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Sager DF, Manz N, Manser S, Laubscher L, Stark AW, Schütze J, Heiniger PS, Markendorf S, Kaufmann PA, Gräni C, Buechel RR. Reproducibility of Left Ventricular Function Derived From Cardiac Magnetic Resonance and Gated 13N-Ammonia Positron Emission Tomography Myocardial Perfusion Imaging: A Head-to-Head Comparison Using Hybrid Positron Emission Tomography/Magnetic Resonance. Acad Radiol 2024; 31:1248-1255. [PMID: 37940426 DOI: 10.1016/j.acra.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
RATIONALE AND OBJECTIVES Cardiac magnetic resonance (CMR) and gated 13N-ammonia positron emission tomography myocardial perfusion imaging (PET-MPI) offer accurate and highly comparable global left ventricular ejection fraction (LVEF) measurements. In addition to accuracy, however, reproducibility is crucial to avoid variations in LVEF assessment potentially negatively impacting treatment decisions. We performed a head-to-head comparison of the reproducibility of LVEF measurements derived from simultaneously acquired CMR and PET-MPI using different state-of-the-art commercially available software. MATERIALS AND METHODS 93 patients undergoing hybrid PET/MR were retrospectively included. LVEF was derived from CMR and PET-MPI at two separate core labs, using two state-of-the-art software packages for CMR (cvi42 and Medis Suite MR) and PET (QPET and CardIQ Physio). Intra- and inter-reader agreement was assessed using correlation and Bland-Altman (BA) analyses. RESULTS While intra- and inter-reader reproducibility of LVEF was high among both modalities and all software packages (r ≥ 0.87 and ICC≥0.91, all significant at p < 0.0001), LVEF derived from PET-MPI and analyzed with QPET outperformed all other analyses (intra-reader reproducibility: r = 0.99, ICC=0.99; inter-reader reproducibility: r = 0.98, ICC=1.00; Pearson correlations significantly higher than all others at p ≤ 0.0001). BA analyses showed smaller biases for LVEF derived from PET-MPI (-0.1% and +0.9% for intra-reader, -0.4% and -0.8% for inter-reader agreement) than those derived from CMR (+0.7% and +2.8% for intra-reader, -0.9% and -2.2% for inter-reader agreement) with similar results for BA limits of agreement. CONCLUSION Gated 13N-ammonia PET-MPI provides equivalent reproducibility of LVEF compared to CMR. It may offer a valid alternative to CMR for patients requiring LV functional assessment.
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Affiliation(s)
- Dominik F Sager
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Nico Manz
- Faculty of Medicine, University of Bern, Murtenstrasse 11, CH-3008 Bern, Switzerland (N.M., S.M.)
| | - Sarah Manser
- Faculty of Medicine, University of Bern, Murtenstrasse 11, CH-3008 Bern, Switzerland (N.M., S.M.)
| | - Lily Laubscher
- Department of Health Science and Technology, ETH Zurich, Ramistrasse 101, CH-8092 Zurich, Switzerland (L.L.)
| | - Anselm W Stark
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Jonathan Schütze
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Pascal S Heiniger
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Susanne Markendorf
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Christoph Gräni
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.).
