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Methodologic Issues on Interrater Reliability Regarding Structural and DTI-Based Corticospinal Tract Asymmetry

Methodologic Issues on Interrater Reliability Regarding Structural and DTI-Based Corticospinal... LETTERS MethodologicIssuesonInterraterReliabilityRegarding StructuralandDTI-BasedCorticospinalTractAsymmetry e read, with interest, the article by Foesleitner et al pub- Limitation of  to assess the reliability of 2 raters’ judgments with different prevalences in the 2 categories Wlished in the June 2018 issue of the American Journal of Rater 1 Total Neuroradiology. The purpose was to investigate a clinically feasible Positive Negative (%) imaging approach to assess corticospinal tract (CST) asymmetry Situation (a) Positive 85 5 90 in unilateral polymicrogyria (PMG), check diffusion-based trac- Rater 2 Negative 5 5 10 tography as a guide to the presumed motor area within the dys- 0.44 Total 90 10 100 plastic cortex, and investigate whether the “rule” of CST asymme- Situation (b) Positive 45 5 50 Rater 2 Negative 5 45 50 try as a good prognostic factor for postsurgical motor function 0.80 Total 50 50 100 preservation specifically applies to cases of unilateral PMG in- volving the central region. The interrater reliability was calculated tractography is a useful alternative to task-based fMRI and helps by the Cohen coefficient. The authors reported that the interrater in the anatomic localization of the primary motor cortex. If one reliability in the assessment of corticospinal tract asymmetry was considered the above-mentioned limitations of the  value to as- most robust at the level of the cerebral crus. Also, excellent con- sess reliability, such a conclusion may be misleading. Therefore, gruence was reached by categorizing the asymmetry degree into 2-4 misinterpretation cannot be avoided. no or minimal asymmetry or moderate/severe asymmetry ( In this letter, we discuss the limitations of the  value to assess 1.0) in the event that the other levels of assessment did not result reliability. Therefore, any conclusion especially in reliability analysis in considerable agreement (  0.21–0.6). should be supported by the above mentioned statistical and method- It is of crucial importance to know that the  value cannot be a ological issues. sign of good agreement. In assessing the agreement of a qualitative variable, the  value has 2 major weaknesses: 1) It depends on the REFERENCES prevalence in each class—that is, there might be different  values 1. Foesleitner O, Nenning KH, Traub-Weidinger T, et al. Assessing cor- of the same percentages for concordant and discordant cells. As ticospinal tract asymmetry in unilateral polymicrogyria. AJNR Am J can be seen in the Table, the prevalence of concordant cells in both Neuroradiol 2018;39:1530–35 CrossRef Medline (a) and (b) situations is 90%, while that of discordant cells is 10%. 2. Szklo M, Nieto FJ. Epidemiology: Beyond the Basics. 2nd ed. Sudbury: However, we can get different values of  (0.44 and 0.80) for Jones and Bartlett Publisher; 2007 3. Naderi M, Jalalvandi F, Fatahi S. Observer reproducibility of breast concordant and discordant cells, respectively. 2) The  value also strain elastography in data acquisition and interpretation: a meth- depends on the number of classes. It is preferable to use a odological issue. Eur J Radiol 2018 May 2. [Epub ahead of print] 2-4 weighted  in such situations to obtain unbiased results. CrossRef Medline They concluded that visual assessment of structural and diffu- 4. Sabour S, Dastjerdi EV. Reliability of four different computerized sion tensor images of the corticospinal tract (especially at the ce- cephalometric analysis programs: a methodological error. Eur J Or- thod 2013;35:848 CrossRef Medline rebral crus) is a reliable and clinically feasible imaging approach in the preoperative work-up of patients with unilateral PMG affect- X F. Jalalvandi X M. Naderi ing the central region. Also, in noncompliant patients, DTI-based Department of Operating Room School of Paramedical Kermanshah University of Medical Sciences http://dx.doi.org/10.3174/ajnr.A5799 Kermanshah, I.R. Iran AJNR Am J Neuroradiol 39:E123 Nov 2018 www.ajnr.org E123 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Methodologic Issues on Interrater Reliability Regarding Structural and DTI-Based Corticospinal Tract Asymmetry

