were circulated among 23 pathologists in 12 countries. All pathologists scored Ki67 by two methods: (i) global: four fields of 100 tumour cells each were selected to reflect observed heterogeneity in nuclear staining; (ii) hot-spot: the field with highest apparent Ki67 index was selected and up to 500 cells scored. The intraclass correlation coefficient (ICC) for the global method [confidence interval (CI) = 0.87; 95% CI = 0.799–0.93] marginally met the prespecified success criterion (lower 95% CI ≥ 0.8), while the ICC for the hot-spot method (0.83; 95% CI = 0.74–0.90) did not. Visually, interobserver concordance in location of selected hot-spots varies between cases. The median times for scoring were 9 and 6 min for global and hot-spot methods, respectively. Conclusions: The global scoring method demonstrates adequate reproducibility to warrant next steps towards evaluation for technical and clinical validity in appropriate cohorts of cases. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between laboratories further.

Background Magnetic resonance enterography (MRE) is increasingly attractive as a noninvasive and radiation-free tool for assessing Crohn's disease (CD). Diffusion-weighted imaging (DWI) is recommended as an optional MRE sequence for CD by the European Society of Gastrointestinal and Abdominal Radiology, and has shown a superb potential as a quantitative modality for bowel inflammation evaluation. However, the measurement reproducibility of quantitative DWI analysis in MRE has not been ascertained so far. To facilitate the application of quantitative diffusion-weighted MRE in the clinical routine, systematic investigations of the intra and interobserver reproducibility of DWI quantitative parameters should be performed. Aim To evaluate the intra and interobserver reproducibility of quantitative analysis for diffusion-weighted MRE (DW-MRE) in ileal CD. Methods Forty-four subjects (21 with CD and 23 control subjects) who underwent ileocolonoscopy and DW-MRE (b = 800 s/mm2) within one week were included. Two radiologists independently measured apparent diffusion coefficients (ADC) of the terminal ileum and signal intensity ratio (SR) of the terminal ileum to ipsilateral psoas muscle on DWI images (b = 800 s/mm2). Between- and within-reader agreements were assessed using intraclass correlation coefficients (ICC), coefficients of variation (CoV), and 95% limits of agreement of Bland-Altman plots (BA-LA LoA). Diagnostic performances of ADC and SR for identifying inflamed terminal ileum from the normal were evaluated by receiver operating characteristic (ROC) curve analysis. Results There were no significant differences in ADC or SR values between the two sessions or between the two radiologists either in the CD or control group (paired t-test, P > 0.05). The intra and interobserver reproducibility of ADC (ICC: 0.952-0.984; CoV: 3.73-6.28%; BA-LA LoA: ±11.27% to ±15.88%) and SR (ICC: 0.969-0.989; CoV: 3.51%-4.64%; BA-LA LoA: ±10.62% to ±15.45%) was excellent for CD. Agreement of ADC measurements was slightly less in control subjects (ICC: 0.641-0.736; CoV: 10.47%-11.43%; BA-LA LoA: ± 26.59% to ± 30.83%). SR of normal terminal ileum demonstrated high intra and interobserver reproducibility (ICC: 0.944-0.974; CoV: 3.73%-6.28%; BA-LA LoA: ± 18.58% to ± 24.43%). ADC and SR of two readers had outstanding diagnostic efficiencies (area under the ROC curve: 0.923-0.988). Conclusion Quantitative parameters derived from DW-MRE have good to excellent intra and interobserver agreements with high diagnostic accuracy, and can serve as robust and efficient quantitative biomarkers for CD evaluation.

PURPOSE: In-vivo quantification of tumor uptake of 89-zirconium (89Zr)-labelled monoclonal antibodies (mAbs) with PET provides a potential tool in strategies to optimize tumor targeting and therapeutic efficacy. A specific challenge for 89Zr-immuno-PET is low tumor contrast. This is expected to result in interobserver variation in tumor delineation. Therefore, the aim of this study was to determine interobserver reproducibility of tumor uptake measures by tumor delineation on 89Zr-immuno-PET scans.METHODS: Data were obtained from previously published clinical studies performed with 89Zr-rituximab, 89Zr-cetuximab and 89Zr-trastuzumab. Tumor lesions on 89Zr-immuno-PET were identified as focal uptake exceeding local background by a nuclear medicine physician. Three observers independently manually delineated volumes of interest (VOI). Maximum, peak and mean standardized uptake values (SUVmax, SUVpeak and SUVmean) were used to quantify tumor uptake. Interobserver variability was expressed as the coefficient of variation (CoV). The performance of semi-automatic VOI delineation using 50% of background-corrected ACpeak was described.RESULTS: In total, 103 VOI were delineated (3-6 days post injection (D3-D6)). Tumor uptake (median, interquartile range) was 9.2 (5.2-12.6), 6.9 (4.0-9.6) and 5.5 (3.3-7.8) for SUVmax, SUVpeak and SUVmean. Interobserver variability was 0% (0-12), 0% (0-2) and 7% (5-14), respectively (n = 103). The success rate of the semi-automatic method was 45%. Inclusion of background was the main reason for failure of semi-automatic VOI.CONCLUSIONS: This study shows that interobserver reproducibility of tumor uptake quantification on 89Zr-immuno-PET was excellent for SUVmax and SUVpeak using a standardized manual procedure for tumor segmentation. Semi-automatic delineation was not robust due to limited tumor contrast.

