RT Journal Article
SR Electronic
T1 A reliability study of colour-Doppler sonography for the diagnosis of chronic cerebrospinal venous insufficiency shows low inter-rater agreement
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e003508
DO 10.1136/bmjopen-2013-003508
VO 3
IS 11
A1 Leone, Maurizio A
A1 Raymkulova, Olga
A1 Lucenti, Ausiliatrice
A1 Stecco, Alessandro
A1 Bolamperti, Laura
A1 Coppo, Lorenzo
A1 Liboni, William
A1 Rivadossi, Gianandrea
A1 Zaccala, Giuseppe
A1 Maggio, Maurizio
A1 Melis, Fabio
A1 Giaccone, Claudia
A1 Carriero, Alessandro
A1 Lochner, Piergiorgio
YR 2013
UL http://bmjopen.bmj.com/content/3/11/e003508.abstract
AB Objective Chronic cerebrospinal venous insufficiency (CCSVI) has been extremely variable, associated with multiple sclerosis in colour-Doppler sonographic studies. We aimed to evaluate inter-rater agreement in a colour-Doppler sonography venous examination. Design Inter-rater agreement study. Setting First-referral multiple sclerosis centre. Participants 38 patients with multiple sclerosis and 55 age-matched (±5 years) controls. Intervention Sonography was carried out in accordance with Zamboni’s five criteria by eight sonographers with different expertise, blinded to the status of cases and controls. Each participant was evaluated by two operators. Primary and secondary outcome measures Inter-rater agreement was measured through the κ statistics and the intraclass correlation coefficient. Results The agreement was no higher than chance for criterion 2—reflux in the deep cerebral veins (κ=−0.02) and criterion 4—flow not Doppler detectable in one or both the internal jugular veins (IJVs) or vertebral veins (VVs; −0.09). It was substantially low for criterion 1—reflux in the IJVs and/or VVs (0.29), criterion 3—IJV stenosis or malformations (0.23) and criterion 5—absence of IJV diameter increase when passing from the sitting to the supine position (0.22). The κ value for CCSVI as a whole was 0.20 (95% confidence limit −0.01 to 0.42). Intraclass correlation coefficients for the measure of cross-sectional area ranged from 0.05 to 0.25. Inter-rater agreement was low for CCSVI experts (κ=0.24; −0.11 to 0.59) and non-experts (0.20; −0.33 to 0.73); neurologists (0.21; −0.06 to 0.47) and non-neurologists (0.18; −0.20 to 0.56); cases (0.19; −0.14 to 0.52) and controls (0.21; −0.08 to 0.49). Zamboni-trained neurosonographers ascertained CCSVI more frequently than the non-trained neurosonographers. Conclusions Agreement was unsatisfactory for the diagnosis of CCSVI as a whole, for each of its five criteria and according to the different subgroups. Standardisation of the method is urgently needed prior to its further application in studies of patients with multiple sclerosis or other neurological diseases.