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5799
Publisher site
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Abstract

LETTERS MethodologicIssuesonInterraterReliabilityRegarding StructuralandDTI-BasedCorticospinalTractAsymmetry e read, with interest, the article by Foesleitner et al pub- Limitation of  to assess the reliability of 2 raters’ judgments with different prevalences in the 2 categories Wlished in the June 2018 issue of the American Journal of Rater 1 Total Neuroradiology. The purpose was to investigate a clinically feasible Positive Negative (%) imaging approach to assess corticospinal tract (CST) asymmetry Situation (a) Positive 85 5 90 in unilateral polymicrogyria (PMG), check diffusion-based trac- Rater 2 Negative 5 5 10 tography as a guide to the presumed motor area within the dys- 0.44 Total 90 10 100 plastic cortex, and investigate whether the “rule” of CST asymme- Situation (b) Positive 45 5 50 Rater 2 Negative 5 45 50 try as a good prognostic factor for postsurgical motor function 0.80 Total 50 50 100 preservation specifically applies to cases of unilateral PMG in- volving the central region. The interrater reliability was calculated tractography is a useful alternative to task-based fMRI and helps by the Cohen coefficient. The authors reported that the interrater in the anatomic localization of the primary motor cortex. If one reliability in the assessment of corticospinal tract asymmetry was considered the above-mentioned limitations of the  value to as- most robust at the level of the cerebral crus. Also, excellent con- sess reliability, such a conclusion may be misleading. Therefore, gruence was reached by categorizing the asymmetry degree into 2-4 misinterpretation cannot be avoided. no or minimal asymmetry or moderate/severe asymmetry ( In this letter, we discuss the limitations of the  value to assess 1.0) in the event that the other levels of assessment did not result reliability. Therefore, any conclusion especially in reliability analysis in considerable agreement (  0.21–0.6). should be supported by the above mentioned statistical and method- It is of crucial importance to know that the  value cannot be a ological issues. sign of good agreement. In assessing the agreement of a qualitative variable, the  value has 2 major weaknesses: 1) It depends on the REFERENCES prevalence in each class—that is, there might be different  values 1. Foesleitner O, Nenning KH, Traub-Weidinger T, et al. Assessing cor- of the same percentages for concordant and discordant cells. As ticospinal tract asymmetry in unilateral polymicrogyria. AJNR Am J can be seen in the Table, the prevalence of concordant cells in both Neuroradiol 2018;39:1530–35 CrossRef Medline (a) and (b) situations is 90%, while that of discordant cells is 10%. 2. Szklo M, Nieto FJ. Epidemiology: Beyond the Basics. 2nd ed. Sudbury: However, we can get different values of  (0.44 and 0.80) for Jones and Bartlett Publisher; 2007 3. Naderi M, Jalalvandi F, Fatahi S. Observer reproducibility of breast concordant and discordant cells, respectively. 2) The  value also strain elastography in data acquisition and interpretation: a meth- depends on the number of classes. It is preferable to use a odological issue. Eur J Radiol 2018 May 2. [Epub ahead of print] 2-4 weighted  in such situations to obtain unbiased results. CrossRef Medline They concluded that visual assessment of structural and diffu- 4. Sabour S, Dastjerdi EV. Reliability of four different computerized sion tensor images of the corticospinal tract (especially at the ce- cephalometric analysis programs: a methodological error. Eur J Or- thod 2013;35:848 CrossRef Medline rebral crus) is a reliable and clinically feasible imaging approach in the preoperative work-up of patients with unilateral PMG affect- X F. Jalalvandi X M. Naderi ing the central region. Also, in noncompliant patients, DTI-based Department of Operating Room School of Paramedical Kermanshah University of Medical Sciences http://dx.doi.org/10.3174/ajnr.A5799 Kermanshah, I.R. Iran AJNR Am J Neuroradiol 39:E123 Nov 2018 www.ajnr.org E123

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Nov 1, 2018

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