Purpose The purpose of this study was to measure the maximal width, middle width, and length of the cavum septi pellucidi (CSP) in normal fetuses, and compare these measurements obtained in the transthalamic (TT) plane with those obtained in the transventricular (TV) plane. Method A prospective study was conducted of normal singleton fetuses, ranging from 18 to 36 weeks in gestational age. In each case, a three-dimensional volume of the fetal head was obtained in the TT plane for further offline measurements, then the maximal width, middle width, and length of the CSP in both the TT and TV planes were measured. Intraobserver and interobserver reproducibility was assessed, and curve estimation was used to assess the possible relationship between these measurements of CSP and gestational age (GA). Results A total of 267 normal fetuses were studied. The CSP width and length in TT and TV planes as a function of GA were analyzed using a quadratic regression model. Intraobserver and interobserver agreement of the CSP measurements was excellent overall (ICCs >0.9), with intraobserver and interobserver differences of less than 4%. Conclusion Measurements of CSP in the TT and TV planes are equally reproducible.

INTRODUCTION The epinephrine challenge has been proposed to improve the diagnosis of congenital long QT syndrome (LQTS). The aim of the study was to evaluate the diagnostic reliability of the epinephrine provocative test for LQTS diagnosis, taking into consideration intra- and interobserver variability in the interpretation of the test. METHODS AND RESULTS A retrospective analysis of 79 consecutive epinephrine provocative tests was conducted. Epinephrine was administered following a standardized protocol at two doses: 0.05 and 0.10 µg kg-1 min-1 . Electrocardiograms were blindly read twice by three different operators at ≥1-week interval. QT and RR intervals were collected at rest and at each dose, as well as final operator interpretation of the test. There was a high interobserver reproducibility of corrected QT measurements with an intraclass correlation (ICC) of 0.74 (95% confidence interval, 0.66-0.80) but a low interobserver reproducibility on the final interpretation with a κ of 0.31. Intraobserver reproducibility of corrected QT was very good (ICC 0.93; 0.91-0.95), but still resulted in an only moderate intraobserver reproducibility in the final diagnosis (κ of 0.47). Perceived certainty of at least 1 reading by 2 operators (N = 62 tests) increased interobserver reproducibility compared with baseline (κ = 0.43). CONCLUSION Inter- and intraobserver agreement in the interpretation of the epinephrine provocation test for LQTS is poor to modest. Complexity in interpretation varies from one case to the next. The low reliability of this test encourages a reconsideration of its importance in the clinical management of patients with suspected LQTS.

Our goal was to assess visual and quantitative aspects of multimodal skeletal SPECT/CT reconstructions (recon) in differentiating necrotic and healthy bone of patients with suspected MRONJ.Prior to surgery, 20 patients with suspected MRONJ underwent SPECT/CT of the jaw 3-4 hours after injection of Tc-99m-DPD (622±112.4 MBq). SPECT/CT data were reconstructed using the multimodal xSPECT Bone and xSPECT Quant algorithms as well as the OSEM-algorithm FLASH 3D. For analysis, we divided the jaw into 12 separate regions. Both xSPECT Bone and FLASH 3D datasets were scored on a four-point scale (VIS xSPECT; VIS F3D), based on the intensity of localized tracer uptake. In F3D and xSPECT Quant datasets, local tracer uptake of each region was recorded as semi-quantitative uptake ratio (SQR F3D) or SUVs, respectively. ROC analysis was performed. Postoperative histologic results served as gold standard.VIS F3D, VIS xSPECT and SQR F3D did not differ significantly in diagnostic accuracy (VIS xSPECT sensitivity=0.64; specificity=0.89). Of the quantitative parameters, SUVpeak yielded the best interobserver reproducibility. SUVpeak was 9.9±7.1 (95%CI: 7.84-11.95) in MRONJ regions, as opposed 3.6±1.8 (95% CI:3.36-3.88) elsewhere, with a cutpoint of 4.5 (sensitivity=0.83; specificity=0.80). Absolute quantitation significantly surpassed VIS and SQR (p0.05) in accuracy and interobserver agreement (SUVpeak: κ=0.92; VIS xSPECT: κ=0.61; SQR F3D κ=0.66).Absolute quantitation proved significantly more accurate than visual and semi-quantitative assessment in diagnosing MRONJ, with higher interobserver agreement.ZIEL: Ziel unserer Studie war es, dass Potenzial der quantitativen Auswertung von multimodalen SPECT/CT-Rekonstruktionen (Recon) zum Nachweis von Kiefernekrosen bei Patienten mit vermuteter MRONJ zu untersuchen.Präoperativ wurden 20 Patienten mit vermuteter MRONJ 3–4h nach Injektion von im Mittel 622±112,4MBq Tc-99m-DPD mittels SPECT/CT untersucht. Die Daten wurden sowohl mittels xSPECT Bone und xSPECT Quant als auch mittels des konventionellen OSEM-Algorithmus Flash3D (F3D) rekonstruiert. Zur Auswertung wurde der Kieferknochen in 12 Regionen unterteilt. Die xSPECT Bone und F3D Recon wurden hinsichtlich der Höhe des Uptakes mithilfe einer visuellen 4-Punkte-Skala (VIS xSPECT; VIS F3D) ausgewertet. Zusätzlich erfolgte eine VOI-basierte Bestimmung von semiquantitativen Ratios anhand der F3D Recon (SQR F3D) bzw. von SUVs anhand der xSPECT Quant Recon in den gleichen Regionen. Eine ROC-Analyse wurde durchgeführt. Das histologische Ergebnis diente als Goldstandard.VIS F3D, VIS xSPECT und SQR F3D zeigten keine signifikanten Unterschiede bei der Genauigkeit und Inter-Observer-Reliabilität (VIS F3D Sensitivität=0,62; Spezifität=0,88). Der SUVDie absolute Quantifizierung zeigt, bei höherer Inter-Observer-Reliabilität, im Vergleich zur visuellen und semiquantitativen Evaluation eine überlegene Genauigkeit beim Nachweis einer MRONJ.

