胃癌肝转移病灶的人工智能辅助半自动分割软件的临床应用评估

目的:评估人工智能辅助胃癌肝转移病灶自动分割软件对胃癌肝转移病灶的分割功能相对于手动分割,能否减少观察者内及观察者间的差异。方法:由2名医生盲法应用西门子医疗开发的基于深度学习网络的肝脏肿瘤分析软件(Liver Lesion Analysis Tool),分别使用全手动模式以及人工智能辅助的半自动模式,对32例患者共81个胃癌肝转移灶的CT图像进行分割,并对最长径及三维体积进行纯手动和全自动重复测量。应用Bland-Altman法分别评估最长径测量及体积测量在2种分割模式下的观察者内及观察者间差异,用组内相关系数(intraclass correlation coefficient, ICC)评估2种模式下最长径测量与体积测量的观察者内及观察者间测量变异度差异。结果:手动、半自动模式最长径测量的观察者内95%一致性区间分别为-31.70%～34.55%,-28.04%～27.89%,手动、半自动模式最长径测量的观察者间95%一致性区间分别为-74.26%～38.85%,-59.54%～40.98%。手动、半自动模式体积测量的观察者内95%一致性区间分别为-148.10%～102.70%,-75.92%～63.79%,手动、半自动模式体积测量的观察者间95%一致性区间分别为-127.40%～111.50%,-87.66%～43.77%。观察者内手动模式最长径测量与体积测量变异度的ICC分别为0.914、0.950,观察者内半自动模式最长径测量与体积测量变异度的ICC分别为0.967、0.970。观察者间手动模式最长径测量与体积测量变异度的ICC分别为0.884、0.939,观察者间半自动模式最长径测量与体积测量变异度的ICC分别为0.928、0.974。相对于手动分割病灶,使用人工智能辅助的肝转移自动分割软件进行半自动病灶分割所需要的时间大大缩短[(25.78±4.23) s比(4.53±2.82) s, P0.01]。结论:使用人工智能辅助的肝转移自动分割软件进行半自动病灶分割在观察者内及观察者间的一致性好,可提高肝转移病灶分割的效率,有望成为临床随访及疗效评估的定量工具。     

VOCAL软件两种取样方法测量附件包块血管参数的诊断结果比较

目的 评价VOCAL软件分析附件包块的三维能量血管成像时,手动勾画轮廓法和球自动取样法对诊断结果的影响.方法 分别运用以上两种取样方法,测量41个附件包块内的血管参数,根据术后病理画出各参数预测恶性肿瘤的ROC曲线.结果 22个良性包块,19个恶性包块.两种取样方法所测得各参数的ROC曲线下面积差异无统计学意义,其预测恶性肿瘤的界值不同.结论两种取样方法不影响三维能量血管成像的诊断结果.     

多普勒、M型及四维时空关联成像检测胎儿左心室每搏输出量的对比观察

目的 比较多普勒、M型与四维时空关联成像(STIC)测量胎儿左心每搏输出量的重复性及测量者间的一致性。方法 2名超声科医师采用双盲法分别应用多普勒、M型与四维STIC测定30胎26~30周正常单胎胎儿左心室输出量,计算组内相关系数(ICC),进行Bland-Altman图分析,评估上述测量方法的重复性和测量者间一致性。结果 ①同一测量者用3种方法测定胎儿左心室输出量的差异无统计学意义(P均>0.05);②2名观察者间3种方法测量重复性比较,其ICC值STIC法最高(多普勒法ICC:0.93,95%可信区间:0.86~0.95;M型法ICC:0.89,95%可信区间:0.82~0.91;STIC法ICC:0.95,95%可信区间:0.88~0.97);③应用Bland-Altman分析2名观察者测量的一致性,STIC法的系统偏倚及一致界限较多普勒法和M型法好(多普勒法平均差值:-0.04 ml,95%可信区间-0.22~0.14 ml;M型法平均差值:-0.06 ml,95%可信区间-0.20~0.08 ml;STIC法平均差值:-0.01 ml,95%可信区间-0.11~0.09 ml)。结论 3种方法均可用于测量胎儿左心室输出量,以STIC法测量的可重复性和一致性最高,是一种较好的选择。     

