Interobserver agreement between eight observers using IOTA simple rules and O-RADS lexicon descriptors for adnexal masses.

PURPOSE: To evaluate interobserver agreement in assigning imaging features and classifying adnexal masses using the IOTA simple rules versus O-RADS lexicon and identify causes of discrepancy. METHODS: Pelvic ultrasound (US) examinations in 114 women with 118 adnexal masses were evaluated by eight radiologists blinded to the final diagnosis (4 attendings and 4 fellows) using IOTA simple rules and O-RADS lexicon. Each feature category was analyzed for interobserver agreement using intraclass correlation coefficient (ICC) for ordinal variables and free marginal kappa for nominal variables. The two-tailed significance level (a) was set at 0.05. RESULTS: For IOTA simple rules, interobserver agreement was almost perfect for three malignant lesion categories (M2-4) and substantial for the remaining two (M1, M5) with k-values of 0.80-0.82 and 0.68-0.69, respectively. Interobserver agreement was almost perfect for two benign feature categories (B2, B3), substantial for two (B4, B5) and moderate for one (B1) with k-values of 0.81-0.90, 0.69-0.70 and 0.60, respectively. For O-RADS, interobserver agreement was almost perfect for two out of ten feature categories (ascites and peritoneal nodules) with k-values of 0.89 and 0.97. Interobserver agreement ranged from fair to substantial for the remaining eight feature categories with k-values of 0.39-0.61. Fellows and attendings had ICC values of 0.725 and 0.517, respectively. CONCLUSION: O-RADS had variable interobserver agreement with overall good agreement. IOTA simple rules had more uniform interobserver agreement with overall excellent agreement. Greater reader experience did not improve interobserver agreement with O-RADS.

Brain Diffusion Imaging Findings May Predict Clinical Outcome after Cardiac Arrest.

BACKGROUND AND PURPOSE: We aim to correlate the patterns of brain diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) map in post cardiac arrest (PCA) patients with clinical outcomes. METHODS: Thirty-eight adult patients with PCA (mean age, 52.8 years; range 18-87 years) whose DWI obtained within 5 days of PCA were retrospectively reviewed. The visual DWI/ADC map categories include: Group 1: Normal; Group 2a: Mild [restricted diffusion (RD) < 1/3 cortical involvement (CI)]); Group 2b: Moderate (RD 1/3 > and < 2/3 CI); Group 2c: Severe (RD > 2/3 CI); and Group 3: Embolic (scattered, discrete foci of RD). Clinical outcomes were categorized according to cerebral performance categories (CPC) and modified Rankin scale (mRS). RESULTS: The most common DWI/ADC map pattern was Group 1 (28.9%, n = 11). The incidence of other DWI patterns such as Group 2a, 2b, 2c, and 3 were 21% (n = 8), 10.5% (n = 4), 21% (n = 8), and 18.4% (n = 7), respectively. Twenty-seven patients (71%) were CPC-5/mRS-6 and died or were category CPC-4/mRS-5, and 4 patients were CPC-1/mRS 0-1 (10.5%). Interobserver agreement for visual classification of DWI/ADC map patterns was excellent (kappa = .8795). There was moderate positive correlation between clinical outcomes and visual DWI classification (r = .461, P = .00358). The positive predictive value of this qualitative classification on DWI/ADC in predicting a poor clinical outcome (CPC-4/mRS-5 and CPC-5/mRS-6) was 81.4 % in the presence of restricted diffusion. CONCLUSION: Simple visual categorization system using DWI/ADC map may be helpful and practical in estimating the clinical outcome of PCA patients.

A cohort evaluation of the laryngeal mask airway-Supreme™ in children.

OBJECTIVES: To assess the clinical performance of the laryngeal mask airway-Supreme in children. AIM: The purpose of this prospective audit was to evaluate the feasibility of the laryngeal mask airway-Supreme in clinical practice and generate data for future comparison trials. BACKGROUND: The laryngeal mask airway-Supreme is a new second-generation supraglottic airway that was recently released in limited pediatric sizes (sizes 1, 2). METHODS: One hundred children, ASA I-III, newborn to 16 years of age, and undergoing various procedures requiring a size 1, 2, or 3 laryngeal mask airway-Supreme were studied. Assessments included insertion success rates, airway leak pressures, success of gastric tube insertion, quality of airway, and perioperative complications. RESULTS: The first-time insertion success rate was 97%, with an overall insertion success rate of 100%. The mean initial airway leak pressure for all patients was 22.3 ± 6.6 cm H(2) O. Gastric tube placement was possible in 98% of patients. Complications were noted in six patients: coughing or laryngospasm (n = 3), sore throat (n = 1), and dysphonia (n = 2). CONCLUSIONS: The laryngeal mask airway-Supreme was inserted with a high degree of success on the first attempt by clinicians with limited prior experience with the device. It was effectively used for a variety of procedures in children undergoing spontaneous and mechanical ventilation with minimal complications. The leak pressures demonstrated in this study, along with access for gastric decompression, suggest that the laryngeal mask airway-Supreme may be an effective device for positive pressure ventilation in children.