Distinguishing between low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) can be difficult on certain Papanicolaou (Pap) tests, hindering interobserver concordance. We investigated the variables influencing the interpretation of LSIL versus HSIL in Pap test slides rejected from the College of American Pathologists PAP education program.Eleven cytologists, who were unaware of the reference interpretation, examined 21 Pap slides (11 submitted as LSIL and 10 as HSIL) rejected from the PAP education program and recorded the number of LSIL cells, HSIL cells, keratinized dysplastic cells, LSIL clusters with mixed HSIL cells, atypical squamous metaplasia, atypical glandular cells, the presence of inflammation or infectious organisms, and the overall interpretation (LSIL or HSIL). We evaluated the significance of these 11 variables using a nonlinear mixed model analysis.LSIL had greater concordance (92 of 121 responses; 76.0% concordance) than HSIL (68 of 110 responses; 61.8% concordance; P0.001). The only predictors of misclassified cases were the number of atypical squamous metaplastic cells and the number of HSIL cells (P0.001). The more of these cells identified, the more likely the reviewers were to classify the slide as HSIL. The reproducibility of the diagnosis was fair (Gwet's agreement coefficient, 0.33).Interobserver reproducibility is a challenge for a subset of cases with features intermediate between LSIL and HSIL. Atypical squamous metaplasia and dysplastic nuclei with a nuclear/cytoplasmic ratio greater than one half of the cell volume (HSIL) present on a Pap test influenced the likelihood that a reviewer would interpret the case as HSIL rather than LSIL.

Purpose. To evaluate the intraobserver repeatability and interobserver reproducibility of Strip Meniscometry Tube (SMTube) and determine the correlations among the SMTube measurements and other ocular examinations in dry eye disease (DED) patients. Methods. The study recruited 73 eyes of 49 DED patients. Every subject was subjected to the following five measurements sequentially: the Ocular Surface Disease Index (OSDI) questionnaire, Tear Meniscus Height (TMH) assessment, SMTube measurements, tear film breakup time (BUT) examination, and Schirmer I test (SIT). The repeatability and reproducibility of the measurements were assessed by the intraclass correlation coefficient (ICC) and the Bland–Altman analysis, and the correlations were evaluated by the Spearman rank-order correlation. Results. The repeatability and reproducibility of the SMTube measurements were good in DED patients. The ICCs between the repeatability and reproducibility of the SMTube measurements were 0.789 and 0.741, respectively, and the Bland–Altman 95% limits of the repeatability and the reproducibility were −1.726 to 1.658 and −0.967 to 1.474, respectively (all P < 0.01 ). The SMTube measurements had correlations with TMH, BUT, and SIT. The Spearman rank correlation coefficients between SMTube and TMH; SMTube and Schirmer I test; and SMTube and BUT were 0.632, 0.617, and 0.653, respectively (all P < 0.01 ). Conclusions. The measurements of the SMTube may provide a novel, swift, noninvasive, and convenient approach to screen and diagnose DED with acceptable repeatability and reproducibility and specific correlations with TMH, BUT, and SIT.