比较阈值调节测量法与常规测量法对评价大脑中动脉狭窄的价值

目的 探讨阈值调节测量法和常规测量法对容积CT数字减影血管造影(VCTDSA)大脑中动脉狭窄程度评价的准确性。方法 用常规测量法和阈值调节测量法对80例大脑中动脉狭窄患者进行分析,评估观察者内及观察者间重复性及一致性,用两种方法测量狭窄处及正常血管管径大小,计算各狭窄处的狭窄率,判定狭窄程度。结果 观察者内及观察者间两种方法对狭窄部位判定有良好一致性(K=0.99、0.99),观察者内阈值调节测量和常规测量狭窄程度一致性强(K=0.92、0.89),观察者间阈值调节测量和常规测量狭窄程度一致性强(K=0.98、0.87)。阈值调节测量比常规测量多检出轻中度血管狭窄共9处,分别是M1段轻度狭窄2处,M1段中度狭窄1处,M2段轻度狭窄5处,M2段中度狭窄1处;阈值调节测量优于常规测量( _阈> _常),两种测量法对血管狭窄程度的判断差异具有统计学意义(P<0.01)。结论 CT血管造影(CTA)测量在观察者内及观察者间具有良好的一致性,阈值调节测量法可减少轻中度狭窄漏诊率,较常规测量更准确反映血管狭窄,为临床介入治疗提供可靠的血管狭窄影像依据。     

基于灰度双阈值自动测量MRI所示膝骨关节炎积液体积北大核心CSCD

目的基于灰度双阈值开发自动测量MRI中膝关节腔积液体积的方法,并验证其可重复性。方法基于Matlab平台对151例膝骨关节炎(KOA)患者的MRI(测试集)进行滤波、双阈值分割等操作,自动提取ROI后计算积液面积,经内插处理后得到积液体积;同时以人工勾画方法测量积液体积并进行等级评价。采用组内相关系数(ICC)评价观察者间测量积液体积及等级评价结果的一致性;分别以Pearson相关性分析和Spearman相关性分析评价自动、手动测量测试集与外部验证集(n=50)积液等级的相关性。结果自动测量测试集平均耗时(4.38±0.98)s,手动测量平均耗时(12.54±5.37)min。观察者间测量积液体积结果的一致性很好(ICC:0.93~0.99,P<0.05)。测试集和验证集中,自动测量与手动测量评价积液等级结果均呈高度正相关(r=0.78、0.87,P均<0.01)。结论基于灰度双阈值自动测量MRI所示膝关节积液方法与手动测量结果的一致性较好,且用时短、人工干预少,可重复性高。     

解剖M型超声心动图测量肺动脉主干运动曲线及其影响因素分析

目的 应用解剖M型超声心动图观察肺动脉主干运动曲线的特点,并探讨其影响因素.方法 收集肺动脉压正常的160例患者,应用解剖M型超声心动图观察肺动脉主干运动曲线,测定肺动脉干前侧壁搏动幅度(PAWPA),并随机抽取20例采用组内相关系数检验对PAWPA测量值进行两位观察者间盲法一致性分析以及同一观察者不同时间的一致性分析.采用多元逐步回归模型,分析年龄、性别、心率、血压、动脉粥样硬化、右心房内径、肺动脉瓣关闭不全等因素对PAWPA的影响. 结果 PAWPA测定值在观察者间与观察者内一致性均好,组内相关系数值分别为0.91(95%CI:0.37～0.99)与0.95(95%CI:0.60～0.99).PAWPA与年龄(β=-0.47,P<0.001)、心率(β=-0.29,P<0.005)呈负相关, 与性别、血压、动脉粥样硬化、右心房内径、肺动脉瓣关闭不全等因素无显著相关. 结论 解剖M型超声心动图可用于观测PAWPA,该指标一致性好、重复性高.在肺动脉压正常的情况下,年龄与心率是其重要影响因素.     

