Interobserver Variation of the Bolus-and-Burst Method for Pancreatic Perfusion with Dynamic – Contrast-Enhanced Ultrasound

Abstract

Purpose Dynamic contrast-enhanced ultrasound (DCE-US) can be used for calculating organ perfusion. By combining bolus injection with burst replenishment, the actual mean transit time (MTT) can be estimated. Blood volume (BV) can be obtained by scaling the data to a vessel on the imaging plane. The study aim was to test interobserver agreement for repeated recordings using the same ultrasound scanner and agreement between results on two different scanner systems. Materials and Methods Ten patients under evaluation for exocrine pancreatic failure were included. Each patient was scanned two times on a GE Logiq E9 scanner, by two different observers, and once on a Philips IU22 scanner, after a bolus of 1.5 ml Sonovue. A 60-second recording of contrast enhancement was performed before the burst and the scan continued for another 30 s for reperfusion. We performed data analysis using MATLAB-based DCE-US software. An artery in the same depth as the region of interest (ROI) was used for scaling. The measurements were compared using the intraclass correlation coefficient (ICC) and Bland Altman plots. Results The interobserver agreement on the Logiq E9 for MTT (ICC=0.83, confidence interval (CI) 0.46–0.96) was excellent. There was poor agreement for MTT between the Logiq E9 and the IU22 (ICC=−0.084, CI −0.68–0.58). The interobserver agreement for blood volume measurements was excellent on the Logiq E9 (ICC=0.9286, CI 0.7250–0.98) and between scanners (ICC=0.86, CI=0.50–0.97). Conclusion Interobserver agreement was excellent using the same scanner for both parameters and between scanners for BV, but the comparison between two scanners did not yield acceptable agreement for MTT. This was probably due to incomplete bursting of bubbles in some of the recordings on the IU22.

Keywords

• interobserver
• dynamic contrast-enhanced ultrasound
• perfusion
• pancreas