Simple Summary Strain elastography is an ultrasound-based technique that assesses the mechanical properties of tissues and gives a relative representation of elasticity. Early diagnosis of tendon injuries and long-term monitoring of the healing process are key to equine practice; thus, an accurate method is needed for analyzing and interpreting the images obtained with strain elastography. The first aim of the study was to demonstrate the intraoperator repeatability and interoperator reproducibility of manual measurements of elastograms obtained from injured superficial digital flexor tendons of horses; the second aim was to perform a standardization of the manual measurement method by comparing it with external software. Despite their subjectivity, manual measurements proved to be repeatable and reproducible. In addition, the results obtained with the manual method matched those obtained with the external software. Abstract Early diagnosis of tendon injuries and accurate long-term monitoring of the healing process are key for equine veterinarians that use conventional ultrasonography. The development of strain elastography could improve the management of clinical cases. The aim of the study was to assess the intraobserver repeatability and interobserver reproducibility of manual measurements of the colored areas of the tendons within elastograms and to standardize this manual modality by comparing the analysis of the images with ImageJ. Twenty elastograms of the injured superficial digital flexor tendons (SDFTs) of horses were analyzed by two different operators after an acute injury was diagnosed with ultrasonography. Statistical analysis demonstrated excellent intraobserver repeatability (intraclass correlation coefficient, ICC = 0.949) and good interobserver reproducibility (ICC = 0.855) for manual measurements performed with tools available on the ultrasound unit. A good agreement between manual measurements and measurements performed with ImageJ (ICC = 0.849) was then demonstrated. Despite its subjectivity, the manual modality proved to be a valid method for analyzing images obtained with strain elastography.

Introduction Accurate results on the status of programmed cell death-ligand 1 (PD-L1) rely on not only the quality of immunohistochemistry testing but also the accuracy of the pathologic assessments. We explored the intraobserver and interobserver reproducibility of the interpretations for the companion diagnostics, the Dako PD-L1 22C3 pharmDx kit (Dako North America, Inc, Carpinteria, CA) and the VENTANA PD-L1 (SP263, Ventana Medical Systems, Inc, Tucson, AZ) assay, and the consistency between microscopic and digital interpretations of PD-L1. Methods A total of 150 surgical specimens diagnosed as NSCLC from December 2013 to July 2017 were included in this study. Twenty pathologists from different medical centers were enrolled to interpret the results of PD-L1 on the same day. A total of 100 sections were stained with the 22C3 clone and scored for the interobserver reproducibility, 20 cases of which were interpreted twice to assess the intraobserver reproducibility, and 50 cases of which were scanned into digital images to measure the consistency between microscopic and digital interpretations. A total of 44 sections were stained with the SP263 clone and scored for the interobserver reproducibility. Results For the intraobserver reproducibility of 22C3, the overall percent agreements were 92.0% and 89.0% for binary tumor evaluation at the cutoffs of 1% and 50%, respectively. The reliability among the pathologists revealed a substantial agreement for 22C3, whereas it revealed a substantial agreement at the cutoff of 1% and moderate agreement at the cutoffs of 25% and 50% for SP263. Microscopic and digital interpretations of PD-L1 revealed good consistency. Conclusions Intraobserver and interobserver reproducibility of the interpretations for PD-L1 was high using the 22C3 clone but lower for the SP263 clone. Corresponding training on such assessments, especially on the cases around the specific cutoffs, is essential for markedly improving such reproducibility. Digital imaging could improve the reproducibility of interpretation for PD-L1 among pathologists.

Background The management of abdominal aortic aneurysm (AAA) is fully dictated by AAA size, but there are no uniform measurement guidelines, and systematic differences exist between ultrasound- and CT-based size estimation. The aim of this study was to devise a uniform ultrasound acquisition and measurement protocol, and to test whether harmonization of ultrasound and CT readings is feasible. Methods A literature review was undertaken to evaluate evidence for ultrasound-based measurement of AAA. A protocol for measuring AAA was then developed, and intraobserver and interobserver reproducibility was tested. Finally, agreement between ultrasound readings and CT-based AAA diameters was evaluated. This was an observational study of patients with a small AAA who participated in two pharmaceutical intervention trials. Results Based on a literature review, an ultrasound acquisition and reading protocol was devised. Evaluation of the protocol showed an intraobserver repeatability of 1.6 mm (2s.d.) and an interobserver intraclass correlation coefficient (ICC) of 0.97. Comparison of protocolled ultrasound readings and local CT readings indicated a good correlation (r = 0.81), but a systematic +4.1-mm difference for CT. Harmonized size readings for ultrasound imaging and CT increased the correlation (r = 0.91) and reduced the systematic difference to +1.8 mm by CT. Interobserver reproducibility of protocolized CT measurements showed an ICC of 0.94 for the inner-to-inner method and 0.96 for the outer-to-outer method. Conclusion The absence of harmonized size acquisition and reading guidelines results in overtreatment and undertreatment of patients with AAA. This can be avoided by the implementation of standardized ultrasound acquisition and a harmonized reading protocol for ultrasound- and CT-based readings., Absence of harmonized size acquisition and reading guidelines result in overtreatment and undertreatment of patients with an abdominal aortic aneurysm. This can be avoided by the implementation of standardized ultrasound acquisition and the proposed harmonized reading protocol for ultrasound- and CT-based readings. Reducing measurement errors

Background: Active surveillance is recommended as an alternative to immediate surgery for low-risk papillary thyroid microcarcinoma (PTMC), and determining meaningful changes in diameter and volume...

