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Intraobserver and interobserver variations in cortical transit time measurement in children with pelviureteric

Vishesh Jain1, Rakesh Kumar2, Shamim Ahmed Shamim2

  • 1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

World Journal of Nuclear Medicine
|April 14, 2021
PubMed

Insights

Qualitative cortical transit time (CTT) assessment is reliable for managing pediatric pelviureteric junction obstruction (PUJO). However, quantitative CTT measurements show significant variations, limiting their clinical use in these children.

Area of Science:

  • Pediatric Nephrology
  • Nuclear Medicine Imaging
  • Urology

Background:

  • Cortical transit time (CTT) is a valuable parameter for managing pediatric pelviureteric junction obstruction (PUJO).
  • Variability in CTT assessment can impact clinical decision-making.
  • Understanding observer variations is crucial for reliable CTT interpretation.

Purpose of the Study:

  • To evaluate intraobserver and interobserver variability in qualitative and quantitative CTT assessments.
  • To determine the reliability of CTT in children with PUJO.
  • To compare CTT assessment in normal, operated, and unoperated affected kidneys.

Main Methods:

  • Retrospective analysis of 99mTc-MAG3 renogram images from children with PUJO (2016-2017).
  • Three observers assessed CTT qualitatively (delayed >3 min vs. normal) and quantitatively at two time points.
  • Kappa statistic for interobserver agreement (qualitative); Bland-Altman plots for inter- and intraobserver agreement (quantitative).

Main Results:

  • Qualitative CTT showed almost perfect agreement for normal kidneys, substantial to almost perfect for operated kidneys, and moderate to substantial for unoperated kidneys.
  • Quantitative CTT revealed significant mean differences and wide limits of agreement in affected kidneys.
  • Kappa values indicated good to excellent interobserver reliability for qualitative CTT.

Conclusions:

  • Qualitative CTT interpretation is a reliable and reproducible parameter for assessing children with PUJO.
  • Quantitative CTT measurements exhibit substantial inter- and intraobserver variability, limiting their clinical applicability.
  • Focusing on qualitative CTT assessment is recommended for managing pediatric PUJO.

Keywords:
Cortical transit timehydronephrosispelviureteric junction obstructionpyeloplastyrenogram

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