TY - JOUR
T1 - Reproducibility of fetal lung-to-head ratio in left diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet)
AU - on behalf of the NAFTNet
AU - Abbasi, Nimrah
AU - Ryan, Greg
AU - Johnson, Anthony
AU - Cortes, Magda Sanz
AU - Sangi-Haghpeykar, Haleh
AU - Ye, Xiang Y.
AU - Shah, Prakesh S.
AU - Benachi, Alexandra
AU - Saada, Julien
AU - Ruano, Rodrigo
N1 - Funding Information:
In the current study, three fetal medicine specialists (A.J., R.R., and G.R.) reviewed and selected axial sonographic video clips of the fetal chest and head from anatomical studies of fetuses with an isolated left CDH. Studies included were obtained between 22 to 33+6 weeks gestation. All images were acquired on a GE Voluson E8 machine at a single center. All US studies were deidentified and encrypted by Trice Imaging Inc© and stored on a secure Trice© cloud, from which principal investigators finalized 16 fetal axial clips of head and chest of varying image quality and fetal position to reflect heterogeneity of study quality encountered in clinical practice. Cases were reviewed by an ER from a European center participating in the TOTAL (Tracheal Occlusion To Accelerate Lung growth http://www.totaltrial.eu/) trial, an international randomized trial comparing FETO with routine postnatal surgical repair in the treatment of moderate and severe CDH (NCT00763737 and NCT01240057). Thirteen studies were selected for use in this study, while three studies were excluded due to inadequate visualization of the lungs. This sample size was selected based on feasibility and practicality to ensure maximal study participation. This study was approved by the NAFTNet steering committee with institutional review board approval from Baylor College of Medicine (H-37017) and Mayo Clinic College of Medicine, Rochester (16-008333) and research ethics board approval from Mount Sinai Hospital, Toronto (17-0168-C). This study was supported by grants from Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD 5R13HD059293-05) and Mount Sinai Hospital, University of Toronto Department of Obstetrics & Gynaecology and University Health Network Research Fund.
Funding Information:
gestation. All images were acquired on a GE Voluson E8 machine at a single center. All US studies were deidentified and encrypted by Trice Imaging Inc© and stored on a secure Trice© cloud, from which principal investigators finalized 16 fetal axial clips of head and chest of varying image quality and fetal position to reflect heterogeneity of study quality encountered in clinical practice. Cases were reviewed by an ER from a European center participating in the TOTAL (Tracheal Occlusion To Accelerate Lung growth http://www.totaltrial.eu/) trial, an international randomized trial comparing FETO with routine postnatal surgical repair in the treatment of moderate and severe CDH (NCT00763737 and NCT01240057). Thirteen studies were selected for use in this study, while three studies were excluded due to inadequate visualization of the lungs. This sample size was selected based on feasibility and practicality to ensure maximal study participation. This study was approved by the NAFTNet steering committee with institutional review board approval from Baylor College of Medicine (H‐37017) and Mayo Clinic College of Medicine, Rochester (16‐ 008333) and research ethics board approval from Mount Sinai Hospital, Toronto (17‐0168‐C). This study was supported by grants from Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD 5R13HD059293‐05) and Mount Sinai Hospital, University of Toronto Department of Obstetrics & Gynaecology and University Health Network Research Fund.
Publisher Copyright:
© 2019 John Wiley & Sons, Ltd.
PY - 2019/2
Y1 - 2019/2
N2 - Objective: To determine the antenatal sonographic lung area measurement method in left congenital diaphragmatic hernia (CDH) with the highest interrater agreement among North American Fetal Therapy Network (NAFTNet) centers within and outside the fetoscopic tracheal occlusion (FETO) consortium and in comparison with a European “expert” reviewer (ER). Methods: Nineteen members from nine FETO consortium centers and 29 reviewers from 17 non-FETO centers reviewed ultrasound clips of the chest from 13 fetuses with isolated left CDH and were asked to select a static plane for lung area measurement using anteroposterior (AP), longest, and trace methods. Interrater agreement in lung area measurements was determined using intraclass correlation coefficient (ICC). Bland-Altman analysis was used to evaluate mean difference (bias) between NAFTNet reviewers and ER. Results: Among FETO centers, agreement was highest using trace (ICC 0.94; 95% CI, 0.83-0.98), followed by longest (ICC 0.89; 95% CI, 0.75-0.97) and lowest for A-P (ICC 0.83; 95% CI, 0.67-0.94). Similar trends were noted in non-FETO centers. When compared with ER, bias was lowest for trace: 14 ± 38 mm2 and 19 ± 36 mm2 for FETO and non-FETO centers, respectively. Conclusion: The trace method demonstrated the highest interrater agreement and lowest bias for lung area estimation in left CDH across NAFTNet.
AB - Objective: To determine the antenatal sonographic lung area measurement method in left congenital diaphragmatic hernia (CDH) with the highest interrater agreement among North American Fetal Therapy Network (NAFTNet) centers within and outside the fetoscopic tracheal occlusion (FETO) consortium and in comparison with a European “expert” reviewer (ER). Methods: Nineteen members from nine FETO consortium centers and 29 reviewers from 17 non-FETO centers reviewed ultrasound clips of the chest from 13 fetuses with isolated left CDH and were asked to select a static plane for lung area measurement using anteroposterior (AP), longest, and trace methods. Interrater agreement in lung area measurements was determined using intraclass correlation coefficient (ICC). Bland-Altman analysis was used to evaluate mean difference (bias) between NAFTNet reviewers and ER. Results: Among FETO centers, agreement was highest using trace (ICC 0.94; 95% CI, 0.83-0.98), followed by longest (ICC 0.89; 95% CI, 0.75-0.97) and lowest for A-P (ICC 0.83; 95% CI, 0.67-0.94). Similar trends were noted in non-FETO centers. When compared with ER, bias was lowest for trace: 14 ± 38 mm2 and 19 ± 36 mm2 for FETO and non-FETO centers, respectively. Conclusion: The trace method demonstrated the highest interrater agreement and lowest bias for lung area estimation in left CDH across NAFTNet.
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U2 - 10.1002/pd.5413
DO - 10.1002/pd.5413
M3 - Article
C2 - 30618058
AN - SCOPUS:85060828415
VL - 39
SP - 188
EP - 194
JO - Prenatal Diagnosis
JF - Prenatal Diagnosis
SN - 0197-3851
IS - 3
ER -