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Molière S, Hamzaoui D, Granger B, Montagne S, Allera A, Ezziane M, Luzurier A, Quint R, Kalai M, Ayache N, Delingette H, Renard-Penna R. Reference standard for the evaluation of automatic segmentation algorithms: Quantification of inter observer variability of manual delineation of prostate contour on MRI. Diagn Interv Imaging 2024; 105:65-73. [PMID: 37822196 DOI: 10.1016/j.diii.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between inter-reader variability in manual prostate contour segmentation on magnetic resonance imaging (MRI) examinations and determine the optimal number of readers required to establish a reliable reference standard. MATERIALS AND METHODS Seven radiologists with various experiences independently performed manual segmentation of the prostate contour (whole-gland [WG] and transition zone [TZ]) on 40 prostate MRI examinations obtained in 40 patients. Inter-reader variability in prostate contour delineations was estimated using standard metrics (Dice similarity coefficient [DSC], Hausdorff distance and volume-based metrics). The impact of the number of readers (from two to seven) on segmentation variability was assessed using pairwise metrics (consistency) and metrics with respect to a reference segmentation (conformity), obtained either with majority voting or simultaneous truth and performance level estimation (STAPLE) algorithm. RESULTS The average segmentation DSC for two readers in pairwise comparison was 0.919 for WG and 0.876 for TZ. Variability decreased with the number of readers: the interquartile ranges of the DSC were 0.076 (WG) / 0.021 (TZ) for configurations with two readers, 0.005 (WG) / 0.012 (TZ) for configurations with three readers, and 0.002 (WG) / 0.0037 (TZ) for configurations with six readers. The interquartile range decreased slightly faster between two and three readers than between three and six readers. When using consensus methods, variability often reached its minimum with three readers (with STAPLE, DSC = 0.96 [range: 0.945-0.971] for WG and DSC = 0.94 [range: 0.912-0.957] for TZ, and interquartile range was minimal for configurations with three readers. CONCLUSION The number of readers affects the inter-reader variability, in terms of inter-reader consistency and conformity to a reference. Variability is minimal for three readers, or three readers represent a tipping point in the variability evolution, with both pairwise-based metrics or metrics with respect to a reference. Accordingly, three readers may represent an optimal number to determine references for artificial intelligence applications.
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Affiliation(s)
- Sébastien Molière
- Department of Radiology, Hôpitaux Universitaire de Strasbourg, Hôpital de Hautepierre, 67200, Strasbourg, France; Breast and Thyroid Imaging Unit, Institut de Cancérologie Strasbourg Europe, 67200, Strasbourg, France; IGBMC, Institut de Génétique et de Biologie Moléculaire et Cellulaire, 67400, Illkirch, France.
| | - Dimitri Hamzaoui
- Inria, Epione Team, Sophia Antipolis, Université Côte d'Azur, 06902, Nice, France
| | - Benjamin Granger
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, 75013, Paris, France
| | - Sarah Montagne
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020, Paris, France; Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France; GRC N° 5, Oncotype-Uro, Sorbonne Université, 75020, Paris, France
| | - Alexandre Allera
- Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France
| | - Malek Ezziane
- Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France
| | - Anna Luzurier
- Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France
| | - Raphaelle Quint
- Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France
| | - Mehdi Kalai
- Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France
| | - Nicholas Ayache
- Department of Radiology, Hôpitaux Universitaire de Strasbourg, Hôpital de Hautepierre, 67200, Strasbourg, France
| | - Hervé Delingette
- Department of Radiology, Hôpitaux Universitaire de Strasbourg, Hôpital de Hautepierre, 67200, Strasbourg, France
| | - Raphaële Renard-Penna
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020, Paris, France; Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France; GRC N° 5, Oncotype-Uro, Sorbonne Université, 75020, Paris, France
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Rouvière O. Evaluation of automated prostate segmentation: The complex issue of the optimal number of expert segmentations. Diagn Interv Imaging 2024; 105:45-46. [PMID: 37863708 DOI: 10.1016/j.diii.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Olivier Rouvière
- Hospices Civils de Lyon, Department of Radiology, Hôpital Edouard Herriot, Lyon 69437, France; Université de Lyon, Lyon, France; Université Lyon 1, Lyon, France; Faculté de Médecine Lyon Est, Lyon 69003, France; LabTau, INSERM U1032, Lyon 69003, France.