自动测量方法测定Tei指数在评估法洛四联症胎儿左室功能中的应用研究

目的探讨自动测量和手动法获取法洛四联症(TOF)胎儿的左心室Tei指数(TI)在评估TOF胎儿左室功能中的应用价值。方法收集经胎儿超声心动图诊断为TOF的胎儿21例(病例组)和正常胎儿39例(对照组),采用左心室Tei指数(LVTI)自动测量法和分步手动测量方法,分析比较两种方法获得的LV-TI的差异性及两组胎儿LV-TI的变化趋势。结果运用TI自动测量方法获得的病例组LV-TI高于对照组(0.577±0.038vs 0.452±0.046),两组比较差异有统计学意义(t=10.59,P=0.00);两种测量方法获得的对照组及病例组胎儿LV-TI测量结果,差异无统计学意义(P=0.78、0.54)。结论 TI是较为理想评价TOF胎儿心功能的敏感指标,自动法较传统手动法测量更简单、快捷,具有更好可靠性和重复性,易于在实际及科研工作中推广应用。     

多排螺旋CT血管造影对颈动脉狭窄诊断价值的Meta分析

目的 对以数字减影血管造影(DSA)为金标准,研究多排螺旋CT血管造影(MSCTA)诊断颈动脉狭窄的文献进行Meta汇总分析,评价MSCTA对颈动脉狭窄的临床诊断价值.方法 检索Cochrane图书馆、PubMed、OVID循证医学数据库、中国期刊网中的英文和中文文献,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献,并对纳入文献进行质量评估,提取纳入研究的特征信息.数据分析采用Meta-DiSc1.4软件,检验异质性,并根据异质性结果选择相应的效应模型.对所有研究进行加权定量合并,按临床狭窄程度分组计算灵敏度、特异度及其95%可信区间.绘制汇总受试者工作特征曲线(SROC),并计算曲线下面积.结果 共纳入7篇文献,均存在异质性.按照随机效应模型计算MSCTA诊断颈动脉狭窄率O~49%组的汇总灵敏度、汇总特异度及95%可信区间分别为0.87(0.82~O.91)、0.97(O.94~0.99);50%～69%组的汇总灵敏度、汇总特异度及95%可信区间分别为0.77(0.67~0.86)、0.95(O.92~0.97);70%~99%组的汇总灵敏度、汇总特异度及95%可信区间分别为0.92(0.86～O.96)、0.93(0.89~0.95).MSCTA诊断颈动脉狭窄率0～49%组、50%~69%组、70%~99%组的SROC曲线下面积分别为:98.36%、90.01%、98.47%.结论 汇总目前关于MSCTA诊断颈动脉狭窄的研究显示,MSCTA是一种灵敏度和特异度较高的无创性检查方法,值得临床推广.     

速度编码电影MR评价心室每搏输出量的可重复性研究

目的探讨速度编码电影MR成像技术在评价心室每搏输出量测量中的应用价值.方法应用速度编码电影MR(VECMR)对9例健康成年志愿者进行心脏检查.重复测量左、右心室每搏输出量(SV)以比较其观察者间、观察者内测量的重复性,并与形态体积法电影MR测得的结果进行比较.结果①VECMR测量左、右心室每搏输出量观察者间及观察者内重复性高,相关性好.②该方法与形态体积法MR所测正常成人左、右心室SV相关性良好,相关系数分别为0.98和0.96,两种方法测得的SV均值比较,差异无显著性意义(P＞0.05).结论速度编码电影MR测量心室每搏输出量准确,重复性高,检查简便、省时,是一种临床实用价值很高的心功能测量技术.     