Left atrium (LA) volume is a biomarker of cardiovascular outcomes. Three-dimensional echocardiography (3DE) provides an accurate LA evaluation, but data regarding the optimal 3DE method is scarce. We assessed the feasibility and reproducibility of LA measurements using different 3DE methods. One hundred and ninety-four patients were prospectively analyzed. Conventional 3DE and two semi-automatic 3DE algorithms (Tomtec™ and Dynamic Heart Model (DHM)) were used in 110 patients. Intra- and interobserver reproducibility and intervendor comparison were performed in additional patients’ subsets. Forty patients underwent cardiac magnetic resonance (CMR). Feasibility was 100% for Tomtec, 98.2% for DHM, and 72.8% for conventional 3DE. Tomtec volumes were higher than 3DE and DHM (p < 0.001). Reproducibility was better for DHM (intraobserver LA maximum volume (LAmax) ICC 0.99 (95% CI 1.0–0.99), LA minimum volume (LAmin) 0.98 (95% CI 0.95–0.99), LApreA 0.96 (95% CI 0.91–0.98); interobserver LAmax ICC 0.98 (95% CI 0.96–0.99), LAmin 0.99 (95% CI 0.99–1.00), and LApreA 0.97 (95% CI 0.94–0.99)). Intervendor comparison showed differences between left ventricle (LV) software adapted for LA (p < 0.001). Tomtec underestimated the least LA volumes compared to CMR. These findings emphasize that dedicated software should be used for LA assessment, for consistent clinical longitudinal follow-up and research.

Purpose To evaluate the intrasession repeatability for non-invasive break-up time (NIBUT) and tear meniscus height (TMH) measurements provided by a new multi-diagnostic platform, and to assess the interobserver reproducibility of TMH measures. Methods Twenty-one healthy eyes of 21 patients (age, 23–65 years) were enrolled. A complete eye examination was performed in all cases with the VX120+ device (Visionix-Luneau Technologies), including an analysis with the new Dry Eye module, performing three consecutive measurements. The within-subject standard deviation (Sw) and Bland–Altman plots were used to assess intersession repeatability. Differences between examiners for TMH were also analysed. Results No statistically significant differences were found between repeated measures of NIBUT (time associated with the first break) and TMH (p > 0.05). However, significant differences were found for NIBUT50% (time associated with half of breaks of the tear film) (p

Purpose To assess the repeatability and reproducibility of swept-source optical coherence tomography (SS-OCT) and Scheimpflug system and evaluate the agreement between the two systems in measuring multiple corneal regions in children. Methods Pachymetric and keratometric maps for both systems were evaluated. Central, midperipheral and peripheral corneal thickness (CT), keratometry and astigmatism power vectors were recorded. The three outcomes yielded by the same observer were used to assess intraobserver repeatability. The differences in the mean values provided by each observer were used to evaluate interobserver reproducibility. Within-subject standard deviation, test-retest repeatability (TRT) and coefficient of variation (CoV) were used to analyze the intraobserver repeatability and interobserver reproducibility. Paired T-test and Bland-Altman were used to appraise interdevice agreement. Results Seventy-eight eyes of 78 children were included. The CoV was ≤2.12 and 1.10%, respectively, for repeatability and reproducibility. TRT and CoV were lower for central and paracentral CT measurements than for peripheral measurements. The SS-OCT device generated higher precision when acquiring CT data, whereas Scheimpflug system showed higher reliability when measuring corneal keratometry. Although the CT readings measured using SS-OCT were significantly thinner than Scheimpflug device (P Conclusions The precision of CT measurements by SS-OCT was higher, while the reliability of keratometry measurements by the Scheimpflug system was higher in children. Apart from the measured values in the central corneal region, the thickness and keratometry readings should not be considered interchangeable between the two systems.

