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Updated: Jun 3, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Interobserver variability in assessment of cranial ultrasound in very preterm infants
C F Hagmann1, M Halbherr, B Koller
1Department of Neonatology, University Hospital Zurich, Zurich, Switzerland. cornelia.hagmann@usz.ch
Insights
Interobserver agreement in cranial ultrasound (cUS) interpretation for preterm infants varies by abnormality and expertise. Structured training is recommended to improve diagnostic accuracy and consistency in clinical practice.
Area of Science:
- Neonatal imaging
- Pediatric neurology
- Medical diagnostics
Background:
- Cranial ultrasound (cUS) is crucial for managing preterm infants and predicting outcomes.
- Accurate interpretation of cUS is essential for both clinical decisions and research.
Purpose of the Study:
- To assess interobserver variability in cranial ultrasound interpretation.
- To determine if varying levels of expertise impact this variability.
Main Methods:
- Fifty-eight cUS series from preterm infants (<32 weeks gestation) were reviewed by 27 observers.
- Observers were categorized as radiologists, experienced neonatologists, or less experienced neonatologists.
- Interobserver agreement was quantified using Kappa statistics.
Main Results:
- Moderate agreement was observed for combined outcomes (cystic periventricular leukomalacia, intraventricular hemorrhage, periventricular hemorrhagic infarction).
- Kappa values were highest for experienced neonatologists (0.7), followed by radiologists (0.67) and inexperienced neonatologists (0.53).
- Significant differences in agreement were noted for hemorrhagic periventricular infarction between experienced neonatologists and radiologists.
Conclusions:
- Interobserver agreement in cUS interpretation is variable, depending on the specific abnormality and the interpreter's expertise.
- Structured training programs are recommended to enhance the performance and consistency of cUS interpretation.
Background:
Cranial ultrasound (cUS) findings help doctors in the clinical management of preterm infants and in their discussion with parents regarding prediction of outcome. cUS is often used as outcome measure in clinical research studies. Accurate cUS performance and interpretation is therefore required.
Aims:
The aims of this study were (i) to assess the interobserver variability in cUS interpretation, and (ii) to evaluate whether level of cUS expertise influences the interobserver variability.
Methods:
Fifty-eight cUS image series of preterm infants born below 32 weeks of gestation collected within the Swiss Neonatal Network were sent to 27 observers for reviewing. Observers were grouped into radiologists, experienced neonatologists and less experienced neonatologists. Agreement between observers was calculated using Kappa statistics.
Results:
When cystic periventricular leukomalacia, intraventricular haemorrhage and periventricular haemorrhagic infarction were combined to one outcome, agreement among all observers was moderate. When divided into subgroups, kappa for the combined outcome was 0.7 for experienced neonatologists, 0.67 for radiologists and 0.53 for inexperienced neonatologists. Marked difference in interobserver agreement between experienced neonatologists and radiologists could be found for haemorrhagic periventricular ifraction (HPI).
Conclusions:
Our results suggest that interobserver agreement for interpretation of cUS varies from poor to good varying with the type of abnormality and level of expertise, suggesting that widespread structured training should be made available to improve the performance and interpretation of cUS.
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