心室射血分数自动测量法评价心肌梗死患者左室整体收缩功能的可行性研究

目的探讨心室射血分数自动测量(Auto EF)法评价心肌梗死患者左室整体收缩功能的可行性和重复性。方法选取我院心肌梗死患者(心肌梗死组)和健康体检者(健康对照组)各35例,应用Auto EF法测量左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)及射血分数(LVEF);并与传统双平面Simpson’s法比较,分析其相关性;随机选取20例心肌梗死患者行Auto EF重复性研究。结果 70例研究对象中,68例(97%)完成Auto EF测量,其中43例(63%)为完全自动,25例(37%)需手动校正;Auto EF测量时间为(59.28±13.13)s,少于Simpson’s法[(96.67±8.26)s],差异有统计学意义(P<0.01);68例总体Auto EF与双平面Simpson’s法测量LVEDV、LVESV、LVEF均有高度相关性(r分别为0.947、0.971、0.974,P<0.01);心肌梗死组和健康对照组中,两法所测LVEDV、LVESV和LVEF差异均无统计学意义,且有良好相关性,但心肌梗死组相关系数均较健康对照组偏低;在观察者自身和观察者间,Auto EF法测定心肌梗死患者LVEF均有良好的一致性。结论 Auto EF法能够简便、及时和快速测量左室容积和LVEF,且经验依赖性较小。     

Comparison of Reproducibility of Manual and Sphere Contour Methods for the Measurement of Vascularization in Cervical Carcinoma Using the Virtual Organ Computer‐Aided Analysis II System

Objective. The purpose of this study was to investigate the reproducibility of virtual organ computer‐aided analysis II software (GE Healthcare, Milwaukee, WI), an integrated tool for 3‐dimensional power Doppler angiography (3D‐PDA), in measuring vascularization of cervical carcinoma under manual and automatic sphere contour modes. Methods. Eighty patients with cervical carcinoma were prospectively examined by observer 1 using transvaginal 3D‐PDA. For each patient, measurements of the vascularization index, flow index, and vascularization‐flow index were repeated twice under both manual and automatic sphere contour modes. Forty patients were randomly selected for another round of examination by observer 2 under the same setting. The reproducibility of vascularization measurements was assessed by the intraclass correlation coefficient (intra‐CC), interclass correlation coefficient (inter‐CC), and 95% limits of agreement (LOAs). Various analysis of variance models were used to estimate the contribution of each factor (observer, contour mode, and patient) to measurement variance. Results. For each observer, the manual contour mode outperformed the automatic sphere contour mode in reproducibility (intra‐CC, 0.96 to 0.99 versus 0.77 to 0.94). In addition, repeated measurements of the manual mode had a smaller SD and a narrower LOA. For the manual contour mode, interobserver agreement was comparable with intraobserver agreement (inter‐CC, 0.91 to 0.98, versus intra‐CC, 0.96 to 0.99). However, the interobserver agreement was significantly smaller than the intraobserver agreement for the automatic sphere contour mode (inter‐CC, 0.51 to 0.85, versus intra‐CC, 0.77 to 0.94; P = .001). Conclusions. The manual contour mode for 3D‐PDA vascular measurements has better interobserver and intraobserver reproducibility than the automatic sphere contour mode. It is especially useful for measuring tumor tissues with irregular shapes and vascularity.     

Intraobserver and interobserver variability of ovarian volume, gray-scale and color flow indices obtained using transvaginal three-dimensional power Doppler ultrasonography.