Objective: To evaluate the feasibility of quantifying visceral adipose tissue (VAT) on computed tomography (CT) and magnetic resonance imaging (MRI) scans, using freeware, as well as calculating intraobserver and interobserver reproducibility. Materials and Methods: We quantified VAT in patients who underwent abdominal CT and MRI at our institution between 2010 and 2015, with a maximum of three months between the two examinations. A slice acquired at the level of the umbilicus was selected. Segmentation was performed with the region growing algorithm of the freeware employed. Intraobserver and interobserver reproducibility were evaluated, as was the accuracy of MRI in relation to that of CT. Results: Thirty-one patients (14 males and 17 females; mean age of 57 ± 15 years) underwent CT and MRI (mean interval between the examinations, 28 ± 12 days). The interobserver reproducibility was 82% for CT (bias = 1.52 cm2; p = 0.488), 86% for T1-weighted MRI (bias = −4.36 cm2; p = 0.006), and 88% for T2-weighted MRI (bias = −0.52 cm2; p = 0.735). The intraobserver reproducibility was 90% for CT (bias = 0.14 cm2; p = 0.912), 92% for T1-weighted MRI (bias = −3,4 cm2; p = 0.035), and 90% for T2-weighted MRI (bias = −0.30 cm2; p = 0.887). The reproducibility between T1-weighted MRI and T2-weighted MRI was 87% (bias = −0.11 cm2; p = 0.957). In comparison with the accuracy of CT, that of T1-weighted and T2-weighted MRI was 89% and 91%, respectively. Conclusion: The program employed can be used in order to quantify VAT on CT, T1-weighted MRI, and T2-weighted MRI scans. Overall, the accuracy of MRI (in comparison with that of CT) appears to be high, as do intraobserver and interobserver reproducibility. However, the quantification of VAT seems to be less reproducible in T1-weighted sequences. Resumo Objetivo: Avaliar a viabilidade da quantificação do tecido adiposo visceral (TAV) pela tomografia computadorizada (TC) e ressonância magnética (RM) usando um software freeware, e também calcular a reprodutibilidade intraobservador e interobservador. Materiais e Métodos: Foi quantificado o TAV em pacientes submetidos a TC e RM de abdome em nossa instituição, entre 2010 e 2015, com um intervalo máximo de três meses entre os dois exames. Selecionou-se um corte adquirido ao nível da cicatriz umbilical. A segmentação foi realizada com o algoritmo de crescimento de região do freeware utilizado. As reprodutibilidades intraobservador e interobservador foram avaliadas, assim como a acurácia da RM em relação à TC. Resultados: Trinta e um pacientes (14 homens e 17 mulheres; média de idade: 57 ± 15 anos) realizaram TC e RM (intervalo médio entre os exames: 28 ± 12 dias). A reprodutibilidade interobservador foi 82% para TC (viés = 1,52 cm2; p = 0,488), 86% para RM ponderada em T1 (viés = −4,36 cm2; p = 0,006) e 88% para RM ponderada em T2 (viés = −0,52 cm2; p = 0,735). A reprodutibilidade intraobservador foi 90% para TC (viés = 0,14 cm2; p = 0,912), 92% para RM ponderada em T1 (viés = −3,4 cm2; p = 0,035) e 90% para RM ponderada em T2 (viés = −0,30 cm2, p = 0,887). A reprodutibilidade entre a RM ponderada em T1 e a RM ponderada em T2 foi 87% (viés = −0,11 cm2; p = 0,957). Em comparação com a TC, a acurácia da RM ponderada em T1 e T2 foi 89% e 91%, respectivamente. Conclusão: O programa utilizado pode ser usado para quantificar o TAV na TC, na RM ponderada em T1 e na RM ponderada em T2. No geral, a acurácia da RM (em comparação com a TC) parece ser alta, assim como a reprodutibilidade intraobservador e interobservador. No entanto, a quantificação do TAV parece ser menos reprodutível nas sequências ponderadas em T1.

PURPOSE Chest radiography is one of the most frequent x-ray examinations performed on children. Reducing the delivered dose is always a major task. The objective of our study was to determine the minimum dose to be delivered while maintaining the image quality of chest radiographs, using dose reduction simulation software. MATERIALS AND METHODS We included 60 children who had had a chest radiography in 5 groups established according to the diagnostic reference levels equitably represented by weight ranges. The software simulated for each radiograph 6 additional simulated photonic noise images corresponding to 100%, 80%, 64%, 50%, 40%, and 32% of the initial dose. The 360 radiographs were blindly scored by 2 radiologists, according to the 7 European quality criteria and a subjective criterion of interpretability, using a semiquantitative visual Lickert scale. RESULTS There was no significant difference in scoring between the reference radiograph (100%) and simulated radiographs at 80% of the dose in children between 5 and 20 kg, 50% of the dose in children between 20 and 30 kg, and between simulated radiographs at 40% of the dose in children over 30 kg. Interobserver reproducibility was moderate to excellent. CONCLUSION Chest radiography dose might be reduced by 20% in children between 5 and 20 kg, 50% in children between 20 and 30 kg, and 60% in children over 30 kg, without any difference in the image quality appreciation. Software that produced simulated x-ray with decreasing delivered dose is an innovating tool for an optimization process.

OBJECTIVES Doppler Color Scoring (DCS) has been used to predict successful expectant management of incomplete miscarriage. The aim of this study was to assess inter- and intraobserver reproducibility of the DCS system in women with incomplete miscarriage noted on transvaginal sonography. METHODS This was a prospective reproducibility study involving offline analysis of 32 prerecorded video sets on transvaginal sonography in real time of women with incomplete miscarriage. Vascularization of retained products of conception was recorded using the DCS system adopted from the International Ovarian Tumor Analysis group. Five gynecologic sonologists of varying experience assigned a DCS classification to each video in the analysis. The same videos were reanalyzed, in a different order, at least 7 days later, to assess intraobserver agreement. Inter- and intraobserver correlations were performed to determine agreement. Interobserver agreement was also measured between each observer and the reference standard (G.C.). A Cohen's κ coefficient value less than 0 suggests poor agreement, 0.01 to 0.20 slight, 0.21 to 0.40 fair, 0.41 to 0.60 moderate, 0.61 to 0.80 substantial, and 0.81 and 0.99 almost perfect. RESULTS Interobserver agreement for all observers for DCS allocation ranged from 0.480 to 0.751. Overall interobserver agreement for 5 observers was substantial (κ, 0.626). Overall interobserver agreements for the 2 inexperienced and 3 experienced observers compared to G.C. were 0.521 and 0.618, respectively. Experienced observers achieved overall almost perfect intraobserver agreement, compared to substantial agreement for inexperienced sonologists. CONCLUSIONS DCS interobserver reproducibility between all observers and GC ranged from moderate to substantial. DCS intraobserver reproducibility was substantial to almost perfect. The DCS system appears to be a reproducible tool in evaluating women with incomplete miscarriage.

