There were significant differences between raters in the number of pixels they chose to outline using free-hand ROIs. Inter-rater reliability refers to the variability between raters and intra-rater reliability measures the agreement within raters across multiple trials. This study sought to evaluate within and between rater agreements in DTI parameter values of the normal pediatric cervical spinal cord. The goal of this study was to assess inter-rater (between) and intra-rater (within) agreement in pediatric spinal cord DTI, as well as agreement between two methods of drawing regions of interest. While extensive data is available on the reliability and reproducibility of brain DTI, to the best of our knowledge there is lack of research on the reliability of ROI placement to quantify spinal cord DTI measures. To be proven clinically reliable, the quantitative properties of spinal cord DTI need to be assessed by multiple reviewers. Parameters derived from DTI can provide information about tissue properties which may have clinical significance.
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Interestingly, most of these studies reported that the variability seen in DTI parameters could be due to the user-dependent manual selection of ROIs. Additionally, they all reported that ROI locations were confirmed using the conventional structural MR imaging sequences, and that care was taken to avoid inclusion of CSF. While these studies used different data acquisition methods and post-processing software, they all shared one common technique to delineate the spinal cord: Manual drawing of regions of interests (ROIs) to calculate DTI parameters. Several studies have investigated the clinical utility of DTI in assessing spinal cord pathology and have shown correlations between DTI and clinical scores. The application of DTI in the spinal cord is technically limited by the small cross-sectional size of the spinal cord, cerebral spinal fluid pulsation (CSF), the presence of nearby vascular and osseous structures, respiratory and cardiac motion.ĭespite these challenges, studies have successfully reported diffusion measures in the intact human spinal cord. Cronbach’s alpha showed moderate-high values for raters and ROI methods.ĬONCLUSION: The study showed that high reproducibility in spinal cord DTI can be achieved, and demonstrated the importance of setting detailed methodology for post-processing DTI data, specifically the placement of ROIs.ĭiffusion tensor imaging (DTI) has become an important technique for evaluating the central nervous system noninvasively. FA showed highest variability in ICC values (0.10-0.87). However, no significant differences were observed in DTI parameter values. There were significant differences between raters in the number of pixels selected using free-hand ROIs ( P < 0.05). RESULTS: Inter- and intra-rater agreement between the two ROI methods showed moderate (ICC = 0.5) to strong (ICC = 0.84). Agreement analyses for fractional anisotropy (FA), axial diffusivity, radial diffusivity and mean diffusivity were performed using intra-class-correlation (ICC) and Cronbach’s alpha statistical methods. ROIs were placed on axial B 0 maps along the cervical spine using free-hand and fixed-size ROIs. ROIs were drawn by two neuroradiologists on each subject data twice within a 3-mo interval. METHODS: Inner-Field-of-View DTI data previously acquired from ten pediatric healthy subjects (mean age = 12.10 years) was used to assess for reliability. AIM: To assess inter- and intra-rater reliability (agreement) between two region of interest (ROI) methods in pediatric spinal cord diffusion tensor imaging (DTI).
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