OBJECTIVE: To assess intraobserver and interobserver variability in ovarian volume and gray-scale and color flow index measurements using transvaginal, three-dimensional, power Doppler ultrasonography. METHODS: Eleven women (22 ovaries) were examined on day 8 of controlled ovarian hyperstimulation therapy, which was part of their in vitro fertilization treatment protocol. The patients were examined twice by the first observer and once by the second observer. The acquired volume datasets were analyzed using the VOCAL imaging program, enabling the assessment of ovarian volume, vascularization index (VI), flow index (FI), vascularization flow index (VFI) and mean grayness (MG). For these parameters the intraclass (intra-CC) and interclass (inter-CC) correlation coefficients, within-observer and between-observers repeatability coefficient (r) and limits of agreement were calculated. RESULTS: Both intraobserver and interobserver repeatability of ovarian volume measurements were considered very good with an intra-CC value of 1.00 and inter-CC value of 0.99, respectively. Also VI, FI, VFI and MG measurements were repeatable by a single observer, the intra-CC ranging from 0.82 to 0.91. The interobserver reproducibility was also good for VI, VFI and MG measurements (inter-CC values 0.73, 0.70 and 0.81, respectively), but for FI measurements the reproducibility was poor (inter-CC = 0.29, r = 7.87). CONCLUSIONS: In general, the intraobserver reproducibility was better than interobserver reproducibility for all parameters. The volume assessments were reproducible both by one observer and by two separate observers. The intraobserver and interobserver variabilities were acceptable for VI, VFI and MG, whereas for FI the interobserver reproducibility was poor. Our results suggest that measurement of gray-scale and color Doppler flow indices is reproducible thus allowing them to be used in clinical practice and research.     

The reliability of virtual organ computer-aided analysis (VOCAL) for the semiquantification of ovarian, endometrial and subendometrial perfusion.

OBJECTIVES: Three-dimensional power Doppler angiography (3D-PDA) has been largely used for the subjective assessment of vascular patterns but semiquantification of the power Doppler signal is now possible. We examined the intraobserver and interobserver reliability of the semiquantification of ovarian, endometrial and subendometrial blood flow using 3D-PDA, virtual organ computer-aided analysis (VOCAL) and shell-imaging. METHODS: 3D-PDA was used to acquire 20 ovarian and 20 endometrial volumes from 40 different patients at various stages of in vitro fertilization treatment. VOCAL was then used to delineate the 3D areas of interest and the 'histogram facility' employed to generate three indices of vascularity: the vascular index, the flow index and the vascularization flow index. Intraobserver and interobserver reliability was assessed by two-way, mixed, intraclass correlation coefficients (ICCs) and general linear modeling was used to examine for differences in the mean values between each observer. RESULTS: The intraobserver reliability for both observers was extremely high and there were no differences in reliability between the observers for measurements of both volume and vascularity within the ovary or endometrium and its shells. With the exception of the outside subendometrial shell volumes, there were no significant differences between the two observers in the mean values obtained for either endometrial or ovarian volume and vascularity measurements. The interobserver reliability of measurements was equally high throughout with all measurements obtaining a mean ICC of above 0.985. CONCLUSIONS: 3D-PDA and shell-imaging offer a reliable, practical and non-invasive method for the assessment of ovarian, endometrial and subendometrial blood flow. Future work should concentrate upon confirming the reliability of data acquisition and the validity of the technique before its predictive value can be truly tested in prospective clinical studies.     

Intraobserver and interobserver reproducibility of three-dimensional gray-scale and power Doppler ultrasound examinations of the cervix in pregnant women.

OBJECTIVES: To determine intraobserver and interobserver reproducibility of three-dimensional (3D) gray-scale and power Doppler ultrasound examinations of the cervix in pregnant women. METHODS: Thirty-two pregnant women underwent transvaginal 3D gray-scale and power Doppler ultrasound examination of the cervix by two examiners. Each observer acquired two volumes, and they each analyzed their volumes twice using the commercially available software Virtual Organ Computer-aided AnaLysis (VOCAL). The variables analyzed were cervical volume (cm3), vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Intraobserver repeatability was expressed as the difference between two measurement results (mean difference +/- 2 SD, i.e. limits of agreement) and as intraclass correlation coefficient (intra-CC). Interobserver agreement was expressed as the difference between the results of the two observers (limits of agreement) and as interclass correlation coefficient (inter-CC). The contribution of various factors (examiner, acquisition, analysis of acquired volume) to intrasubject variance was estimated using different analysis of variance models. All statistical analyses were performed using log-transformed data. The results presented are those obtained after antilogarithmic transformation, i.e. the results are presented as ratios between two results of the same observer, or as ratios between the results of Observer 1 and Observer 2. RESULTS: All intraobserver and interobserver log-transformed differences were normally distributed. There was no systematic bias between the two observers. Both intra- and inter-CC values were high (0.93-0.98) for all variables except FI (0.63-0.88), despite the limits of agreement being wide, especially for VI (widest range 0.4-2.4) and VFI (widest range 0.3-2.6). Acquisition explained most of the intrasubject variance of the flow indices, the contribution of examiner and analysis being unimportant. CONCLUSIONS: Given the wide range between the lower and upper limits of agreement, it would probably not be possible to detect anything but large differences or changes in cervical volume or cervical flow indices using current 3D ultrasound techniques. Because acquisition explained most of the intrasubject variance, the average of several repeated acquisitions should be used to enhance reproducibility. However, it is not worth doing more than one analysis of an acquired volume, because the effect of analysis on measurement results is small.     