The current World Health Organization (WHO) classification for endocervical adenocarcinoma (EA) is based on descriptive morphologic characteristics; however, it does not fully reflect our current knowledge of the diverse pathogenesis of cervical glandular neoplasia. A novel classification system, the International Endocervical Adenocarcinoma Criteria and Classification (IECC), which incorporates etiology and biological behavior into the morphologic scheme, has been recently proposed. We aimed to validate the IECC by assessing its interobserver reproducibility in comparison to the WHO system. A cohort of 75 EAs was reviewed independently by 7 gynecologic pathologists and categorized following IECC and WHO criteria based on hematoxylin and eosin material alone and after immunohistochemistry results for p16, PR, p53, Napsin-A, vimentin, CDX2, and GATA3 were provided. Human papillomavirus (HPV) in situ hybridization and polymerase chain reaction results were compared with consensus diagnoses. IECC was superior to WHO in terms of interobserver agreement with κ=0.46 versus 0.3, respectively, on hematoxylin and eosin review and κ=0.51 versus 0.33, respectively, with immunohistochemistry. Under the IECC, 73 (97%) of EAs had majority agreement (≥4 reviewers in agreement) whereas 42 (56%) had perfect agreement (7/7 reviewers in agreement). Conversely, WHO showed majority agreement in 56 (75%) and perfect agreement in only 7 (10%) EAs. Reproducibility was poor in HPV-related WHO types (usual κ=0.36, mucinous not otherwise specified κ=0.13, intestinal κ=0.31, villoglandular κ=0.21) and good in major HPV-unrelated categories (gastric type κ=0.63, clear cell κ=0.81, mesonephric κ=0.5). Classification as per the IECC had excellent correlation with HPV status (by RNA in situ hybridization or polymerase chain reaction). We have shown that the IECC has superior interobserver agreement compared with the WHO classification system, and that distinction between HPV-related and HPV-unrelated EA can be made with good reproducibility and excellent prediction of HPV status. WHO morphologic variants of HPV-related EA are poorly reproducible. Conversely, agreement is high among important high-risk HPV-unrelated subtypes. Thus, our results further support replacing the current WHO classification with the IECC.

Objective Because of the indolent nature of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and potential requisite for a more conservative treatment, it is crucial to identify features of this entity preoperatively. Our group recently published findings that there are several cytomorphological features that may be used as clues to distinguish NIFTP, papillary thyroid carcinoma (PTC) and follicular adenoma (FA) on fine needle aspiration. Therefore, we aimed to determine the interobserver reproducibility of these findings. Methods Presurgical fine-needle aspiration slides from NIFTP (n = 30), classic PTC (n = 30) and FA (n = 30) collected from 1/2013-8/2016 were reviewed by seven cytopathologists blindly. Presence of selected cytomorphological features was recorded and compared to determine percent agreement and inter-rater reliability among study cytopathologists using Gwet's AC1 statistics. Results For all the cytomorphological features, the overall percent agreement amongst the pathologists ranged between 65.1% and 86.8% (Gwet's AC1 0.30-0.80). There was substantial or almost perfect agreement (Gwet's AC1 > 0.60) in seven cytomorphological features in the classic PTC group, in six features in the NIFTP group and in five features in the FA group. There were no features with poor agreement (Gwet's AC1 Conclusions The current study supports the reproducibility of our previous findings. The high level of agreement amongst pathologists for these groups, and particularly the NIFTP group, supports the notion that when viewed in combination as a cytological profile, these cytomorphological features may assist the cytopathologist in raising the possibility of NIFTP preoperatively. This can potentially aid clinicians in deciding whether more conservative treatment may be appropriate.

