Original Article

Pediatric Radiology

, Volume 37, Issue 12, pp 1201-1208

First online:

Observer variability assessing US scans of the preterm brain: the ELGAN study

  • Karl KubanAffiliated withDivision of Pediatric Neurology, Boston University Medical Center, Boston University School of Medicine
  • , Ira AdlerAffiliated withEastern Radiologists, Inc.
  • , Elizabeth N. AllredAffiliated withNeuroepidemiology Unit, Children’s Hospital Boston, Harvard Medical School, Harvard School of Public Health
  • , Daniel BattonAffiliated withDepartments of Pediatrics and Neonatology, William Beaumont Hospital
  • , Steven BezinqueAffiliated withDepartment of Radiology, DeVos Children’s Hospital
  • , Bradford W. BetzAffiliated withDepartment of Radiology, DeVos Children’s Hospital
  • , Ellen CavenaghAffiliated withDepartment of Radiology, Sparrow Hospital
  • , Sara DurfeeAffiliated withDepartment of Radiology, Brigham & Women’s Hospital, Harvard Medical School
  • , Kirsten EcklundAffiliated withDepartment of Radiology, Children’s Hospital Boston, Harvard Medical School
    • , Kate FeinsteinAffiliated withDepartment of Radiology, University of Chicago Hospital, University of Chicago
    • , Lynn Ansley FordhamAffiliated withDepartment of Radiology, University of North Carolina School of Medicine
    • , Frederick HampfAffiliated withDepartment of Radiology, Baystate Medical Center
    • , Joseph JunewickAffiliated withDepartment of Radiology, DeVos Children’s Hospital
    • , Robert LorenzoAffiliated withDepartment of Radiology, Children’s Healthcare of Atlanta, Emory University School of Medicine
    • , Roy McCauleyAffiliated withDepartment of Radiology, Tufts-New England Medical Center, Tufts University School of Medicine
    • , Cindy MillerAffiliated withDepartment of Radiology, Yale-New Haven Hospital, Yale University School of Medicine
    • , Joanna SeibertAffiliated withDepartment of Radiology, Arkansas Children’s Hospital, University of Arkansas Medical School
    • , Barbara SpecterAffiliated withDepartment of Radiology, Forsyth Hospital, Baptist Medical Center, Wake Forest University School of Medicine
    • , Jacqueline WellmanAffiliated withDepartment of Radiology, Milford Regional Medical Center
    • , Sjirk WestraAffiliated withDivision of Pediatric Radiology, Massachusetts General Hospital, Harvard Medical School
    • , Alan LevitonAffiliated withNeuroepidemiology Unit, Children’s Hospital Boston, Harvard Medical School Email author 

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Neurosonography can assist clinicians and can provide researchers with documentation of brain lesions. Unfortunately, we know little about the reliability of sonographically derived diagnoses.


We sought to evaluate observer variability among experienced neurosonologists.

Materials and methods

We collected all protocol US scans of 1,450 infants born before the 28th postmenstrual week. Each set of scans was read by two independent sonologists for the presence of intraventricular hemorrhage (IVH) and moderate/severe ventriculomegaly, as well as hyperechoic and hypoechoic lesions in the cerebral white matter. Scans read discordantly for any of these four characteristics were sent to a tie-breaking third sonologist.


Ventriculomegaly, hypoechoic lesions and IVH had similar rates of positive agreement (68–76%), negative agreement (92–97%), and kappa values (0.62 to 0.68). Hyperechoic lesions, however, had considerably lower values of positive agreement (48%), negative agreement (84%), and kappa (0.32). No sonologist identified all abnormalities more or less often than his/her peers. Approximately 40% of the time, the tie-breaking reader agreed with the reader who identified IVH, ventriculomegaly, or a hypoechoic lesion in the white matter. Only about 25% of the time did the third party agree with the reader who reported a white matter hyperechoic lesion.


Obtaining concordance seems to be an acceptable way to assure reasonably high-quality of images needed for clinical research.


Brain Newborn Premature