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Könik A, Miskin N, Guo Y, Shinagare AB, Qin L. Robustness and performance of radiomic features in diagnosing cystic renal masses. Abdom Radiol (NY) 2021; 46:5260-5267. [PMID: 34379150 DOI: 10.1007/s00261-021-03241-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/22/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE We study the inter-reader variability in manual delineation of cystic renal masses (CRMs) presented in computerized tomography (CT) images and its effect on the classification performance of a machine learning algorithm in distinguishing benign from potentially malignant CRMs. In addition, we assessed whether the inclusion of higher-order robust radiomic features improves the classification performance over the use of first-order features. METHODS 230 CRMs were independently delineated by two radiologists. Through a combination of random fluctuations, dilation, and erosion operations over the original region of interests (ROIs), we generated four additional sets of synthetic ROIs to capture the inter-reader variability realistically, as confirmed by dice coefficient measurements and visual assessment. We then identified the robust features based on the intra-class coefficient (ICC > 0.85) across these datasets. We applied a tenfold stratified cross-validation (CV) to train and test the performance of the random forest model for the classification of CRMs into benign and potentially malignant. RESULTS The mean area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value were 0.87, 0.82, 0.90, 0.85, and 0.93, respectively. With the usage of first-order features alone, the corresponding values were nearly identical. CONCLUSION AUC ranged for the robust and uncorrelated features from 0.83 ± 0.09 to 0.93 ± 0.04 and for the first-order features from 0.84 ± 0.09 to 0.91 ± 0.04. Our study indicates that the first-order features alone are sufficient for the classification of CRMs, and that inclusion of higher-order features does not necessarily improve performance.
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Affiliation(s)
- Arda Könik
- Imaging Department, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Nityanand Miskin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yang Guo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lei Qin
- Imaging Department, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Ekpo EU, Hogg P, Wasike E, McEntee MF. A self-directed learning intervention for radiographers rating mammographic breast density. Radiography (Lond) 2017; 23:337-342. [PMID: 28965898 DOI: 10.1016/j.radi.2017.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/18/2017] [Accepted: 05/27/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Subjective methods of mammographic breast density (MBD) assessment are prone to inter-reader variability. This work aims to assess the impact of a short self-directed, experiential learning intervention on radiographers' reproducibility of MBD assessment. METHOD The study used two sets of images (test and learning intervention) containing left craniocaudal and left mediolateral oblique views. The test set had MBD ratings from Volpara™ and radiologists using the fourth edition Breast Imaging and Data Systems (BI-RADS®). Seven radiographers rated the MBD of the test set before and after a self-directed learning intervention using the percentage descriptors in the fourth edition BI-RADS® Atlas. The inter-reader agreement, the agreement between radiographers and Volpara™ as well as radiologists, was assessed using a Weighted Kappa (кw). RESULTS Overall, radiographers' inter-reader agreement (кw) was substantial (0.79; 95% CI: 0.70-0.87) before the intervention and almost perfect (0.84; 95% CI: 0.77-0.90) after the intervention. Before the intervention, radiographers demonstrated fair agreement with radiologists (0.24; 95% CI: -0.46-0.61) and Volpara™ (0.24; 95% CI: -0.41-0.59). A fair but slightly improved agreement was also observed between radiographers and radiologists (0.31; 95% CI: -0.33-0.64) as well as Volpara™ (0.28; 95% CI: -0.34-0.61) after the intervention. CONCLUSION Findings demonstrate that a short duration self-directed, experiential learning intervention reduces inter-reader differences in MBD classification, but has a negligible impact on improving the agreement between inexperienced and expert readers.
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Affiliation(s)
- E U Ekpo
- Faculty of Health Sciences, The University of Sydney, Discipline of Medical Radiation Sciences, Cumberland Campus, 75 East Street, Lidcombe, NSW 2141, Australia; Faculty of Health Sciences, University of Calabar, Department of Radiography and Radiological Sciences, PMB 1115 Calabar, Nigeria.
| | - P Hogg
- Directorate of Radiography, Center for Health Science Research, University of Salford, UK; Center for Health Science Research, Karolinska Institute, Stockholm, Sweden
| | - E Wasike
- Faculty of Health Sciences, The University of Sydney, Discipline of Medical Radiation Sciences, Cumberland Campus, 75 East Street, Lidcombe, NSW 2141, Australia
| | - M F McEntee
- Faculty of Health Sciences, The University of Sydney, Discipline of Medical Radiation Sciences, Cumberland Campus, 75 East Street, Lidcombe, NSW 2141, Australia
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