Reproducibility of three-dimensional ultrasound endometrial volume measurements in patients with postmenopausal bleeding.

OBJECTIVE: To evaluate the reproducibility of transvaginal three-dimensional (3D) endometrial volume measurement in patients with postmenopausal bleeding and to compare the reproducibility of this technique to that of two-dimensional (2D) endometrial thickness measurement. METHODS: In a prospective, blinded study, transvaginal ultrasound examinations were performed in 51 consecutive patients with postmenopausal bleeding. Three-dimensional volume and 2D thickness measurements were made and intraobserver and interobserver reproducibility of each technique were assessed. RESULTS: The intraobserver correlation of 3D endometrial volume measurement of the first observer was 0.97 and that of the second observer was 0.99. Thus, mean intraobserver correlation was 0.98. The mean interobserver correlation was 0.95 (0.95 vs. 0.96). There was no significant difference in reproducibility at different volume cut-offs. The mean intra- and interobserver correlation of endometrium volume measurements for five patients with endometrial carcinoma did not differ significantly from that for patients without carcinoma (0.98, 0.98 vs. 0.98, 0.95). The intraobserver correlation of 2D endometrial thickness measurements from the first observer was 0.71 and that from second observer 0.87. Thus, mean intraobserver correlation of the endometrial thickness measurements was 0.79. The mean interobserver correlation was 0.76 (0.84 vs. 0.70). CONCLUSIONS: Endometrial volume and thickness measurements by 3D and 2D ultrasound, respectively, show good reproducibility but the reproducibility of 3D ultrasound is better.     

Intraobserver and interobserver reproducibility of ovarian volume, antral follicle count, and vascularity indices obtained with transvaginal 3-dimensional ultrasonography, power Doppler angiography, and the virtual organ computer-aided analysis imaging program.

OBJECTIVES: The purpose of this study was to assess intraobserver and interobserver reproducibility of the parameters of ovarian response and oocyte ability, studied by 3-dimensional ultrasonography and power Doppler angiography (PDA), and the possible influence of the ovarian functional stage. METHODS: Twenty-nine women were included in an in vitro fertilization program. Fourteen women were evaluated after pituitary suppression (basal group), and 15 were scanned on the human chorionic gonadotropin administration day, after gonadotropin ovarian stimulation (stimulated group). A first observer acquired 2 volumes for each ovary. Another observer performed a second analysis of the volumes acquired by the first observer. We analyzed ovarian volume, follicle number in the basal group, vascularization index, flow index, and vascularization-flow index. The volumes were processed by the Virtual Organ Computer-Aided Analysis imaging program using plane A and 15 degrees rotational steps. RESULTS: Ovarian volume showed excellent intraobserver and interobserver agreement, with an intraclass correlation coefficient (Intra-CC) and an interclass correlation coefficient (Inter-CC) close to the unit. The Intra-CC and Inter-CC about the number of follicles were 0.964 and 0.978, respectively. Vascularity indices showed an Intra-CC greater than 0.90. The vascularization index and the vascularization-flow index showed higher interobserver than intraobserver reproducibility (Inter-CC > 0.96 for both). The flow index Inter-CC was 0.898. The reproducibility differences between the basal and stimulated ovary measurements were not significant. CONCLUSIONS: There is an excellent intraobserver and interobserver reproducibility of the ovarian volume, follicle counts, and 3-dimensional PDA indices. The ovarian functional stage has no influence on the reliability. Three-dimensional ultrasonography and PDA improve the study of ovarian parameters, and their reliability impels a change in the current clinical routine of performing and interpreting ultrasonography.     

