Inter- and intraobserver reliability for diagnosing levator ani changes on magnetic resonance imaging

K. Lammers, K.B. Kluivers, M.E. Vierhout, M. Prokop and J.J. Fütterer

Ultrasound in Obstetrics and Gynecology 2013;42:347-352



OBJECTIVES: The aim of this study was to assess the inter- and intraobserver reliability for diagnosing pubovisceral muscle avulsions and measurements of the levator hiatus on magnetic resonance (MR) imaging. Women with recurrent POP or in whom there was a discrepancy between clinical signs and symptoms of pelvic floor dysfunction were potentially eligible to participate. METHODS: Magnetic resonance imaging datasets of the pelvic floor of 262 women were obtained and scored by two observers. A random sample of 100 patients was reviewed a second time by one of the observers. Intraclass correlation coefficient with 95% confidence interval (ICC 95 of all measurements were calculated. Furthermore, mean differences with accompanying limits of agreement were calculated to estimate agreement between two measurements and to detect possible systematic biases. RESULTS: Good interobserver reliability for pubovisceral muscle avulsions was found (ICC 0.76 - 0.79) and excellent agreement for measurements of the levator hiatus (ICC 0.85 - 0.89). The intraobserver reliability for pubovisceral muscle avulsions and other levator hiatus measurements also showed to be excellent (ICC 0.80 - 0.97). A significant systematic bias was observed in the mean difference of levator hiatus transverse diameter when measured by both observers, however, narrow limits of agreement were observed. CONCLUSIONS: Pubovisceral muscle avulsions and levator hiatus measurements can be assessed with good to excellent reliability.

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