BACKGROUND To demonstrate whether the distance between the middle point of the patellar tendon and posterior cruciate ligament (PT-PCL) calculated on a single axial MR image could be an alternative measure to tibial tubercle-PCL (TT-PCL) distance for TT lateralization without the need of imaging processing. To show that normalization of PT-PCL (nPT-PCL) against the maximum diameter of the tibial plateau may help to identify patients with patellar instability (PI). METHODS MR scans of 30 patients (13 females, age 32 ± 13 years) with known PI and 60 patients (31 females, age 39 ± 19 years) with no history of PI were reviewed. Two operators calculated TT-PCL, and PT-PCL nPT-PCL. Intraclass correlation coefficient, Student's t-test, Receiver Operator Characteristic curves, Spearman's Rho and McNemar's test were used. RESULTS Interobserver reproducibility was 0.894 for PT-PCL for TT-PCL (95% CI = 0.839-0.930) and 0.866 for TT-PCL (95% CI = 0.796-0.912). The PT-PCL was 23.5 ± 3.8 mm in patients and 20.0 ± 2.7 mm in controls (P

Left atrial (LA) strain is an emerging technique with potential applications including arrhythmia prediction in atrial fibrillation and early identification of atrial dysfunction. The aim of this study was to evaluate reproducibility of LA strain and strain rate (SR) using multi-vendor analysis software between novice and expert. For LA strain to be a reliable tool, the technique must be reproducible by observers with variable experience. Use of multi-vendor analysis software allows serial strain assessment when echocardiographic images are acquired using different vendors. Fifty subjects underwent 2D-Speckle tracking echocardiographic (STE) derived LA strain and SR analysis measured from apical four and two-chamber views. Three strain parameters of LA function were assessed: reservoir (S-LAs, SR-LAs), contractile (S-LAa, SR-LAa) and conduit (S-LAs–S-LAa, SR-LAe). Strain analyses were performed by 2 independent, blinded novice and expert observers using multi-vendor analysis software. Intraobserver and interobserver analyses were performed using intra class correlation coefficients (ICC) and Bland–Altman analysis. LA strain and SR measured by novice observer demonstrated excellent intraobserver reproducibility (ICC for all strain and SR values > 0.88). There was good interobserver agreement of LA strain values between novice and expert (S-LAs:ICC 0.81, S-LAe:ICC 0.82, S-LAa:ICC 0.74). SR values also demonstrated good interobserver agreement (SR-LAs:ICC 0.83, SR-LAe:ICC 0.79, SR-LAa:ICC 0.86). Of all parameters, SR-LAa had the best interobserver and intraobserver agreement (ICC 0.86, 0.96). Global LA strain and SR values were highly reproducible by novice strain reader using multi-vendor analysis software. Interobserver reproducibility between novice and experts were good and acceptable within limits of agreement.

Purpose To follow the evolution of intracranial hemorrhage (ICH) by using quantitative susceptibility mapping (QSM). Materials and Methods Thirty-six patients with ICH confirmed at CT were enrolled to follow ICH evolution on day 2, 7, and 30 after symptom onset between August 2013 and April 2017. QSM was reconstructed from MRI gradient-echo phase images acquired at 1.5 T or 3.0 T. ICH regions were manually drawn on two-dimensional sections of co-registered CT and MR images independently by two raters. The ICH areas and mean values were compared between CT and MRI by using Bland-Altman plots and Pearson correlation. QSM time evolution of ICH was assessed by using paired t tests and was compared with conventional T2-weighted fluid-attenuated inversion recovery, or T1-weighted or T2*-weighted magnitude intensities. Results Significant reductions in ICH susceptibility were found between day 2 and day 7 (P < .001) and between day 7 and day 30 (P = .003), corresponding to different disease stages. The ICH areas measured at CT and QSM were linearly correlated (r2 = 0.98). The mean CT attenuation and mean susceptibility of ICH were linearly correlated (r2 = 0.29). Excellent intra- and interobserver reproducibility were found for QSM (intraclass correlation coefficient, 0.987 and 0.966, respectively). Conclusion Longitudinal evolution of intracranial hemorrhage (ICH) by using quantitative susceptibility mapping (QSM) demonstrated susceptibility differences in different disease stages, which was not found at conventional MRI; therefore, QSM may assist in quantitatively following ICH iron content.

Nida Wongchaisuwat,1,2 Ankana Metheetrairat,1 Pratuangsri Chonpimai,1 Waree Nujoi,1 Pinnita Prabhasawat1 1Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Ophthalmology, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand Purpose: To compare the central corneal thickness (CCT) measurements in subjects with corneal edema using ultrasound pachymetry, Visante anterior-segment optical coherence tomography (OCT), Cirrus OCT, and Pentacam Scheimpflug camera tomography.Methods: This prospective cross-sectional study included 46 eyes of 33 patients with corneal edema and a CCT exceeding 550 μm evaluated by ultrasound pachymetry, Visante OCT, Cirrus OCT, and Pentacam. Two observers measured each eye twice. Intraobserver and interobserver reproducibility were determined and agreement among the devices calculated.Results: CCT was measured in 40 eyes of 29 patients. Regardless of the CCT, the measurements obtained using Visante OCT, Cirrus CCT, and ultrasound pachymetry were well correlated. Interobserver and intraobserver reproducibility were high among the three devices. Pentacam overestimated the results compared with the other devices, and ultrasound pachymetry was unmeasurable in six (13%) eyes with very thick and opaque corneas. In eyes with mild corneal edema (CCT 551–650 μm), measurements from the four devices were comparable.Conclusion: All devices reliably measured the CCT