The use of inversion mode and 3D manual segmentation in volume measurement of fetal fluid-filled structures: comparison with Virtual Organ Computer-aided AnaLysis (VOCAL)

OBJECTIVE: Volume measurements by three-dimensional (3D) ultrasonography are considered more accurate than those performed by two-dimensional (2D) ultrasonography. The purpose of this study was to compare the agreement of three techniques, as well as the inter- and intraobserver agreements for volume measurements of fetal fluid-filled structures. METHODS: Fifty 3D volume datasets of fetal stomachs and bladders were explored. Volume measurements were performed independently by two observers using: (1) Virtual Organ Computer-aided AnaLysis (VOCAL); (2) inversion mode; and (3) 'manual segmentation'. Reliability was evaluated using intraclass correlation coefficient (ICC), and Bland-Altman plots were generated to examine bias and agreement. The time required to complete the measurements was compared using Student's t-test or the Wilcoxon Signed Rank Test, and P-values < 0.025 or < 0.05 were considered statistically significant. RESULTS: All volume datasets could be measured using the three techniques. A high degree of reliability was observed between: (1) VOCAL and inversion mode (ICC, 0.995; 95% CI, 0.992-0.997); (2) VOCAL and manual segmentation (ICC, 0.997; 95% CI, 0.995-0.998); and (3) inversion mode and manual segmentation (ICC, 0.995; 95% CI, 0.992-0.997). There was good agreement between VOCAL and inversion mode (mean, - 2.4%; 95% limits of agreement, - 20.1 to 15.3%), VOCAL and manual segmentation (mean, - 8.3%; 95% limits of agreement, - 28.8 to 12.2%) as well as between inversion mode and manual segmentation (mean, 5.9%, 95% limits of agreement: - 14.3 to 26%). Manual segmentation and inversion mode measurements were obtained significantly faster than those by VOCAL. CONCLUSIONS: Volume measurements of fetal fluid-filled structures of relatively regular shape with inversion mode and manual segmentation are feasible. Both techniques have good agreement with VOCAL and are significantly faster than VOCAL. Inversion mode is a reliable method for volume calculations of fluid-filled organs, whereas manual segmentation can be used when volume measurements by VOCAL or inversion mode are technically difficult to obtain, such as solid structures with poorly defined borders as the volume dataset is rotated, like the uterine cervix.     

Reproducibility of two different methods for performing mean gray value evaluation of cyst content in endometriomas using VOCAL

Objective

To compare two different methods (manual sampling of the entire cyst and semi-automated spherical sampling from the central part of the cyst) for calculating the mean gray value (MGV) from the cystic content in endometriomas using virtual organ computer-aided analysis (VOCAL).

Methods

Forty-one volumes from histologically confirmed endometriomas were retrieved from our database and the volumes were analyzed to compare the MGVs obtained via the two modalities. In addition, to evaluate the reproducibility in a sample of 20 volumes, two different observers calculated the MGV from cyst content using VOCAL software. For each method, each examiner analyzed the volumes twice, 3 weeks apart, for assessment of intra-observer agreement. First, manual sampling of the internal contour of all the cysts was performed, and 1 week later semi-automated 2-cm sphere sampling from the central part of the cyst was carried out. In addition, the observers recorded the time spent performing each analysis. Inter- and intra-observer reproducibility was evaluated for each method using intra-class correlation coefficients (ICC).

