Aim:To determine the computed tomography(CT)features of non-alcoholic fatty liver disease(NAFLD)associated hepatocellular carcinoma(HCC).Methods:In this institutional review board approved study,we reviewed 38 patient...Aim:To determine the computed tomography(CT)features of non-alcoholic fatty liver disease(NAFLD)associated hepatocellular carcinoma(HCC).Methods:In this institutional review board approved study,we reviewed 38 patients with NAFLD(68.4%male;mean age 63 years)with histology confirmed HCC and triphasic liver CT.CT images were independently reviewed by four readers blinded to clinical and pathology data.The reviewers assessed HCC for arterial phase hyper enhancement(APHE),portal venous phase washout(PVWO),delayed phase washout(DPWO),and enhancing capsule.Features of cirrhotic morphology and portal hypertension(PH)were also evaluated.The final CT features were determined by majority and a fifth reader reviewed cases lacking majority.Inter-rater agreement was determined by prevalence-adjusted kappa.Results:Mean HCC size was 3.6±2.8 cm(range,1.1-16.0 cm).The HCCs showed APHE in 92.1%,PVWO in 55.3%,DPWO in 81.6%,and enhancing capsule in 44.7%.Cirrhotic morphology was present in 65.8%and PH in 63.2%.Inter-rater agreement was moderate to almost perfect for APHE(0.74-1.0),cirrhosis(0.79-0.89),and PH(0.79-0.95),weak to perfect for DPWO(0.47-0.95)and poor for PVWO(0-0.42). ;Conclusion:NAFLD associated HCC demonstrate less frequent portal venous washout on CT which may affect their imaging diagnosis.展开更多
Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been sh...Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been shown to be superior to other clinical tools for the assessment of spasticity in children with cerebral palsy but reliability has not been previously examined in adults. Method: Four muscle groups were rated on one occasion by four assessors using the ASAS in sixteen adults with unilateral hypertonia following acquired brain injury. Twelve participants returned one week later for reassessment by the same assessors. Results: Overall inter-rater reliability of the ASAS using a quadratic weighted Kappa was moderate (Kqw 0.58) with ranges from moderate to good (Kqw 0.42 - 0.70). Agreement between raters was greatest for soleus muscle and least for wrist flexors. Overall intra-rater reliability of each of the four raters was moderate to good (Kqw 0.48 - 0.79). Agreement within raters was greatest for soleus muscle and least for biceps muscle. Conclusions: The ASAS may represent an appropriate alternative to the clinical scales currently used to assess spasticity;however inter and intra-rater reliability data from this investigation are lower than those which have previously been reported by experienced users of the ASAS in children with cerebral palsy. Further investigation with a larger sample size is warranted before any firm conclusions may be drawn about the reliability and validity of this tool to assess spasticity in adults with acquired brain injury.展开更多
文摘Aim:To determine the computed tomography(CT)features of non-alcoholic fatty liver disease(NAFLD)associated hepatocellular carcinoma(HCC).Methods:In this institutional review board approved study,we reviewed 38 patients with NAFLD(68.4%male;mean age 63 years)with histology confirmed HCC and triphasic liver CT.CT images were independently reviewed by four readers blinded to clinical and pathology data.The reviewers assessed HCC for arterial phase hyper enhancement(APHE),portal venous phase washout(PVWO),delayed phase washout(DPWO),and enhancing capsule.Features of cirrhotic morphology and portal hypertension(PH)were also evaluated.The final CT features were determined by majority and a fifth reader reviewed cases lacking majority.Inter-rater agreement was determined by prevalence-adjusted kappa.Results:Mean HCC size was 3.6±2.8 cm(range,1.1-16.0 cm).The HCCs showed APHE in 92.1%,PVWO in 55.3%,DPWO in 81.6%,and enhancing capsule in 44.7%.Cirrhotic morphology was present in 65.8%and PH in 63.2%.Inter-rater agreement was moderate to almost perfect for APHE(0.74-1.0),cirrhosis(0.79-0.89),and PH(0.79-0.95),weak to perfect for DPWO(0.47-0.95)and poor for PVWO(0-0.42). ;Conclusion:NAFLD associated HCC demonstrate less frequent portal venous washout on CT which may affect their imaging diagnosis.
文摘Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been shown to be superior to other clinical tools for the assessment of spasticity in children with cerebral palsy but reliability has not been previously examined in adults. Method: Four muscle groups were rated on one occasion by four assessors using the ASAS in sixteen adults with unilateral hypertonia following acquired brain injury. Twelve participants returned one week later for reassessment by the same assessors. Results: Overall inter-rater reliability of the ASAS using a quadratic weighted Kappa was moderate (Kqw 0.58) with ranges from moderate to good (Kqw 0.42 - 0.70). Agreement between raters was greatest for soleus muscle and least for wrist flexors. Overall intra-rater reliability of each of the four raters was moderate to good (Kqw 0.48 - 0.79). Agreement within raters was greatest for soleus muscle and least for biceps muscle. Conclusions: The ASAS may represent an appropriate alternative to the clinical scales currently used to assess spasticity;however inter and intra-rater reliability data from this investigation are lower than those which have previously been reported by experienced users of the ASAS in children with cerebral palsy. Further investigation with a larger sample size is warranted before any firm conclusions may be drawn about the reliability and validity of this tool to assess spasticity in adults with acquired brain injury.
