Interobserver reliability and accuracy of cranial ultrasound scanning interpretation in premature infants

J Pediatr. 2007 Jun;150(6):592-6, 596.e1-5. doi: 10.1016/j.jpeds.2007.02.012.


Objective: To assess interobserver reliability between 2 central readers of cranial ultrasound scanning (CUS) and accuracy of local, compared with central, interpretations.

Study design: The study was a retrospective analysis of CUS data from the National Institute of Child Health and Human Development (NICHD) trial of inhaled nitric oxide for premature infants. Interobserver reliability of 2 central readers was assessed with kappa or weighted kappa. Accuracy of local, compared with central, interpretations was assessed by using sensitivity and specificity.

Results: CUS from 326 infants had both central reader and local interpretations. Central reader agreement for grade 3/4 intraventricular hemorrhage (IVH), grade 3/4 IVH or periventricular leukomalacia (PVL), grade of IVH, and degree of ventriculomegaly was very good (kappa = 0.84, 0.81, 0.79, and 0.75, respectively). Agreement was poor for lower grade IVH and for PVL alone. Local interpretations were highly accurate for grade 3/4 IVH or PVL (sensitivity, 87%-90%; specificity, 92%-93%), but sensitivity was poor-to-fair for grade 1/2 IVH (48%-68%) and PVL (20%-44%).

Conclusions: Our findings demonstrate reliability and accuracy of highly unfavorable CUS findings, but suggest caution when interpreting mild to moderate IVH or white matter injury.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchodilator Agents
  • Cerebral Hemorrhage / diagnostic imaging*
  • Cerebral Hemorrhage / pathology
  • Cerebral Ventricles / diagnostic imaging*
  • Cerebral Ventricles / pathology
  • Dilatation, Pathologic / pathology
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Leukomalacia, Periventricular / diagnostic imaging*
  • Leukomalacia, Periventricular / pathology
  • Nitric Oxide / therapeutic use
  • Observer Variation
  • Predictive Value of Tests
  • Respiratory Insufficiency / drug therapy
  • Retrospective Studies
  • Sensitivity and Specificity
  • Ultrasonography


  • Bronchodilator Agents
  • Nitric Oxide