Results

There was no difference in the mean MGV between manual sampling (22.211 ± 7.541) and the semi-automated modality of sampling (23.840 ± 8.621, p = 0.439). The correlation between manual and semi-automated sampling measurement was high (r = 0.92). According to the ICCs, there was no significant difference in interobserver reliability between manual sampling (0.931; 95 % CI, 0.824–0.973) and the semi-automated modality of sampling (0.924; 95 % CI, 0.809–0.970). Intra-observer reproducibility for both examiners was good (ICC > 0.94). Semi-automated measurements were obtained faster than those obtained by manual evaluation (p = 0.0001 for observer 1 and p = 0.083 for observer 2).

Conclusions

Both methods seem to be reliable, but the semi-automated method using the sphere should be preferred because it is a less time-consuming procedure.     

Reproducibility of transvaginal three-dimensional endometrial volume measurements with virtual organ computer-aided analysis (VOCAL) during ovarian stimulation.

OBJECTIVE: To calculate inter- and intraobserver reliabilities for three-dimensional endometrial volume measurements during in vitro fertilization using virtual organ computer-aided analysis (VOCAL). PATIENTS AND METHODS: Three-dimensional ultrasound measurements of the endometrium using VOCAL software were performed on the day of oocyte retrieval in each of 79 consecutive patients undergoing in vitro fertilization or intracytoplasmic sperm injection. Endometrial volume was calculated every 15 degrees and every 30 degrees by two different observers in order to determine the reproducibility of the technique. RESULTS: Intraobserver reliability for the 15 degrees measurements was 0.97 for both observers; for the 30 degrees measurements, it was 0.93 for one observer and 0.96 for the other. Interobserver reliability was 0.80 for the endometrial volumes calculated every 15 degrees and 0.83 for the volumes calculated every 30 degrees. The intra- and interobserver measurement agreement showed good reproducibility. However, the volumes calculated every 15 degrees were more accurate because the means of differences were close to zero. CONCLUSION: VOCAL provides a reproducible method for the estimation of the endometrial volume.     

Endometrial volume and vascularity measurements by transvaginal 3-dimensional ultrasonography and power Doppler angiography in stimulated and tumoral endometria: an interobserver reproducibility study.

OBJECTIVE: The purpose of this study was to evaluate interobserver reproducibility of endometrial volume and vascular indices of the endometrium and subendometrial area estimated by 3-dimensional power Doppler angiography (3D-PDA) using the Virtual Organ Computer-Aided Analysis program, determining the influence of the endometrial growth etiology on measurements. METHODS: Forty women underwent 3D-PDA ultrasonography. Group A comprised 25 women scanned on the day after controlled ovarian stimulation with human chorionic gonadotropin. Group B comprised 15 patients who had uterine bleeding and questionable endometrial thickening. (Histologic evaluation revealed 10 endometrial cancers and 5 endometrial hyperplasias.) A single observer examined all patients and acquired all volume data sets. Forty volume data sets were then analyzed with the Virtual Organ Computer-Aided Analysis program by 2 different observers. Endometrial volume and vascularity indices (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]) of the endometrium and subendometrium were manually calculated in the coronal plane with a 9 degrees rotation step. An intraclass correlation coefficient (ICC) was used to assess interobserver reliability. RESULTS: Endometrial volume was more reproducible in group A (ICC = 0.98) than in group B (ICC = 0.58) (P < .05). Endometrial and subendometrial VI, FI, and VFI also presented good reproducibility with ICC greater than 0.84. The ICC was not statistically different for endometrial and subendometrial VI, FI, and VFI according to patient group, although subendometrial VFI was less reproducible in group B (ICC = 0.53) than in group A (ICC = 0.88). CONCLUSIONS: Endometrial volume and endometrial and subendometrial 3D power Doppler indices have acceptable reproducibility. The interobserver reproducibility in tumoral endometrium was more similar than in stimulated endometrium. Our results indicate that 3D-PDA is a reliable method to evaluate physiologic and pathologic endometrial changes.